3 ms·

So says the cardiology fellow… One theory as to why statins have a small degree of influence is that they actually have an anti-inflammatory action. When my fat

by tcj_phx 10y ago

So says the cardiology fellow… One theory as to why statins have a small degree of influence is that they actually have an anti-inflammatory action. When my father talks with his patients, he finds many of them couldn't tolerate statins' side effects.

carbocation 10y ago
> So says the cardiology fellow… Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography? > One theory as to why statins have a small degree of influence is that they actually have an anti-inflammatory action. When my father talks with his patients, he finds many of them couldn't tolerate statins' side effects. Given the predictable effects of LDL-cholesterol lowering on MACE and death, invoking beneficial mechanisms of statins beyond LDL-cholesterol lowering (e.g., by anti-inflammatory effects) is not that well supported (or necessary to explain the benefits), but it's not out of the realm of possibility.
- tcj_phx 10y ago
  > Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography? The American Heart Association still promotes Ancel Keys' dietary philosophy, so everything they touch is tainted. An appology for The Mistake (promoting vegetable oil) is necessary to begin the process of rebuilding trust. I subscribe to a medical news email - one of the recent editorials was about needing to re-examine the profession's obsession with cholesterol. When I find the link I'll post again. But basically the gist is that the CETP agents are good at lowering cholesterol levels, but not so good at lowering mortality, so maybe the hypothesis needs to be reconsidered.
  - carbocation 10y ago
    Apheresis, HMG-CoA reductase inhibition (statins), PCSK9 inhibition (-cumabs), and NPC1L1 inhibition (ezetimibe) all lead to reduced LDL-C. Statins and ezetimibe lead to reduced MACE and death. The -cumabs should be reporting trial results in the next 12 months, but the genetic data strongly suggests that they will reduce mortality. Unusual for cholesterol modification agents, some of the CETP drugs (which were designed around their HDL-C raising properties but do lower LDL-C) increased MACE, while others had neutral effect, so there is something about CETP that we have yet to understand.
    - tcj_phx 10y ago
      I can't match you on credentials or acronyms, but I'm pretty good at figuring out what matters for improving my own health. "Should cardiologists evaluate their obsession with LDLs and HDLs?" - http://www.kevinmd.com/blog/2016/04/should-cardiologists-evaluate-their-obsession-with-ldls-and-hdls.html?pop=0&ba=1 http://www.kevinmd.com/blog/2016/04/should-cardiologists-eva... (April 2016) Saw this link on the sidebar: "Slow Medicine: Pressing Pause on Statins For Primary Prevention" - http://www.medpagetoday.com/Blogs/SlowMedicine/61836 http://www.medpagetoday.com/Blogs/SlowMedicine/61836 (December 4 2016) I would estimate that the cholesterol fetish has about 2 more years before it begins to slide into irrelevance, and the field begins to refocus on the causes behind the symptom. A classic fun movie clip: https://www.youtube.com/watch?v=02Or-Hx3yqc https://www.youtube.com/watch?v=02Or-Hx3yqc
- coldtea 10y ago
  >Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography? If there were differing opinions and results on some computer science subjects by different specialties (cryptography, data science, language design, algorithms, etc), then yes.
tcj_phx 10y ago
The article is about Billionaires trying new approaches to medical research. My point was that more progress could be made by re-examining old assumptions. > So says the cardiology fellow… For the record, I was traveling when I wrote this and my later comments. If I'd had a keyboard, and had spent more time drafting, I might've said things differently. I wanted to point out that the carbocation has a vested interest in promoting statins. I note that carbocation never responded to the substance of my comments: that an old science-mistake that has never been officially corrected contributes to many people's health problems. That inflammation -- caused by the consumption of partially hydrogenated oils and Omega-6 PUFA oils -- is a primary consideration for heart problems, moreso even than cholesterol lab #'s. In summary, I apologize for being short and less-than-courteous yesterday. It was a combination of not having a keyboard for my followup posts, and responding to someone whose initial post was entirely dismissive of the 'dissidents' complaints about the drugs that [s]he apparently thinks highly of.
- carbocation 10y ago
  I don't have a vested interest in promoting statins: I have no financial stake in companies that produce them, and my job as a cardiologist would still exist if statins were proven to be harmful. I do think that your views about statins are wrong on the scientific merits. There is a preponderance of evidence that supports their use as not only safe, but also effective (though costly if you don't select your population at all). Your views on inflammation aren't right or wrong; they're speculative. Some evidence can be interpreted as supporting the inflammation hypothesis (JUPITER trial), other evidence suggests that much of what we measure as a sign of inflammation has no direct impact on CAD (see the CRP Mendelian randomization). So, this is still an active area of research.

