Yep, sorry, I bought into Dinsdale’s narrative during this discussion (probably because it applies to me). Clearly there are a lot of people to whom it does not apply.
I have absolutely normal blood pressure, slightly lower than normal cholesterol, no family history of heart disease or any other heart ailments, and I’m relatively fit. When I was diagnosed with Type II diabetes my doctor started me on statins. He said it was prophylactic. This was at age 56. All my other bloodwork than A1C was normal.
I just assumed it was common now to prescribe statins tomolder men if any risk factors show up at all.
I fought my genetic disposition to high cholesterol for years. My doctor applauded my efforts, but eventually the statins won. My Dad would never take them. He died of vascular dementia, as his brain didn’t get sufficient blood due to clogged arteries. At least that’s what we were told. Scared me right into pharmacopeia.
That sorta throws me for a loop, as I had thought one of the - admittedly rare - potential side effects of statins was messing w/ your blood sugar.
Statins have been shown to cause some increase in insulin resistance in some patients, but the benefits still far outweigh the downside of that effect for the vast majority of patients. Especially where insulin resistance or DM has already been identified and is being appropriately treated.
The evidence is quite clear. Diabetics who are placed on statins experience a significance reduction in risk for heart attack and stroke when compared to those who are not placed on statins, regardless of what their cholesterol levels are.
I was borderline on needing statins via Risk Calculator but NP mentioned that if I was willing to pay out of pocket for “Calcium Scan”, results of that test would show whether statins would provide no benefit. Paid for the scan, which showed zero score (which is good) and therefore statins were not indicated. I recommend you get Calcium Scan to give your doctor better information about whether you need statins, unless he/she tells you your situation is different and even with a zero score, you should be on them.
That’s pretty much what my endocrinologist told me, back in 2005 when I was diagnosed as diabetic, and he put me on a statin. I’ve never had high cholesterol (thank you, mom, for that good gene), but the doctor told me that the numbers supported going on a statin anyway, as a diabetic.
My PCP has been making noises about it and has given me orders for some studies and scans since my LDL insists in going down only at an extreme slow crawl on diet alone. We’ll see. Mom’s genes, apparently, her cholesterol and triglycerides have been way up all her life even though she’s a healthy eater and active person.
But, meanwhile, there’s days it feels like EVERYONE in my personal circle are all bigly “DON’T LET THEM PUT YOU ON STATINS!!!1!1” It’s an interesting observational exercise on people who normally “follow the science” turning skeptic.
It’s odd, but I get that as well. Some friends of mine are all holier-than-thou about it and see it as a person failing of mine that I am not disciplined enuf with the diet and not exercising enuf (or correctly) to control the lipids. I explained to them about genetics and the risk factors and that it costs me nearly nothing and have no side effects, and I cannot find a good reason NOT to take them. These are the same people who fully embrace vaccinations. I don’t get the skepticism.
Heh, my PCP (retired now) always presented himself as the gatekeeper to specialists. He did very little. When I came in very concerned about pigment disappearing, he never used the word “vitiligo”, he just wrote up a derm referral. During an appointment 5% of the time would be writing the referral, 50% of the time would be updating my chart, and 45% of the time would be him bitching about healthcare in the US.
Yeah - my impression was that the doc advised the calcium scan solely because I was hesitant about taking statins. The way he presented it, if the calcium scan was positive, that might persuade me to take them.
Yeah - that’s pretty much what I’ve heard as well. I tend to be pretty extreme in my unsophisticated approach to health.
-I try to eat pretty well - but if I want to gorge on something, I will. Never counted a calorie in my life.
-I exercise a reasonable amount - knowing I could exercise more/better. Never understood a Fitbit. If you ask me, could tell you if I’ve been active or a slug.
-Many years ago I stopped smoking/alcohol/drugs.
-And I realize I’m not going to live forever, and have every expectation of taking myself out if things get too bad physically and/or mentally.
