OT: statins, SEs vs benefits

Isn't there some claim that statins improve prognosis for those of us with PC?

Well, maybe, but their main use is obviously to decrease risk of heart attacks and maybe strokes. There have always been plenty of people (some who would probably be called quacks by mainstream Docs) who have insisted that cholesterol has little to do with heart attack unless extremely high. And that lowering the #s did not really help much, and then you have bad effects that seemed like they just could not be good for ones over all health. Like muscle pain and weakness.

And of course there is the cost. One of these articles said a new injectable cholesterol lowering drug would run abot $14,000 per year.

Well, I just saw a couple of new studies both on effectiveness and the most common SE, pain and weakness.
Muscle pain study:
www.cbsnews.com/news/study-confirms-what-millions-taking-statins-have-said-for-years/?ftag=YHF4eb9d17&ref=yfp
www.ncbi.nlm.nih.gov/pubmed/27039291

Somebody said...
The patients in the study were given a statin or a sugar pill. about 42 percent who took a statin experienced muscle pain or weakness...............

. While the new injection route drug lowere chol more and only had 21% muscle pain/weakness,

Somebody said...
What are the costs per year when talking about the injectable non-statin drugs?

"It's about $14,000 a year," said Dr. Nissen. "So they are quite expensive."

Effectiveness of a new drug which impressively lowers bad and raises good cholesterol. I'm not sure if it is a statin or not, I think probably not, but it sure does a number on the "bad" and greatly increases the "good", which is supposed to be a good thing:
www.cbsnews.com/news/once-promising-cholesterol-drug-fails-to-improve-patients-heart-health/

Somebody said...


Despite its success in lowering LDL -- known as "bad" cholesterol -- while increasing levels of "good" cholesterol HDL, the drug evacetrapib is not effective in helping protect patients from major cardiovascular events like heart attack and stroke, a large clinical trial finds.

The research, presented at the American College of Cardiology's 65th Annual Scientific Session on Sunday, explains why the drug's maker, Eli Lilly, halted the study in October.

"Here we've got an agent that more than doubles the levels of good cholesterol and lowers bad cholesterol and yet has no effect on clinical events," lead study author Dr. Stephen Nicholls, a professor at Australia's University of Adelaide and cardiologist at Royal Adelaide Hospital, said in a statement. "We were disappointed and surprised by the results."

The study involved more than 12,000 patients from approximately 540 global health centers at high risk for serious cardiovascular health problems. The participants were randomly selected to receive either 130 milligrams of evacetrapib or a placebo pill daily for at least 18 months. The patients also received standard medical therapy -- the majority of which included statins or other cholesterol-lowering drugs -- throughout the trial.

The research showed that, on average, patients taking evacetrapib lowered their "bad" cholesterol by 37 percent and increased their "good" cholesterol by 130 percent compared to the other patients taking the placebo. However, the drug's favorable effects on cholesterol did not translate into a reduced risk of heart attack, stroke, coronary artery bypass surgery, hospitalization for chest pain, or amount of time until cardiovascular death.

This marks the third failure in a class of drugs known as cholesteryl ester transfer protein (CETP) inhibitors, which are made to disrupt the natural process by which HDL cholesterol is converted into LDL cholesterol in the body. The first drug was abandoned after it was found to increase the risk of heart trouble and death. The second was deemed ineffective.

"There has been, and continues to be, a lot of confusion about what's going on with this class of drugs, since we don't yet have one that can be brought to the clinic to prevent heart attack and stroke in our patients," Nicholls said. "As we close out the trial, we're trying to understand how a drug that seems to do all the right things in terms of blood cholesterol levels doesn't then translate into reducing clinical events."

Though researchers don't know the answer to this question, some have hypotheses.

"As we learn more about this class of medications, perhaps it is not enough to raise HDL and lower LDL and see beneficial effects," Dr. Jeffrey Kuvin, a cardiologist at Tuft's Medical Center and the co-chair of the 2016 ACC meeting, told CBS News.

Another possible explanation, Nicholls said, is that existing treatments like statins are already so effective at improving heart health that it has become more difficult to further improve outcomes in high-risk patients. Or it may be that evacetrapib's active ingredient or the biological pathway it is designed to affect simply has no effect on cardiovascular risk.

Whatever the reason, experts say CETP's are looking less and less like a viable option to treat and prevent heart problems in high risk patients.

"As we gain further evidence with this class of medications," Kuvin said, "there is further skepticism as to whether or not these drugs are actually going to be effective in the treatment of cardiovascular disease."