by tcj_phx 10y ago

carbocation 10y ago

> So says the cardiology fellow… Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography? > One theory as to why statins have a small degree of influence is that they actually have an anti-inflammatory action. When my father talks with his patients, he finds many of them couldn't tolerate statins' side effects. Given the predictable effects of LDL-cholesterol lowering on MACE and death, invoking beneficial mechanisms of statins beyond LDL-cholesterol lowering (e.g., by anti-inflammatory effects) is not that well supported (or necessary to explain the benefits), but it's not out of the realm of possibility.

tcj_phx 10y ago
> Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography? The American Heart Association still promotes Ancel Keys' dietary philosophy, so everything they touch is tainted. An appology for The Mistake (promoting vegetable oil) is necessary to begin the process of rebuilding trust. I subscribe to a medical news email - one of the recent editorials was about needing to re-examine the profession's obsession with cholesterol. When I find the link I'll post again. But basically the gist is that the CETP agents are good at lowering cholesterol levels, but not so good at lowering mortality, so maybe the hypothesis needs to be reconsidered.
- carbocation 10y ago
  Apheresis, HMG-CoA reductase inhibition (statins), PCSK9 inhibition (-cumabs), and NPC1L1 inhibition (ezetimibe) all lead to reduced LDL-C. Statins and ezetimibe lead to reduced MACE and death. The -cumabs should be reporting trial results in the next 12 months, but the genetic data strongly suggests that they will reduce mortality. Unusual for cholesterol modification agents, some of the CETP drugs (which were designed around their HDL-C raising properties but do lower LDL-C) increased MACE, while others had neutral effect, so there is something about CETP that we have yet to understand.
  - tcj_phx 10y ago
    I can't match you on credentials or acronyms, but I'm pretty good at figuring out what matters for improving my own health. "Should cardiologists evaluate their obsession with LDLs and HDLs?" - http://www.kevinmd.com/blog/2016/04/should-cardiologists-evaluate-their-obsession-with-ldls-and-hdls.html?pop=0&ba=1 http://www.kevinmd.com/blog/2016/04/should-cardiologists-eva... (April 2016) Saw this link on the sidebar: "Slow Medicine: Pressing Pause on Statins For Primary Prevention" - http://www.medpagetoday.com/Blogs/SlowMedicine/61836 http://www.medpagetoday.com/Blogs/SlowMedicine/61836 (December 4 2016) I would estimate that the cholesterol fetish has about 2 more years before it begins to slide into irrelevance, and the field begins to refocus on the causes behind the symptom. A classic fun movie clip: https://www.youtube.com/watch?v=02Or-Hx3yqc https://www.youtube.com/watch?v=02Or-Hx3yqc
coldtea 10y ago
>Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography? If there were differing opinions and results on some computer science subjects by different specialties (cryptography, data science, language design, algorithms, etc), then yes.

tcj_phx 10y ago

The article is about Billionaires trying new approaches to medical research. My point was that more progress could be made by re-examining old assumptions. > So says the cardiology fellow… For the record, I was traveling when I wrote this and my later comments. If I'd had a keyboard, and had spent more time drafting, I might've said things differently. I wanted to point out that the carbocation has a vested interest in promoting statins. I note that carbocation never responded to the substance of my comments: that an old science-mistake that has never been officially corrected contributes to many people's health problems. That inflammation -- caused by the consumption of partially hydrogenated oils and Omega-6 PUFA oils -- is a primary consideration for heart problems, moreso even than cholesterol lab #'s. In summary, I apologize for being short and less-than-courteous yesterday. It was a combination of not having a keyboard for my followup posts, and responding to someone whose initial post was entirely dismissive of the 'dissidents' complaints about the drugs that [s]he apparently thinks highly of.

carbocation 10y ago
I don't have a vested interest in promoting statins: I have no financial stake in companies that produce them, and my job as a cardiologist would still exist if statins were proven to be harmful. I do think that your views about statins are wrong on the scientific merits. There is a preponderance of evidence that supports their use as not only safe, but also effective (though costly if you don't select your population at all). Your views on inflammation aren't right or wrong; they're speculative. Some evidence can be interpreted as supporting the inflammation hypothesis (JUPITER trial), other evidence suggests that much of what we measure as a sign of inflammation has no direct impact on CAD (see the CRP Mendelian randomization). So, this is still an active area of research.