Heart Disease Community
Angiogenesis a bypass
About This Community:

This patient support community is for discussions relating to angina, angioplasty, arrhythmia, bypass surgery, cardiomyopathy, coronary artery disease, defibrillator, heart attack, heart disease, mitral valve, pacemaker, PAD, stenosis, and stress tests.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Angiogenesis a bypass

My father has blocked arteries, but it appears there is adequate blood flow around a completely blocked left-side large vessel.of the heart.  I'm concerned and interested because this may happen to me so I have done some reading on the subject.  I read angiogenesis is the process and posts on this forum indicate the process is collateral vessel?  Thank you in advance.:)
Related Discussions
84 Comments Post a Comment
Blank
367994_tn?1304957193
Yes, there is a difference.  Angiogenesis is the development of small vessels mostly small arterioles, capillaries and venules. It has a connection to generate small vessels from epithelium cells (lines the vessel), blood flow, etc.  Angiogenesis happens as an example from a wound.  Out of control, it can be cancerous tumor.

But when an exsisting artery is occluded  the development of blood flow from existing collaterals may be activated.  There is evidence, mechanisms leading to the development of collaterals capable of conducting blood efficieniently differs from those usually involved in angiogenesis.  I have read arteriogenesis is "state of art"  term that includes both angiogeneis and collateral growth recognizing the difference between the two processes.

If you have other questions...what has been stated is not very much detail, and I hope it is not confusing!
Blank
Avatar_m_tn
Is there any physiological basis that can be relied on to develop collateral vessel bypass?  It seems some people or at least most people that have heart issues have stents or by-pass.  The short answer may be people that have a natural bypass don't participate on health forums as they don't have a heart a problem.  Are there autopsy reports or something?  I read autopsy reports state military personnel autopsies showed significant blockage in many young people!  No mention of any natural bypass.
Blank
976897_tn?1379171202
The development of collaterals doesn't occur in everyone. During one of my many stays in hospital, I was talking to a man who had a 95% occlusion in his LAD but no collaterals were forming. His Cariologist told him that the collaterals don't seem to always form in people and this is why it is still believed by some experts to have a genetic element. Collaterals are good if they form in that they can keep heart tissue alive. However, in many people they only provide enough Oxygen backup to be at rest or very slight exertion. So many people have the luxury of collaterals keeping them alive until a better solution can be decided.
I am still unsure what effect on collaterals a bypass or stent has. How does the increase in pressure in the LAD affect these newly formed vessels and the vessel providing them. Surely back pressure will be created. Collaterals in the bottom of my LAD were pushing blood UP the vessel and keeping me alive. However, now my LAD is fully patent, and high pressure is pushing DOWN the LAD, how is this affecting other vessels in my heart through the collaterals. I have an outpatients appointment with my cardiologist soon, I will ask him such questions and let everyone know. I also have a working Lima grafted to the LAD and this must also play around with pressure/flow as blood also streams in through the left main stem.
Blank
367994_tn?1304957193
Max, if I understand your question,  you are asking if there are any attributes or identifiable characteristics that are reliable to predict if one will have collaterals for their blocked vessels.
No, there is no way to know prior.  If your father has CAD, and collateral blood flow and you are concerned there may a genetic component for CAD, you need to take precautionary measures to prevent CAD such as control your cholesterol, blood pressure, proper diet, exercise, etc.

However, my notes on the subject  from a few years ago indicate there is evidence why some people with diabetes do not have adequate blood supplying collaterals.  There is a biological component associated with diabetes and the cardiovascular system.... and my notes indicate there is evidence supported by lab experiments and general knowledge of fluid dynamics (or hemodynamics) that more than one occlusion in the same vessel prevents an adequate flow of blood from collaterals....may require interventional therapy.
Blank
367994_tn?1304957193
This a Cleveland Clinic  doctor's response:  Stents, if patent, are likely to decrease collateral flow to the arteries in which they are in, thye will not affect distant arteries.  This is not a problme because forward flow (throught the stent) and collateral flow are both driven by a pressure difference, so as long as there is forward flow, the collateral flow is no longer necessary.  Again, stents do not inhibit collateral flow to the unstented arteries.  EECP is done to alleviate chest pain from disease in arteries that are still diseased (unstented), therefore it is not contraindicated.  Finally, stents have struts in them so they do not cover the openings of the diagonals, thereby, permitting continuous flow to those segements.