Post Edited (BillyBob@388) : 4/4/2016 9:57:34 PM (GMT-6)

RCS said...
Interesting on the statins.

Here's some news on vitamin D3 and the heart;
www.medicaldaily.com/heart-failure-vitamin-d-deficiency-supplements-380600

"A daily dose of vitamin D3 improved heart function in people with heart muscle weakness, said the University of Leeds researchers, led by Dr. Klaus K. Witte, a senior lecturer in cardiology. While patients who took placebos saw no changes, those who received vitamin supplements experienced up to a 34-percent improvement in heart pumping function."

Thx, good to know! Actually, though it would be even better if it was PC related, still pretty darn impressive and interesting considering we all have hearts to deal with:

Somebody said...
The VINDICATE study involved 163 patients already being treated for heart failure using a proven and accepted treatment, including beta-blockers, ACE-inhibitors, and pacemakers. The researchers assigned study participants to take either vitamin D3 — though not a calcium-based product, which could harm heart failure patients — or placebo pills for one year. To measure potential changes in heart function, they used a technique known as ejection fraction, which involves scanning the heart with an echocardiogram and measuring how much blood pumps away from the heart with each beat.

In healthy people, the ejection fraction is usually between 60 and 70 percent. For the VINDICATE patients, the average ejection fraction was just 26 percent before the study began.

So what happened after a year on either vitamin D or placebo?

Patients taking vitamin D3 experienced an improvement in heart function, while the placebo patients remained unchanged. Patients taking vitamin D3 saw their heart pumping function improve by 8 percent, rising to 34 percent.

Witte and his co-authors say this represents a significant breakthrough for patients. Most importantly, vitamin D3 supplements may prevent some patients from needing an implantable cardioverter defibrillator device, which can detect irregular heart rhythms and shock the heart to restore normal rhythm. These devices are not only expensive, they also involve surgery, a risk most older people prefer not to take.

Source: Witte K, Gierula J, Paton MF et al. Vitamin D Supplementation Improves Cardiac Function in Patients with Chronic Heart Failure. American College of Cardiology 65th Annual Scientific Session. 2016.

www.acc.org/latest-in-cardiology/articles/2016/03/23/18/25/mon-2pm-vindicate-vitamin-d-supplementation-improves-cardiac-function-in-patients-with-chronic-hf-acc-2016?w_nav=LC

Somebody said...
In this randomized, placebo-controlled double-blind trial, Klaus K. Witte, MD, FACC, and colleagues studied 223 patients with chronic heart failure due to secondary left ventricular (LV) systolic dysfunction and vitamin D deficiency ((25(OH) vitamin D3 <50nmol/L (<20ng/mL)). 20ng/mL)). Participants were either allocated to one year of vitamin D3 supplementation (4000 IU (100μg) 25(OH)D3 daily) or matching non-calcium-based placebo. A total of 163 patients completed the study. The primary endpoint was change in six-minute walk distance from baseline to 12 months, and the secondary endpoint included the change in left ventricular ejection fraction at one year.

While vitamin D supplementation had no effect on the six minute walk test distance, it effectively restored normal levels of 25-OH vitamin D3 and was associated with improvements in cardiac function, resulting in an increase of left ventricular ejection fraction by 6.07 percent, from an average baseline of approximately 26 percent. After 12 months, patients who took vitamin D had greater improvement in echocardiographic measures of LV function, LV dimensions and volumes than patients who took a placebo.

According to the authors, these findings suggest that taking vitamin D supplements may lead to beneficial reverse remodeling. Patients with chronic heart failure are also frequently deficient in vitamin D and low levels are associated with more severe disease and worse outcomes in these patients.

“New therapies for serious chronic conditions including chronic heart failure are often expensive, increasingly technical and frequently fail to meet the rigorous demands of large phase 3 clinical trials,” the authors write. “Vitamin D might be a cheap and safe additional option for chronic heart failure patients and may have beneficial effects on multiple features of the syndrome.”
- See more at: http://www.acc.org/latest-in-cardiology/articles/2016/03/23/18/25/mon-2pm-vindicate-vitamin-d-supplementation-improves-cardiac-function-in-patients-with-chronic-hf-acc-2016?w_nav=LC#sthash.ftKvdiP2.dpuf

6% ejection fraction added to baseline 26%: isn't that about a 23% improvement, over 1/4 better? That sounds really worth while. I wonder by what amount the usual drugs improve EF?