-I’m wary of potential effects of taking just about any meds over an extended period of years. Just if I CAN avoid them, I TRY to.
-My work exposes me to medical records which convince me that way to many people consume way too much medical care, way too many care providers provide too much care, and a huge business tries to persuade people to rely on drugs rather than exercise/diet.
I was mainly surprised, because I had assumed that there would be a gradual approach towards statins. I assumed he would first tell me to try to get my chol down through diet. So I was uninformed and ill-prepared to even ask intelligent questions.
You should check the Venn Diagram on people who smoke marijuana and the ones who complain about people putting toxins in their bodies…
Some very helpful links on what the research says on statins (scroll down and click on “view transcript” if you can’t or don’t want to watch any videos):
Who Should Take Statins? | NutritionFacts.org
The True Benefits vs. Side Effects of Statins | NutritionFacts.org
How Much Longer Do You Live on Statins? | NutritionFacts.org
You might want to use the following online tool from the Mayo Clinic to give an estimate on the potential benefit on using a statin for 10 years if you know your blood pressure and cholesterol values.
Statin Choice Decision AID - Site
The bottom line is that, for those with high cholesterol, statins can drastically reduce your chance of dying if taken regularly during a 10 year period with a fairly low risk of side effects, especially serious ones. However, best practice is never start taking a statin taken without simultaneous lifestyle (i.e. diet, exercise, quitting smoking etc.) changes.
To get the best of both worlds, with a sufficient lifestyle intervention (most importantly, eating an increased variety and quantity of whole plant foods and less junk) all benefits of statins can be obtained without any of the potential side effects (in fact, there are many side benefits including weight loss, more energy, and improved quality of life!).
Current statin recommendations for those with a calcium score of zero from UpToDate, the source for the latest evidence-based info:
" Among those with a calcium score of 0, due to the established low 10-year ASCVD risk, we recommend against statin and aspirin therapy for up to five years (at which point repeat risk stratification should be performed), unless there are other compelling risk factors (eg, diabetes, active smoking, hypertension, family history of premature coronary disease)."
I’m a tad confused. Are you suggesting that if I get a zero calcium score, that would weigh against my taking statins - even considering my Risk Calculator score, and the fact that my dad had a stroke in his mid-60s and died of CHF in his mid-70s?
In the absence of compelling risk factors, statins would not typically be recommended for a score of zero. But your primary care physician should help figure whether your risk factors are compelling enough ones where statins would most likely be a net benefit.
It is awkward when a doc tells you something like that, and you have insufficient info to even discuss at the time. I’m not sure if I should ask to schedule another appt, try to ask questions on-line, schedule the test, or what. The dynamic just sorta confused me, and was not conducive to my making an informed choice.
The job of the PCP is a hard one. But from the patient’s POV, their concept of time seems odd to me. At times, they act as tho time is of no concern. Then at others, they seem to rush through the important bits. And the patient really is ignorant until after the appt when they have a chance to think and research.
I’ve noticed several times with different doctors, that it often seems that doctors only provide the really critical info if you know enough to ask the right questions. And the doc likely has very good basis for their recommendations. And I like to defer to the opinion of someone I respect and have had a good relationship with. But not entirely.
Based on info you supplied, I calculated your risk to be 8.2% over the next 10 years. But your lifetime risk is 27.7%, assuming you never smoked. So statins could well add some significant years to your health/life.
Smoked cigs for maybe 5 yrs - stopped 37 yrs ago. Pot for significantly longer. Not last 10 yrs or so.
Acknowledging that you are not my doc! Thx.
This makes sense, but I think the first person you should consult in making any choice concerning medications is who suggested it in the first place: your doctor. “Doing your own research” is likely to lead to more confusion, especially if you include the “online research” part. Just write down your questions and concerns and call up your doctor’s office and ask for a phone consult and have s/he explain their rationale, in terms you can understand, and then go from there.