Is it actually possible? Common sense about cholesterol from conventional doctors?
How low can you go?
“We’ve been worrying too much about people’s cholesterol level and not enough about their overall risk of heart disease.”
Wow! That’s refreshing!
It’s also a surprise, coming from deep in the medical mainstream–a professor of internal medicine who’s also director of the Veterans Affairs Center for Health Services Research and Development.
He’s Dr. Rodney A. Hayward, and he led an Annals of Internal Medicine study that inspired him to add this remark: “Our fixation on just one factor, LDL cholesterol, is leading us to often treat the wrong people.”
Well, welcome to the conversation, Dr. Hayward! I mean, you’ve got to like a conventional physician who appears to be bucking the system and shouting “Enough!” to the insane overuse of statin drugs.
Dr. Hayward and his team examined several statin trials conducted between 1994 and 2009. They focused on two different treatment approaches:
1) “Treat-to-target”–an approach that uses statins to force LDL cholesterol to less than 70 for high-risk patients and no higher than 130 for people not at risk
2) “Tailored treatment”–an approach that gives far less importance to LDL level, while weighing multiple risk factors to develop a variety of treatments including exercise, diet modification, etc.
Results showed that tailored treatment prevented more coronary artery disease events while treating fewer subjects with high-dose statins. The authors wrote: “No circumstances were found in which a treat-to-target approach was preferable to tailored treatment.”
All this sound reasoning about statins is making me dizzy!
But old habits die hard
In a University of Michigan press release, Dr. Hayward said, “The bottom line message–knowing your overall heart attack risk is more important than knowing your cholesterol level.”
And if only–IF ONLY–he had just buttoned it up right there, we’d have a happy ending.
But he didn’t.
He added: “If your overall risk is elevated, you should probably be on a statin regardless of what your cholesterol is and if your risk is very high, should probably be on a high dose of statin.”
Noooooo! So close.
Come on, Dr. Hayward! After the results of your study, after making so much sense, why in the world would you recommend a statin? Even when cholesterol is LOW? Just because risk is ELEVATED? Complete nonsense!
Years ago, the Framingham Heart Study showed that total cholesterol levels below 160 caused heart disease problems to RISE! So it’s been well known for decades that low lower lowest is not good better best.
More recently, a team of U.S. and Swedish researchers examined about 20 years of medical records for elderly subjects and found that elevated levels of total cholesterol recorded while subjects were in their early 70s were linked with REDUCED dementia risk in their later 70s. And elevated cholesterol throughout their 70s was associated with reduced dementia risk throughout their 80s.
In an interview with HealthDay News, one member of the U.S. team, a Johns Hopkins researcher, noted that we can no longer rely on oversimplified answers, “for example, that high cholesterol is always bad and low cholesterol is always good.”
Maybe there’s hope for these mainstreamers after all.
Sources:
“For Heart Health, Focus on Risk Factors” HealthDay News, 1/18/10, healthscout.com
“Treat the Risk, Not the Cholesterol: Study Challenges Current Guidelines” University of Michigan press release, 1/18/10, med.umich.edu
“Optimizing Statin Treatment for Primary Prevention of Coronary Artery Disease” Annals of Internal Medicine, Vol. 152, No. 2, 1/19/10, annals.org
“Could High Cholesterol Ward Off Dementia?” HealthDay News, 5/24/05, healthday.com