Though not mentioned, I suspect there were also no apparent significant SEs, unlike so many of the expensive newer drugs. And who knows, it is also possible it might be good for various other health related things, though I would not dare to guess what. A significant improvement in heart function PLUS dirt cheap, though insurance probably won't cover it. I'll be watching to see if this make the headlines. Seems to me like it should. But I doubt we will see the prime time add "ask your doctor if vitamin D is right for you".

Post Edited (BillyBob@388) : 4/5/2016 2:52:03 PM (GMT-6)

Billybob, funny you should mention it. I read that study yesterday on a Heart Health Forum that I belong to . To make a long story short, cohort of 12,000 people, half got the new drug, half a placebo. The half that got the drug indeed saw their cholesterol , and LDL drop drastically, and the placebo group did not. But in the end, they both presented with incredibly similar rates of heart events and stroke. By the way, Dr Nissan,aka Captain Statin, is the same guy that was instrumental in preventing the CT Heart Scan from becoming a mainstream diagnostic tool, for decades, while hundreds of thousands who could have benefitted from it, died.gg watch the Widowmaker , a documentary on the topic, on Netflix.

My numbers may be a bit off, but that's the gist of it. Here is a link to a NYtimes article on the study...

www.nytimes.com/2016/04/04/health/dashing-hopes-study-shows-cholesterol-drug-has-no-benefits.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region®ion=bottom-well&WT.nav=bottom-well&_r=0

I am at a point where I am starting to believe the "quacks" are not quacks. Do you know that the cause of 70% of sudden death heart attacks is NOT a calcium blockage? In fact it's a rupture in soft (new) plaque, that causes a clot, which then closes up the artery.

I have been following the methodology presented on that website, by the quacks. I think I'm not supposed to post other forum urls here, so if you want the website, just email me. It's a for pay site, $9.99 a month.

I'm still not 100% sure about their methodology, but it's making sense to me. I have been wheat free, grain, free and added sugar free for two months. No bread, pasta, rice, of any kind, no sugar, quinoa, faro, etc. Very low carb, higher fat (opposite of Ornish) These are things that cause inflammation in the arteries, which they claim are the real cause of coronary plaque. My triglycerides have come down in two months from 208, to 85 last week. These guys say LDL is not the problem, it's triglycerides, HDL, and other markers like LDL particle size, lipoprotein A, etc. I'm being tested for all of that,

It's a work in progress for me, I'm still learning. I'm on statins, one of my doctors would like to see me off them at some point but agrees that I need to be on them for now. The other says, take the Statin, don't worry about it, enjoy your life.

It's very murky , there is a lot that the medical profession still doesn't know for sure, and a lot that they won't admit is truth, because it's out of the mainstream. Example, stents (I had 2) are a bandaid. They don't fix the problem. And it's been shown that they do NOT reduce mortality rates from heart attacks, yet they keep putting stents in people. Why? Because the insurance company, paid the hospital $52,000 for my 45 minute procedure.
It's a mess. Like PC you have to be a skeptic, and your own advocate.
Unfortunately, there is no resource for heart disease, like Healingwell Prostate Forum

Sorry, enough rambling. For now.

Post Edited (Pratoman) : 4/5/2016 5:03:46 PM (GMT-6)

Prato, great post! Many good points!

So, Nissan, "aka Captain Statin, is the same guy that was instrumental in preventing the CT Heart Scan from becoming a mainstream diagnostic tool"? Now, I wonder why he would do that? Hmmmm. Thinking real hard. Just can't imagine why. He must have had some motive, giving him some kind of bias. My docs would still be pressuring me real hard to get on statins if I did not have that zero Calcium Score. Which they had fully expected to be the final proof that I had plenty of coronary artery disease, despite zero symptoms, low BP, no fam history (though fam history of cerebral aneurysms are plenty scary) and low triglycerides. Still, I had somewhat high cholesterol, and that is the number one issue for so many Docs. Knock it down at any cost.

Somebody said...
I am at a point where I am starting to believe the "quacks" are not quacks.

Come on in the pool where we can quack like a duck, Bro, the water is kind of stormy sometimes but occasionally you learn something interesting!

Somebody said...
Very low carb, higher fat (opposite of Ornish) These are things that cause inflammation in the arteries, which they claim are the real cause of coronary plaque. My triglycerides have come down in two months from 208, to 85

Well, well, well. So you do what the "quacks" say, ignoring conventional low fat/plenty of carb wisdom, and in 2 months or less you SLASH your TGLs 60%? Kind of like we have previously discussed happens almost every time? Do they even have one expensive, SE inducing drug that can even touch that?

