Cholesterol, heart disease, statins, Update and Review on the debate

We have many postings here at JS on the problem of treating the numbers to prevent heart and vascular disease and the side effects and problems with statins.

Here is a succinct discussion by an emeritus prof of surgery U of Washington School of Medicine. Published by my favorite editor, Jane Orient MD, Internist and exec of the American Association of Physicians and Surgeons.

Treating lipid numbers and cholesterol may be the foundation of one of the largest religions in the western world.

I know plenty of people who haven’t been to church much but know their good lipid numbers and bad lipid numbers and such.

I would remind you that genetics and other unknowns may be more important, only extremely bad numbers are associated with significant risk.

As for more detail on magic numbers for lipids and cholesterol and the debate about statins, read this essay by Dr. Miller, who is published by Dr. Orient and the Journal of the American Association of PHysicians and Surgeons, good info for you old duffers who worry about these things. I am a young at heart duffer/emergency physician and I don’t worry so much:

http://www.jpands.org/vol20no2/miller.pdf

Advertisements

18 responses to “Cholesterol, heart disease, statins, Update and Review on the debate

  1. Being a simple Chem-major, I could never see how the presence of an emulsifier in the bloodstream could have any main function other than keeping lipids in suspension/emulsion….
    .As Miller puts it the MSMM appeared to be ‘blaming the firemen for the fire’.
    I would like to know the HLB number for cholesterol…Maybe ENC et al could provide this??

    • ernestncurtis

      I’ll take a shot at it if you’ll tell me what HLB stands for.

    • Soluble at about HLB 35. What would this tell you at HLB <35 you start plating out the chloresterol that isn't in the micelles? http://link.springer.com/article/10.1007%2Fs003960050213#page-1
      As a simple minded chemist, I'm not sure what the HLB of blood means http://www.hpflabor.de/en/bluttest.html

      • You’re kiilling me Greene—remember that the distinguishing factor in people who went to medical school is that they hated organic chem.

        In fact any chem, physical, organic, you name it.

        John Dale Dunn MD JD Consultant Emergency Services/Peer Review Civilian Faculty, Emergency Medicine Residency Carl R. Darnall Army Med Center Fort Hood, Texas Medical Officer, Sheriff Bobby Grubbs Brown County, Texas 325 784 6697 (h) 642 5073 (c)

        • And I was the Chem TA you budding premeds hated because I was part of the weeding process. Organic chemistry is easy. You don’t have to memorize all that much compared to the doctor thing. There were a few faces I tried to memorize based on the theory that if I were in an emergency room and saw that face peering down at me, I’d make a decision on accepting treatment.

      • http://www.hpflabor.de/en/bluttest.html…….This ‘HLB’ test has nothing to do with HLB numbers; It is the initials of the authors of a not-very-useful blood inspection process.
        I hate, misunderstand and fear organic chem, especially the surfactant field, but it seems that cholesterol is highly hydrophilic and it could well contribute as a hydrotrope to keeping lipids in suspension………
        I leave it to all you Doctors of various subjects to look further at this…[there may even be FUNDING available.]
        the HLB of 35 for cholesterol

        • ernestncurtis

          Can’t help with the HLB thing. I’m probably over my head when discussing anything beyond the simplest biochemistry but I’m pretty sure that cholesterol is lipid soluble and, therefore, hydrophobic. That’s why it has to be carried by lipoprotein molecules in the blood.

  2. ernestncurtis

    This is a good summary of many of the shortcomings of the cholesterol theory of atherosclerosis and the hazards of statin therapy. But like so many others that push the “inflammation” ot “carbohydrate” theories of causation he quotes statistics to support this that are based on science just as junky as those cited to support the cholesterol theory. Dr. Miller has written some excellent articles about a number of myths in medicine but he is a big advocate of vitamins and supplements–especially vitamin D.

    • Interestingly, statins both reduce cholesterol and are mild antiinflammatories as well. Work on both hypothesis at once! Though, if inflammation is really the cause it would nlbe nice to get stronger antiinflammatories rather than take weak acting statins.

  3. gonewiththewind

    Inflamation of what? How do they know since it is inside? How do they know inflamation is bad since it seems those things that cause it are consumed by just about everyone and “everyone” has different life and health outcomes. The whole “inflamation” thingy always smelled like a scam.

    • ernestncurtis

      Excellent question. Inflammation is a normal physiologic response to infection or injury. So it has never made sense to me that this normal protective and reparative response would be a cause of disease. Rather whatever causes the supposed inflammatory response would be the culprit. I don’t know if the inflammation theory is a scam but it is certainly junk science.

      • Correct and my response wasn’t good. Cholesterol has limited water solubility and is oil/lipid soluble. The calculated HLB (nonionic scale)number is ~0.9 which puts it in the oil soluble/water insoluble range.

        • Aaaaaaaaarrrrrrgggggghhhhhh…..So much for my theorizing…….. At least it all qualifies as JS [ie the small part that is not BS]..
          Have an enjoyable Independence Day or should I say ‘independence day’……………

    • Because it can be seen during heart surgery. I would imagine there is some blood test as well, but don’t know for a fact.

  4. carbon bigfoot

    I take 10 mg of Lipitor and have for 6-7 years. It is the only statin that worked for me and my levels are in appropriate ranges for a diabetic. Now if I can only avoid glucose spikes I’d be a happy camper.

    • ernestncurtis

      @carbon bigfoot
      I wouldn’t worry about glucose spikes. They do no harm whatsoever. What is harmful are the downward spikes where the blood sugar goes way too low and can cause serious neurologic problems and even death. Much better to have the periodic glucose spikes and avoid the truly dangerous hypoglycemic episodes.

      • I completely agree, from personal experience. I often wake at night, usually from a dream about drowning, to find myself in a typical hypoglycemic state of a cold sweat and quick shallow breathing. I assume the dreams of drowning are because I was breathing so shallow that my oxygen levels had dropped. Quite unpleasant.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s