5 ms·

Yup. Highly effective and widely prescribed.

by wjn0 9y ago

HarryHirsch 9y ago
What do the meta-studies have to say about statins and life expectancy? Back then, before we had statins we had clofibrate. It decreased cholesterol levels just fine but overall mortality went up. Also, why isn't dietary adjustment the first-line treatment for high cholesterol?
- matte_black 9y ago
  Because changing human behavior is much more difficult than just making people take a pill.
- lazerpants 9y ago
  "Unfortunately, even the strict very low saturated fat, lowcholesterol American Heart Association Step 2 diet only minimally lowers serum cholesterol. Hunninghake et al found a mean 5% reduction in low-density lipoprotein (LDL) cholesterol in patients following this program and discouragingly found an equivalent 6% fall in high-density lipoprotein (HDL) cholesterol, so that ratios were unchanged. Low-fat diets as commonly prescribed rarely produce significant LDL declines. Studies performed on controlled metabolic units where intakes are rigidly enforced can demonstrate cholesterol reductions of 15% with diet alone; however, in the real world, people can rarely replicate these results." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/
- wjn0 9y ago
  > What do the meta-studies have to say about statins and life expectancy? For long term maintenance, they're definitely recommended. Near EOL is a bit different, but I don't know the guidelines. > Also, why isn't dietary adjustment the first-line treatment for high cholesterol? It is, but only in conjunction with medication. It seems that having a poor diet (e.g. high saturated fats) has long-lasting effects on cholesterol levels, and short-term dietary changes do little to "repair the damage", so to speak. Additionally, we know very little about what other factors affect HDL/LDL levels. For example, for a long time, there was concern that dietary cholesterol had an impact on serum levels, but I believe now the consensus is that this is false. Cholesterol is complex, and while its role in disease is what gets attention, it's a vital compound with a number of downstream effects. In most cells, it acts as a modulator of membrane structure and function: absolutely crucial aspects of every cell's job, regardless of what tissue they're in. My point is twofold: first, statins likely have unknown "off-target" effects on cholesterol synthesis throughout the body (which potentially speaks to the life expectancy issue); and second, the comorbidity of high cholesterol and obesity is likely more complex than "bad diet." Of course, keep in mind that having a "good diet" in the cholesterol sense (low saturated fats, possibly low dietary cholesterol) has been shown to be a good idea regardless. It's temporary changes to diet that seem ineffective, at a population level.

Yup. Highly effective and widely prescribed.

by wjn0 9y ago

Yup. Highly effective and widely prescribed.

What do the meta-studies have to say about statins and life expectancy? Back then, before we had statins we had clofibrate. It decreased cholesterol levels just fine but overall mortality went up. Also, why isn't dietary adjustment the first-line treatment for high cholesterol?

matte_black 9y ago
Because changing human behavior is much more difficult than just making people take a pill.
lazerpants 9y ago
"Unfortunately, even the strict very low saturated fat, lowcholesterol American Heart Association Step 2 diet only minimally lowers serum cholesterol. Hunninghake et al found a mean 5% reduction in low-density lipoprotein (LDL) cholesterol in patients following this program and discouragingly found an equivalent 6% fall in high-density lipoprotein (HDL) cholesterol, so that ratios were unchanged. Low-fat diets as commonly prescribed rarely produce significant LDL declines. Studies performed on controlled metabolic units where intakes are rigidly enforced can demonstrate cholesterol reductions of 15% with diet alone; however, in the real world, people can rarely replicate these results." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/
wjn0 9y ago
> What do the meta-studies have to say about statins and life expectancy? For long term maintenance, they're definitely recommended. Near EOL is a bit different, but I don't know the guidelines. > Also, why isn't dietary adjustment the first-line treatment for high cholesterol? It is, but only in conjunction with medication. It seems that having a poor diet (e.g. high saturated fats) has long-lasting effects on cholesterol levels, and short-term dietary changes do little to "repair the damage", so to speak. Additionally, we know very little about what other factors affect HDL/LDL levels. For example, for a long time, there was concern that dietary cholesterol had an impact on serum levels, but I believe now the consensus is that this is false. Cholesterol is complex, and while its role in disease is what gets attention, it's a vital compound with a number of downstream effects. In most cells, it acts as a modulator of membrane structure and function: absolutely crucial aspects of every cell's job, regardless of what tissue they're in. My point is twofold: first, statins likely have unknown "off-target" effects on cholesterol synthesis throughout the body (which potentially speaks to the life expectancy issue); and second, the comorbidity of high cholesterol and obesity is likely more complex than "bad diet." Of course, keep in mind that having a "good diet" in the cholesterol sense (low saturated fats, possibly low dietary cholesterol) has been shown to be a good idea regardless. It's temporary changes to diet that seem ineffective, at a population level.