Of course, whether or not it is actually a helpful thing to lower TGLs is another matter. But there are certainly plenty of big brains who say it is, and who say it is even more important than cholesterol.

Somebody said...
It's very murky , there is a lot that the medical profession still doesn't know for sure, and a lot that they won't admit is truth, because it's out of the mainstream. Example, stents (I had 2) are a bandaid. They don't fix the problem. And it's been shown that they do NOT reduce mortality rates from heart attacks, yet they keep putting stents in people. Why? Because the insurance company, paid the hospital $52,000 for my 45 minute procedure."

Well, even if stents are indeed just a bandaid, $52,000 for 45 minutes is good work if you can get it(did that include the docs fee?). So just like so much else, that explains a lot, doesn't it?

What do you think about the Vitamin D and heart failure study that RCS turned me on to? Not too shabby even compared to powerful beta blocker drugs. And I'm sure much safer and much less SEs. If it is indeed helpful for heart failure, I have a feeling it might be good for overall heart health. Maybe some other things also.

Pratoman said...
Or maybe they ARE all quacks, and I'm nuts, gullible, or both, and have become one of them. I don't know (seriously)

In any case, here is some more interesting reading on statins (which I take)

blog.drbrownstein.com/1201-2/

Makes sense to me. (the linked article that is)

Paul, I'm curious about your comment that folic acid (B12?) for the heart is a bust, can you expound on that?

I ask because the heart health forum I am on recommends, I believe, folic acid supplements in certain situations

You seem to have a very good understanding of inflammation and the role it plays in coronary heart disease.

PDL17,
Beyond statins, any thoughts on how to reduce inflammation ..... prescription and non-prescription?

I have been using statins for nearly 20 years and the best is the Lipitor (IMHO) or generic equivalent. I had the muscle pain and cramps and finally told my doctor that I wanted to lower the dose to the point that the pain went away. Went from 40mg to 20mg. Pain subsided cramps infrequent now. I also take CoQ10 and believe that has helped. By the way the total cholesterol rose about 10%. My last test, non fasting, was 175 total. I did not get the HDL or LDL fractions as it was a screening type test that was part of a larger battery of tests for another purpose.

Word of warning, stay away from 80mg or higher dose of simvastatin. Google FDA warning on the drug and dose. Can cause kidney damage and I believe it cause my decline in filtration to borderline after being on it for four years. Never checked kidney function was always focused on liver. Never any problem there with any of the statins.

I was taking curcumin for inflammation and believe that it worked. I was requested to stop taking it as a condition for participation in a trial. I washed out of the trial yesterday so I have resumed my curcumin. Both the CoQ10 and curcumin are non prescription and relatively inexpensive.

Don

---

Diagnosed 04/10/08 Age 58
Gleason 4 + 3 DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85% Bone scan and chest x ray clear CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5 at diagnosis
07/10 0.10 nadir
06/11 3.47 HT (Lupron started again in late July)
09/11 0.70

RCS said...
I really do think triglycerides is the problem with clogging the arteries. Google images of blood with high triglycerides and you will be amazed at the milky (fatty) appearance of blood with high triglycerides.

I would think the stuff could clog my sewer pipes!

Well if that is so, and if that is a bad thing, I know how to drastically decrease TGLs with out any prescription drug or even supplement. It has worked for me in the past, and for several people I know, probably some on this forum, and modern studies repeatedly confirm it. But even today most docs and dieticians probably still recommend the opposite.

So whether or not it actually helps heart disease or not, I could not say. I am not aware of any clinical studies or at least can't think of any at the moment. The dietary changes it involves go against the conventional wisdom of recent decades, and I have been told for many years by many esteemed authorities that eating that way will give you a heart attack sooner or later, as well as make you fat. But if I want to cut my TGLs a lot, and probably raise my HDL while I am at it, and in my experience lower my BP dramatically without meds, and even loose weight, then a low carb diet easily does the trick for me and several folks I know, and again, studies confirm it. Cutting the carbs( the more I cut them, the greater the response) either leading to a decrease in overall calories, or replacing the carbs with various types of fat to maintain the calories, either way, seems to do the trick. Most especially when it comes to TGLs. But is all of that a good thing, and actually good for our hearts or our overall health such as avoiding diabetes? What about cancer? I suspect it is an overall good thing, but we need the studies.