>>>I agree with the doctor's post  [except some spellings] :)  I will go into detail from my years of researched notes and prior forum posts to answer your questions.  This is Max's thread, and I will wait to see if he has any questions first!
Blank
976897_tn?1379171202
Thank you for that information kenkeith, much appreciated. Do you know what happens with regards to my Lima pumping blood into the LAD along with the flow through the main left stem? I assume that there shouldn't be a problem because the LAD will only accept the flow/pressure it requires?

Thanks again :)
Blank
Avatar_m_tn
No one has ever stated collaterals develop with everyone from what I have read on this forum.  What has been said is that everyone has collateral vessels and the focus of this discussion it seems to me should be what underpinnings open and remodel collateral vessels for people with CAD or development after an acute myocardium infarction.  I spent some time searching the internet regarding collaterals and found nothing that reports anything other than everyone has collateral vessels.

Ed, how do we know what you describe actually occurred?  Could be a mistake!.  Maybe if you start a thread someone can help you that had a similar experience.  I would like to know more about what causes collaterals to develop and if there is anything I can do now because my father has CAD and I understand there is a genetic factor for CAD that can occur to a person at a young age. I wouldn't like to have my chest cracked open.  Thank you in advance.  Maybe I should have titled my post "collateral bypass" and not "angiogenesis bypass"; that seems to be irrelavant.

Blank
976897_tn?1379171202
well max these things are determined and witnessed by a history of angiograms.
In my case, in Feb 07 there was a 90% occlusion in the top of my LAD and small vessels were seen on the Angiogram grouping around the base of the LAD. I had very bad angina at that time, but stenting a blockage in the mid circumflex cured that. No
collaterals were seen trying to feed the circumflex.
In aug 07 I suddenly felt very strong bouts of angina and was admitted back into hospital because they included chest pains. A new angiogram showed that the LAD was 100% blocked at the top and the group of vessels gathered at the bottom of the LAD had now anatomised to it, giving it a small feed. The feed was very small indeed and just enough to keep the heart tissue alive when at rest. A bypass was then performed and three months this failed as the 2 veins closed up. Strangely enough the collaterals hadn't receeded, which is a good thing because otherwise I would likely have died. They were still there as a backup and feeding into the LAD. I don't know how long they stay in place but they are still there two years later. Now my LAD is fully opened, it will be interesting to see what happens to those collaterals in the future.
Blank
367994_tn?1304957193
Hi Max, you are doing the right thing by learning as much as you can about heart disorders...I have found it very helpful to decrease anxiety, apprehension, and it does motivate to exercise, maintain a healthful diet, etc.

I will depend on my notes going back several years and it hasn't been updated with current information, if any, on the subject (collateral vessels), as I have felt the issues are settled. It seems stress induced vessel remodeling (change in size, development) is altered by pathological conditions such as diabetes, hypertension and artherosclerosis (hardening of vessels).

Now, my take and certainly open for discussion as no one has all information, and starting with the facts that are not professionally disputed.  It is recognized that gradient pressure is perfusion force "F" and resistance "R" times blood flow "B" are directly proportional to F.  R is the resistence due to fluid shear stress (friction of blood flow against vessel walls) and B blood flow...both R and B are low when conduction through a healthy vessel is not impeded.

We analyze a segment from the opening "a" to "b" the end of the segment. When the vessel (segment a to b) becomes occluded,  R increases and that is directly proportional to F causing an increase of perfusion force across the gradient....this the beginning of a single-vessel blockage.  As the occlusion increases, the diameter of the vessel decreases and F increases until F overcomes the resistence of the smaller collateral vessels.  As F increases B (blood flow) will increase and collateral vessels will provide sufficient blood supply, and probably no heart issue is every known.  

Now consider a second occlusion begins downstream in segment a to b. This will change  the  fluid dynamics within the segment of the upstream collaterals that is proportional to the driving pressure (ie, the pressure gradient) between these 2 points a and b.  After occlusion, a pressure gradient between the upstream and the downstream part of the segment results in increased blood flow in the collateral network. However, because this blood pressure gradient is limited by the resistance vessels lying downstream of the occlusion, and is further diminished as collateral flow increases, the remodeling of the collateral vessels is restrained. This would explain why only about  40% of the maximal physiological conductance is restored after arterial occlusion....May require intervention with two or occlusions even if there is some collateral flow.. It is my understanding collateral flow is not picked up with an angiogram until there is 99to 100% blockage.

