Tablets of the cholesterol-lowering statin drug Lipitor.

When two leading heart organizations released new cholesterol guidelines last week, they included an online risk calculator to help doctors assess whether or not patients should take cholesterol-lowering statin drugs. Now, some experts say the new calculator overestimates heart attack risk, and could lead to over-prescription of statins. We discuss the controversial new guidelines and calculator, and examine the latest research on cholesterol and heart disease.

Doctors Divided Over New Cholesterol Guidelines 19 November,2013forum

Rita Redberg, cardiologist, professor of medicine at UCSF Medical Center and the editor of JAMA Internal Medicine
David Goff, dean of the Colorado School of Public Health, chair of the American Heart Association Council on Epidemiology and Prevention and co-leader of the group that came up with risk assessment guidelines for cardiovascular disease
Gina Kolata, science reporter for The New York Times

  • Selostaja

    I’ve begun taking statins and my quality of life has declined due to side effects. The muscle weakness, joint pain, nausea and exhaustion is affecting my ability to move! Not to mention the affect on my mental function.How do you weigh the benefits of statins to the negative side affects?

  • Mark T. Burger

    Please address the fact that the ACA and AHA receiving lots of $$ from Pharma. Also: people on the panel that developed the guidelines have also rec’d. $$ from Pharma.

  • Ann Krilanovich

    Please discuss the effect of TMAO on heart disease. TMAO is a by-product of microbes feasting on Carnitine in the gut. Red meat and all meat has Carnitine.

    • Mark T. Burger

      Fish has TMAO, too. TMAO is a “red herring”. Look to Lp(a), HDL-2b, Fasting Insulin, Myeloperoxidase, F2-isoprostanes, size of lipid particles vs. mg%. L-carnitine/TMAO does not cause heart disease. In fact, just the opposite.

  • Mark T. Burger

    Cholesterol doesn’t cause heart disease. Elevated cholesterol is a by-product of inflammation … an innocent bystander that has been co-opted by Pharma because they can manipulate it. 50% of people with heart attacks do NOT have elevated cholesterol.

  • Ali

    Gina we heard you loud and clear and we will take anything and everything you say with a grain of salt because you are neither the creator nor the expert on the calculator, but its just rude to repeat yourself that many times.

    • trite

      I thought her response was honest and on point.

      • Ali

        Maybe Mr. Krasny could have begun the discussion with another panel member instead of starting with Ms. Kolata which I believe was the point of her multiple caveats- I was merely addressing my frustration with her repetition which came across as condescension.

  • Mark T. Burger

    Cholesterol does not cause heart disease. Statins cause congestive heart failure. Measure OxLDL, Lp(a), HDL-2b, fasting insulin, HbA1c. Cure your diabetes with your FORK, Michael K.

  • Tam Gray

    I have extremely high HDL (270). Some years ago my doctor in San Francisco said that before prescribing statins I could have a heart scan that would determine the amount of plaque accumulation. The scan showed that I had no discernible plaque accumulation. I am not on statins today.

    Cheers, Tam Gray

  • Mark T. Burger

    JUPITER Trial: 0.74% control group; 0.35% statin group … a change in absolute risk of < 0.5% NOT a 54% reduction. Please address this. What is the NNT (the number needed to treat)?

  • Madolin Wells

    Amen to the listener that mentioned the side effect of CoQ10 depletion thus increased heart attack risk! (Besides all the other side effects). Dr. Goff (representing the point of view of AHA and the American Cardiologists) keeps focusing on the percentage of people who are likely to die of CVD and concluding that therefore, prescribing statins is an important focus. One does not ncessarily follow from the other. C-Reactive Protein (CRP) and inflammation in general, as well as homocisteine, are much more significant factors – if indeed, high cholesterol is even a risk factor at all, with the exception of those with the rare genetic cholesteremia, with numbers in the 600-900 range. Older doctors who practiced in the 60’s and 70’s saw 350mg total cholesterol as a typical number, without any concern for CVD – and relative numbers of deaths from CDV was lower then. Moreover, low cholesterol is a danger, often associated with criminal behavior and compromised immune function.

    As with much of the prevailing medical conventional wisdom, outcomes are not clear. Too much of the research is funded by or strongly influenced by pharmaceutical interests which, in addition, underwrite much of the cost of medical school to begin with, so doctors are trained from the start with an orientation toward medical treatment instead of prevention. “Prevention” usually consists of prescribing drugs even more prematurely.

    Low sodium as prevention is another bugaboo. Sodium is an essential micronutrient, but needs to be consumed in the complex matrix of 90 minerals including all the trace elements present in evaporated sea salt, or mined salt from the mountains – not factory-processed (which use caustic elements and includes the neurotoxic aluminum, i.e. NaCl). Most people are severely deficient in minerals, leading to a damaging internal acidic environment as well as demineralization of bones ( = osteoporosis) and teeth.

    The real dietary culprit is a high-glycemic diet, including all those grains (esp. wheat)! recommended in the food pyramid and by medical organizations. This is why there’s a high correlation between heart disease, diabetes, and obesity. For many people, dairy and soy are also inflammation-causing foods.

  • Mark T. Burger

    People with the lowest cholesterol die first.

  • Selostaja

    The biggest gain to pharma will probably be in the increased use of medications that will be used to address the side affects.

    • Madolin Wells

      That might be part of the overall plan. Profit-driven motivation influences too much of medicine, and that has been the case since Reagan changed the rules allowing medical institutions to become profit-based organizations. There was once a time that advertising by doctors, pharmaceuticals, and medical institutions was against the law, the way smoking advertising is now.

  • Mark T. Burger

    David: Re-stating the obvious (that HD and Stroke are such terrible takers of life, blah, blah) does NOT mean someone should take a drug that alters the metabolic pathway of a NECESSARY component of metabolism that does NOT cause atherosclerosis. Geez!

  • Eric Olson

    I had a heart attack at 40. I had cholesterol numbers that were elevated but not high. I, however, have high blood pressure that has been treated for over twenty years. I have been on statins and have had side effects with all of them. At the moment my triglycerides are high and have remained high for quite a while, pre-diabetic, despite adjusting diet and increasing my exercise and muscle mass. I have discussed the side effect with my Cardiologist and I keep being told the risk of going off the statin out weighs the risk of developing diabetes. I, however, feel developing another risk factor, diabetes, for heart disease a higher risk.

  • MarĂ­a-Elena

    Dr. Redberg stated that cholesterol (high LDL) does not cause heart disease or strokes & is a negligible risk factor. She focused on healthy lifestyle, prevention, & smoking cessation. As a 42 year-old stroke survivor (vegetarian for 20 years, healthy weight, normal blood pressure, never ever smoked anything), my cholesterol is monitored by my physician (who I really like, & who does see cholesterol as a concern). If cholesterol is not actually an indicator of future stroke risk – can anyone can suggest which data/metrics I *should* I be monitoring to reduce my risk?

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