When do you think we will see the RCTs where docs take some of their heart disease patients and put 1/2 on low carb( and even gasp high fat) diets vs the conventional diet recommended for decades now? It might be a while, since they would go in believing they were sentencing these patients to early death, and who is going to do that?

And if Y'all start researching low carb diets vs standard recommendations or low fat, please keep in mind that very often what these researchers are calling low carb barely- if at all- qualify for that term. They just can't seem to bring themselves to do that to people. So often what they mean is less than 100 net gms of carb, or < than 75. It is a start, and it helps, but it barely qualifies except in comparison to high carb. Or in comparison to the 200-300 probably still recommended. I think every one might be changing their recommendations slightly these days with all the new studies, but:

www.diabetes.org/mfa-recipes/about-our-meal-plans.html

Somebody said...
1550-1650 calories per day

Your calorie level may vary based on your age, gender, activity level and whether or not you need to lose weight.
Calories are spaced throughout the day between meals and two snacks.
We also include tips each month to add or cut total calories by 200.

Moderate-carbohydrate (about 45% of calories come from carbohydrate)

Carbohydrate intake is spread throughout the day.
Most meals have 45-60 grams of carbohydrate.
Most snacks have 10-25 grams of carbohydrate.

- See more at: http://www.diabetes.org/mfa-recipes/about-our-meal-plans.html#sthash.YkqNqooR.dpuf

So even at this near starvation(for me any way! ) level of 1600 calories per day, 45% from carbs(didn't they recommend more than that until recently?) = 720 calories/ 4 cal per carb gm= 180 gms of carb per day! If this was based on a more reasonable 2000-2400 cal per day, that would be 225- 270 carb gms per day! So, compared to that, 100 gms would be quite low, but not exactly Atkins etc. But probably enough to start seeing some good benefits, just not as fast.

Post Edited (BillyBob@388) : 4/6/2016 9:29:50 AM (GMT-6)

Boz, you sound like a serious physical specimen with serious conditioning!

---

PSA 10.9 ~112013
Bx on 112013 at age 64 yrs 11 months, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, still G9 but down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/11, 8/20/14 and 3/4/15, up to .01 on 9/1/15, .01 3/10/16

Billybob,

Actually the carb-triglyceride relationship has been written about for some time. Here is a 2000 paper you may find interesting.

ajcn.nutrition.org/content/71/2/412.full?ijkey=34cf92dd47dd2ac896d0e975e1f108ef31aa5b16

"Current trends in health promotion emphasize the importance of reducing dietary fat intake. However, as dietary fat is reduced, the dietary carbohydrate content typically rises and the desired reduction in plasma cholesterol concentrations is frequently accompanied by an elevation of plasma triacylglycerol. We review the phenomenon of carbohydrate-induced hypertriacylglycerolemia, the health effects of which are among the most controversial and important issues in public health nutrition today. We first focus on how seminal observations made in the late 1950s and early 1960s became the basis for subsequent important research questions and areas of scientific study. The second focus of this paper is on the current knowledge of biological mechanisms that contribute to carbohydrate-induced hypertriacylglycerolemia."

Pratoman said...
..................... My fat intake is now up to 50% of total calories with about 20% of that, or about 15 grams a day (i think) saturated fat. So mostly good fats. I've dropped from182 to 169 in those 9 weeks. Seldom hungry. I walk 30-40 minutes a day, and intersperse 2 minutes of running at a time, into my walks.

I don't know what all this has done for my inflammation markers, but I suspect they are improved. I'll know more about that in June.

But I guess we'll know more about the ultimate endpoint when I'm dead. I'll tell my wife to post the final result

Be sure to sign up for an autopsy and have them mail us the results so we can know if anything did any good, then if so we can do it and live a little longer!

From your post above, I think the Seldom hungry. tells a large part of the story. That is the key. People will not voluntarily starve, or very rarely will they do so for long. I always have a lot of trouble dropping my food addictions and giving up certain tastes, it is always very hard for me to get started. But in the past, when I get past the first few days or at least couple of weeks of low carb with at least adequate fat, I invariably realize I am no longer hungry. I typically no longer think much about food, and not infrequently realize close to supper that I forgot to eat lunch. Is there any other approach that can have all of the well known benefits without even being hungry and maybe even obsessing about food?

But though I have done very well with it a few times over the years, taking those first steps is always a bear.