**""An experiment developed by Eitenmüller and colleagues associated both femoral occlusion and femoral arteriovenous fistula, bypassing that downstream resistance arteries. The pressure gradient between the upstream and downstream segments of the occluded femoral was therefore quite significant, representing 60 to 70 mm Hg, driving a pronounced increase in collateral artery blood flow. The authors used this clever surgical model to demonstrate downstream resistance arteries to demonstrate that higher blood flow in collaterals results in more extensive remodeling such that maximal limb conductance reaches normal values or is even surpassed. This experimental process could be compared with events occurring during muscular exercise: there are several lines of evidences suggesting that the molecular mechanism of exercise-induced upregulation of vascular eNOS expression are closely related to the changes in fluid shear stress in the vasculature. Exercise increases heart rate, which in turn increases blood flow and vascular shear stress, leading to enhanced NO production".      May help explain why exercise is helpful and when a cardiologist decides to stent or bypass procedure for multi-vessel occlusions and not to open an occluded vessel with good collateral blood flow.

Sorry for the long explanation....and that is the skinny on the subject. :)
Blank
Avatar_m_tn
Thanks for your time.  To understand and referring to the model (segment 'a' to point 'b', and occlusion1 and occlusion2), if occlusion 2 (downstream lesion) is stented, that will increase collateral flow from occlusion1, and if occlusion1 is stented, that will regress collateral flow!!  If that is true, my father's collaterals will be sufficient if there is no blockage down stream. Would that be correct? .
Blank
Avatar_m_tn
I am not associated with the medical profession however, I have read many, many papers and studies on the subject matter and, have had 4x CABG in July 2008. Once again in my lifetime I consider myself to be among the luckiest of lucky.  My understanding is that everyone does not grow collateral arteries around their blockage. Furthermore, "Expert Reviews" suggests . . . "transferring the promising experimantal results into clinical practice has been more cumbersome than initially anticipated"  Several of the papers I have read refeer[sp] to this process as fluid dynamics. Point A to point B. At point B a blockage has developed @ 100%. Fluid continues to flow in the direction of point B in which the artery begins to develop a collateral. To determine the size and magnitude of the collateral(s),  testing must take place.
In my case, my EF remained within normal range. My first cardiac catherization revealed "a lot of collaterals" back in 1995. I clearly had CAD.
I am going to go back to the lab's who performed the testing and get copies of the test notes to check what exactly my EF was.
Blank
367994_tn?1304957193
It is my understanding the vessels (can be microvessels as well) are in place and remodel (develop) based on hemo dynamics or fluid dynamics if you chose.
Blank
Avatar_m_tn
Had Nuclear Imaging Study - Exercise Stress about 3 weeks prior to 4x CABG. Went and received the results yesterday. My EF was 60% !
Ok, so now luck is my new best friend. My opinion is that I attribute this to my body developing collateral arteries over a period of 30 to 40 years. First detected in 1995, these 'collaterals" continued to grow at a pace > my arteries deterioration. I was very active and had almost NO symptoms. These collaterals suplied more than sufficient blood as is evidenced by the EF of 60% just prior to my CABG.
Interesting to note that I had conversations last night with over 50 years of medical experience of the BSRN, BS, MS RN type and,opinions seemed to be scattered all over the place. Is there a reader out there who would argue against me having CAD and Ischemic Heart Disease? I appreciate your input. Thank You.  
Blank
367994_tn?1304957193
I experienced the same phenomonon over a period of years....Not everyone seems to be a good candidate and that appears to be diabetics (vascular disease), and aging individuals who may have some hardening of the vessels and loss of flexibility of vessel walls.  My thoughts are as a vessel begins to occlude, hemodynamics (arterial pressure, blood flow velocity increases, etc.) begins to remodel vessels  and has the occlusion increases so does the hemodynamics.

My theory has been when there is medication and/or stents to treat CAD the hemodynamics change and the system does not see an occlusion problem to react. I have read there is a school of thought that does not agree.
Blank
976897_tn?1379171202
"My thoughts are as a vessel begins to occlude, hemodynamics (arterial pressure, blood flow velocity increases, etc.) begins to remodel vessels  and has the occlusion increases so does the hemodynamics. "

