Monday, May 12, 2014

When doctors question cholesterol guidelines

Long-time readers of this blog know that I have some very definite opinions on how our medical industry treats cholesterol -- or rather, over-treats it.  I feel very strongly that statins are prescribed far too aggressively -- and, even scarier, doctors are getting more aggressive about it all the time.

It's bad enough that some doctors are even questioning the newest cholesterol treatment guidelines.  I didn't even realize that there were new guidelines, but apparently they are so aggressive that they would have half of all adults over 40 on statins.  The thought is preposterous and infuriating to me.  And of course, what do you want to bet the drug companies have some kind of influence in this matter?  It wouldn't make sense otherwise, especially since statins aren't really effective in lowering the risk of heart attack in people who don't have heart disease, regardless of cholesterol levels.

Even scarier to me is how the new guidelines treat people with diabetes:

"Under the new guidelines, statin therapy is urged for everybody over 40 who has diabetes," states this NPR article.  The guidelines themselves state:

A high level of evidence supports the use of moderate-intensity statin therapy in persons with diabetes 40 to 75 years of age. The only trial of high-intensity statin therapy in primary prevention was performed in a population without diabetes. However, a high level of evidence was considered for event with statin therapy reduction in individuals with a ≥7.5% estimated 10-year ASCVD risk (Section 4.6) who did not have diabetes to recommend high-intensity statin therapy preferentially for individuals with diabetes and a ≥7.5% estimated 10-year ASCVD risk (Section 4.7). This consideration for those with diabetes 40 to 75 years of age recognizes that these individuals are at substantially increased lifetime risk for ASCVD events and death. Moreover, individuals with diabetes experience greater morbidity and worse survival following the onset of clinical ASCVD.

Do you see what bothers me about this paragraph?  Here it is again:

The only trial of high-intensity statin therapy in primary prevention was performed in a population without diabetes.

Really?  You want to stick me on a statin the minute I turn 40 based on a study that wasn't even done on diabetics in the first place?  I don't think so.  Plus, there have been studies that have shown statins don't actually lower the risk of heart attacks in diabetics.

It's nice to see a doctor questioning the new guidelines, but unfortunately that seems to be the exception, not the norm.  Luckily my doctor has not tried to push statins on me, despite my (marginally) high LDL, but unless these guidelines change before I turn 40 (which could happen -- that's 6 years for the medical industry to come to their senses.  Doable, right?) he will probably start getting more insistent at some point!

If he does, though, I will gather all my research and present my case that there is no good reason for me to be on statins!

No comments: