The more I’ve delved into the research, as well as based on my personal experience, the more I think this is the way to go.
That’s a good mnemonic but I can always remember because my HDL is the one that is too low every time. Luckily the statin fixed my bad LDL and that’s what matters. Fairly radically changing my diet didn’t do a thing and my doc said that and the HDL part is genetic so don’t panic.
What conditions would this be?
I’m increasingly hearing that almost everyone would benefit from statins, even generally healthy people. Basically any reduction in LDL is a benefit. And this is integrated over time, so the earlier you start the more the benefits accrue.
In fact I see some calls to make low-dose statins an OTC drug, since the benefits are large compared to the minuscule risk. In the UK, simvastatin 10 mg is already an OTC drug and there seem to be no major problems.
I mean, the second post in the thread (from 2022 though) by Kayaker mentioned being on statins for one year, and having jump-out-of-bed leg cramps (god I hate those) 3 nights a week. I suspect @Qadgop_the_Mercotan was giving us a professional option that depending on severity of side effects, and possible interactions with other meds, that it’s a poor assumption to proscribe it to all willy-nilly.
https://www.goodrx.com/classes/statins/interactions
Or I could just quote the learned QtM himself from upthread:
So I think it’s more caution in creating the right solution to the right problem for the individual in question, rather than a blanket diagnosis. Unless they’ve changed their minds since (always possible, the field is ever-evolving) they certainly weren’t dismissing statins as a benefit in many cases!
I saw that, but that wouldn’t be a reason not to prescribe them–how would you know in advance if some individual was prone to cramps? It would just be a reason to consider the cost-benefit analysis for continued use, and possibly justification to try a different medication.
At any rate, I think you detected some hostility in my question that wasn’t intended. It was a genuine question and I’d be interested in his perspective, especially if it’s shifted in the past 3 years from new data.
My doctor doesn’t discuss them with me, but my LDL for the past 3 years was 55, 69 and 62 for the test I just took. I eat well but not that well. I just have excellent genes.
My LDL is a tad high.
Total=184
Triglycerides=67
HDL=52
VLDL=13
LDL=119
Not awful overall, and I could probably improve this with diet. Still, I see data here and there that the lower the LDL the better. I don’t know if this extends to the very low numbers you have, but for people closer to the 100-ish range it probably does.
I’ll probably get a calcium test soon as a secondary check.
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Intolerable side effects
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People such as myself who naturally have very low lipid profiles. I wish I could bottle and sell it, I’d make a fortune. The highest my cholesterol has ever been as a combined value is 110. It has been as low as 100. That’s low cholesterol. That can be a sign of starvation or malnutrition. It isn’t in my case, but not only is there no reason to lower my cholesterol doing so could have negative effects. It’s hard to find information on cholesterol being too low but apparently it is a factor in anxiety, depression, diabetes, brain bleeds, and cancer. Fortunately I’ve escaped four of those, although I have had to deal with cancer these past three years. Not my only risk factor for that, but I don’t feel like slogging through that right now.
You actually do need SOME cholesterol. Being too low probably does have bad consequences, it’s just that levels that are too low for health are rare in our society so not much work is done on them. I’m right on the bottom rung of “normal”, perhaps on the highest rung of “low” (depends on who you ask). There’s really no reason to give me a statin.
In my case, with my levels probably being set low by my genes, it’s apparently not a problem. I’m not showing any signs of ill health as a result. But handing me a statin to lower my cholesterol/lipids is almost certainly not a good idea in my particular case.
I can’t take any credit for this - this has nothing to do with my diet or exercise, it’s a lucky roll of the genetic dice as my dad had the same cholesterol levels and presumably I inherited something from him in regards to this. I certainly didn’t get it from mom, who had familial hypercholesterimia (which I probably misspelled, sorry). She had the opposite problem - levels too high due to her genes and nothing she did with diet and exercise moved the needle. Or at least not in a detectable way. With a maximum statin dose they were able to get her levels down into the mid-300’s. Once down to 280 but only combined with such a restricted diet there was no way to maintain it. Poor mom.
Clearly there is a genetic component to all this. I wish that was acknowledged more. You have to deal the hand you are given, and it’s not always a fair one. Once you get into middle age - let’s say above 50 - things that you could brush off in your 30’s and 40’s start to really catch up with you. Lifestyle changes are arguably the first thing you should do but if they aren’t sufficient taking a statin is a lot less invasive and bothersome than the decades of agina pain, multiple heart attacks, two triple-bypasses, stroke, non-healing wounds on the extremities, vascular dementia, and other suffering my mother experienced in her lifetime. Heck, a statin is less invasive and bothersome than even one heart attack. Many/most have no or minor and very tolerable side effects. As long as you’re able to tolerate them (not everyone is) they may not be strictly necessary to preserve life but they might make your old age not only reachable but a lot more enjoyable.
Modern medicine is a great thing. Make use of it.
The question there is causality? Not my area of expertise but my limited understanding is that the thought is that there is not much thought that the low LDL causes any of those things, but that the things that do cause them also result in low cholesterol. So far at least I believe there is no evidence that causing very low LDL levels with a statin increases the incidence of any of those things. But true cannot be ruled out.
The other side of the argument of statins for all of a certain age (not convinced of it mind you) is that statins do not only work by way of lowering LDL: they also decrease baseline chronic inflammation as measured by CRP.
The concept has been batted around for while, it isn’t crazy. Goes back to here:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/fulltext
Reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0·79, 95% CI 0·77–0·81, per 1·0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality. The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories
Not as rare as you might think, which is why I’m not a fan of statins in the very elderly. Among the population I treat, the frail elderly in nursing homes, when I do check cholesterol levels, I almost always see results of LDLs in the 10s through 30s. Among the population of people who are in their 80s and 90s, frail, underweight, and with advanced dementia, it’s very rare to see an LDL over 50, at least in my direct experience. My first order for these patients when they first come under my care is almost always “discontinue atorvastatin”.
I’d still vote that it’s likely that humans have had low, chronic exposure to statins through molds and fungi on unrefrigerated/poorly preserved foods. Of course, those foods probably also contained mycotoxins that were harmful.
With modern knowledge, we could probably introduce natural sources in a safe way, back into our diet as it seems like low-level exposure to natural sources may have been providing a small benefit to us.
Hmmm. At the time, I didn’t think you were being hostile, but upon re-reading, you’re correct that my response seems far more snippy than jocular. You are likely correct that I was reading in some hostility on your part and responding to it, though not on a conscious level. Thanks for the rational response and I apologize.
I still think the point is valid though - yes, most physicians prescribe on the basis of what works well based on the most common scenarios, but as this thread posts, there are so many different possible responses based on known side-effects, idiosyncratic diets and personal biology/genetics, and my point about drug interactions that I still don’t think a blanket “yes for all” is a good idea. Though ideally a personal physician who has worked with you for years and knows all of your individualities shouldn’t hesitate to prescribe it when appropriate.
The FDA currently bans red yeast rice supplements with non-trace levels of monacolin K, which is chemically identical to lovastatin. They could just withdraw that ban.
There are of course the usual problems with supplements, where natural variation means you never really get a consistent dose, and on top of that the manufacturers might be artificially boosting the dose. And this is difficult to detect since it’s the same chemical (though the FDA does have a technique using isotope ratios).
At any rate, at least some of the drugs are already “introduc[ing] natural sources in a safe way”, because it’s the same chemical found in fungi but with a consistent dose and the toxic components removed.
The first statin appears to have been isolated from blue cheese. Another source is in oyster mushrooms, which are readily available in many stores.
Cheese-making molds, as I understand it, are often sold as a very specific set of isolated varieties. Traditionally, they may have included several dozen or hundred varieties, and now probably less than 3 for most purposes. While it might not be a good idea to make cheese out of Penicillium citrinum, possibly there’s some mix of varieties that proves to be safe and supplies beneficial compounds at better rates - or that could be developed through breeding.
Probably the most common form of mushroom in the US diet is portobello, served on pizzas. If Pizza Hut and Dominos mixed in oyster mushrooms, that could (in theory - you’d need to do the math) have a notable effect on us.
If you want to dose yourself with statins then, yes, you might need to turn to something like red yeast. But that’s much different from talking about regular dietary consumption. The stuff is available from a variety of sources at low levels, just not as commonly as could be.
That does make me curious about a couple things:
- What are the effect of statins at very low doses? Do you get 90% of the effect from 10% of the dose, say?
- What is the effect with a variable dose? Say one gets a variable dose every few days at random. Do you get at least some benefit in this case?
It is my limited understanding that low cholesterol levels are usually down to two things:
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starvation (which can certainly make you depressed, anxious, and probably cause a lot of other problems) and
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heredity, where it does not seem to cause any harm. But that’s a really small group and not studied because they don’t seem to be having any problems linked to that.
#1 is fixable - provide people with food so they aren’t starving. #2 doesn’t really need fixing.
I would push back against being described a statin since in my case it would strike me as solution in search of a problem, that basically there isn’t anything there to fix.
There are other ways to decrease inflammation if that’s an issue.
Nutrition choices and exercise are moderately effective but I am not aware of other medications impacting this sort of chronic disordered inflammation in a way that as effectively and safely decreases vascular event risks.
To be absolutely clear, I am not arguing for the position of statins for everyone. I suspect that among the lower risk population the number needed to treat to prevent one significant even would be quite large. Probably so large that even very infrequent side effects reach a bigger impact. But some benefit might be gained even by those with low cholesterol. Might.
I do believe it comes back to actual doctors thoughtfully considering and making decisions for individual patients. But we all know that we don’t live in an ideal world of that sort.
Certainly we should be thoughtful about medical decisions as a general policy, but what if a drug really is so beneficial and harmless that the risks of not taking it by default exceed those of taking it? If so, the default should be to take it unless there’s an overriding and obvious negative.
Perhaps (and I’m not arguing this, just putting the idea out there), statins should be viewed more like a micronutrient, which historically we got low doses of just from the ambient environment, and now have virtually eliminated due to modern food hygiene standards? That might argue that we should add them back in in a controlled way, like we do for iodine, niacin, etc.
It’s an interesting thought. I told a couple of friends of mine I was using a statin and they looked at me like I had started an elicit drug regimen, like I was a failure for not being able to control my cholesterol levels by diet and exercise alone. When one of them was told they had high cholesterol by their doctor, and suggested starting on a low-dose statin, they were repelled by the idea and started following a very narrow diet to get their numbers down, and it seemed to work. Now I hear the old “well, if I can do it, anyone can!” without context of genetics and other factors (such as environment).