I find it hard to swallow this, not that I'm arguing with expert, but simply that I can't see any plain logic in it. I have seen patients with no collateral developement who are in their 40's and without diabetes, I wouldn't class these as old. I was 46 when collaterals were seen forming so I assume that the age limitation factor much be further upstream.
My real struggle with this idea is that blood pressure is high in many patients who develop CAD and it has been high for many years. So if blood pressure was an issue, one would expect to see everyone develop collaterals (in my opinion anyway). Flow velocity is really going to achieve nothing because it's the pressure which matters.
What intrigues me is that according to my history of angiograms, my collaterals started to form when I began experiencing angina discomforts. I still cant help but wonder whether a chemical process triggers collaterals to begin forming. Has research been done for example to see what happens when collaterals (undeveloped) sense the presence of Troponin I ?
Blank
367994_tn?1304957193
QUOTE: "My real struggle with this idea is that blood pressure is high in many patients who develop CAD and it has been high for many years. So if blood pressure was an issue, one would expect to see everyone develop collaterals (in my opinion anyway). Flow velocity is really going to achieve nothing because it's the pressure which matters".

>>>>I don't have the knowledge of molecular science related to the anatomy of arteries, nor the a complete understanding of the physics  related to hemodynamics as that also involves neurohormones in the blood that is a chemical mediator, etc., etc.  

But one cannot dismiss velocity when referring to hemodynamics. For reference the study of the causes of motion is called "dynamics" and that would include  "dynamical" variables: momentum, force, potential energy, pressure and power. Each of these quantities will directly or indirectly involve the mass of the object.  Mass is defined dynamically in terms of force and acceleration (velocity).

Start with anastomosis: When blood vessels connect to form a region of diffuse vascular supply it is called an anastomosis (pl. anastomoses). Anastomoses provide critical alternative routes for blood to flow in case of blockages.  

Then understandingly, force (pressure) is required to change momentum; alternatively, a change of momentum ("impulse") causes a force to be felt.  Since momentum has dimensions of mass times velocity, force has dimensions of mass times acceleration.  But  not all of that energy goes into moving the blood. Some of it is stored as potential energy in the increased blood pressure, some is stored as elastic energy in the walls of the vessel (inner lining of vessel),  and some is lost to dissipation. Regarding the age that would more accurately refer anatomically and not chronologically, and age can break down the inner lining and a loss of elasticity.  This would inhibit vessel remodeling.

As you know hemodynamics also involves macroscopic turbulence (You may know about turbulance of the major vessels and its significance) for anastomosis . But the relevant turbulance are eddies (smaller turbulance)  This is due to the assumption that viscous dissipation is proportional to the velocity gradient.  I don't believe one can dismiss velocity any more than any other factor for hemodynamics.

Blank
976897_tn?1379171202
After doing some more research in EECP, I think I am getting a bit closer to understanding why collaterals form. EECP simply opens existing arteries and it isn't the pressure/flow or mass that creates collateral growth, I read this....

"There is preliminary data suggesting that EECP can help induce the formation of collateral vessels in the coronary artery tree, by stimulating the release of nitric oxide and other growth factors within the coronary arteries. "

So, it looks as though certain chemicals are required which excite the collaterals into developing which makes much more sense to me.
Blank
367994_tn?1304957193
I agree with what you have stated except your conclusion is partially incorrect.  To add what has been said, collateral arteriolgenesis starts with endothelium cells (inner most cells that line the vessel),  but it is the physical forces that is the primary stimuli.  It is FLOW that increases size, and PRESSURE determines wall thickness of the vessel and are the mechanisms of transduction of the mechanical stimulus into collateral vessel growth  response (don't confuse angiogenesis growth factors with arteriogenesis, arteriogenesis has another dimension).  This in part is the basis of my theory that a stent implant inhibits collateral growth because there is damage to the endothelium cells and smooth muscle mitosis is affected as well.  And when the stent dilates the vessel that will also affect the pressure and velocity of blood flow. And studies have identified a host molecules whose endothelium production is mediated by shear stress (velocity).  That may be what you are referring to (NO, growth factors, etc), but velocity is the stimulus and the variable factor.  EECP increases pressure, pressure increase velocity, and velocity increase shear stress.

It is known blood flow velocity is inversely related to the cube of the collateral  vessel radius...so increased blood flow (velocity) directly results in an increase shear stress.  Since growth increases collateral vessel diameter, shear stress falls quickly.  This maybe the reason ateriogenesis stops prematurely and restores only 35-40% of the maximal condition of the replaced artery.  Also, large vessels with low blood flow tend to close or reduce their lumen (vessel channel), but small vessels with chronically (possibly years) increased flow tend
to get wider.
Blank
Avatar_m_tn
QUOTE: "My real struggle with this idea is that blood pressure is high in many patients who develop CAD and it has been high for many years. So if blood pressure was an issue, one would expect to see everyone develop collaterals (in my opinion anyway). Flow velocity is really going to achieve nothing because it's the pressure which matters"
_________________________________________________________

Thanks kenkeith to take your time to answer questions.  Pressure between segment A-B is not systemic pressure, and it is clear to me what has been said regarding arterial pressure, and it is that pressure that opens or increases blood flow in the already established microvessels and any other vessel available.  Flow velocity, shear stress, endothelium cells, etc. (velocity) is not going to achieve anything is an ignorant conclusion. The elements are all intricately involved for cardiovascular maintenence, etc.

QUOTE: "Also, large vessels with low blood flow tend to close or reduce their lumen (vessel channel), but small vessels with chronically occluded (possibly years) increased flow tend to get wider"

Answer: For consideration, I believe vessels do not need to be chronically occluded before there is remodeling.  I have read acutely occluded vessels have induced remodeling of vessels and have saved heart tissue during an MI.  Thanks again.

QUOTE:HeartTwo:Is there a reader out there who would argue against me having CAD and Ischemic Heart Disease? I appreciate your input. Thank You.  

Answer: How can anyone argue against you having CAD and Ischemic heart disease when you have stated you have had 4x CABG.  Are you suggesting you may not have had occlusions and the by-pass was unnecessary?

.
Blank
367994_tn?1304957193
Max quote: "For consideration, I believe vessels do not need to be chronically occluded before there is remodeling.  I have read acutely occluded vessels have induced remodeling of vessels and have saved heart tissue during an MI.  Thanks again".

Do you have a source for acutely occluded vessels developing collaterals? Thanks.
Blank
Avatar_f_tn
This is a fascinating discussion.  I have (or at least had) CAD.  I ran for 30 years.  In 2001 I experienced a frightening syncopation of my pulse (arrhythmia) and, after tests and procedures, underwent 5XCABG plus a left carotid endarterectomy.  This got my attention, and I radically changed my diet.  As of this week no further visible occlusion has occurred.  I have tried to educate myself about heart disease since my bypass, and had I known then what I know now I'd have refused the surgery, with its attendant risks.

My cardiologist informed me that, without collaterals, I would have suffered angina and eventually collapsed as the arteries closed completely.  As it was, I ran several miles the day before my surgery, albeit with some difficulty.  After the surgery I had far less difficulty running, to be sure, but I could have done without it at that time with almost no other diminution of my life quality.

I continue to believe that the "trigger factor" for collateral development is aerobic exercise of a sufficient level.  All of us have the latent vessels, and certainly the factors enumerated by Kenkeith are valid, but I believe exercise is the factor almost no one discussed, but that is essential to foment their development.  

To me the process is quite simple:  Bad dietary habits produce plaque in the arteries, even if one exercises (see Jim Fixx).  Occlusion(s) occur.  Exercise increases the F factor (perfusion pressure)  Fluid dynamics explains why the collaterals are developed.  And life continues, with some loss of physical capability.  One can do several things about this:  Nothing, surgery, stent(s), angioplasty, chemicals, dietary change, reduce arterial inflammation, or some combination of these actions.  Most patients will do whatever their cardiologist recommends, as I did.  

Some day someone (not the major drug companies, who love things the way they are) will develop a process whereby plaque can safely be removed from arteries, and this issue will become moot.  But most of us will be long gone by then.  Mainstream medicine still buys and peddles the lipid hypothesis, even though it's been largely discredited by many studies and physicians (Eades, Kendrick, Masterjohn, Taubes, among many others).  Studies such as JUPITER are a sham and a farce, funded by and promulgated for the pharmaceutical industry.  Alternative approaches to healing are sneered at, and studies of these approaches are never funded.  Virtually all elective admissions to hospitals today are the direct result of bad dietary habits and/or self-abuse or self-neglect.  This will probably never change, regardless of what healthcare "reforms" are passed.  

So it's up to the individual to educate him/herself and take charge of his/her health.  This forum certainly attracts those people.  I'm glad I found it.
Blank
976897_tn?1379171202
Exercise does seem to make a lot of sense. It's as if you reach a certain level of fitness and the body knows it has to maintain that level as much as possible. If you do nothing, and your heart is fine at rest, then perhaps this is the key to not developing collaterals.
I had been working in the building trade for a few years when I had to have my first stent and collaterals were noticed. I had been digging 3 metre deep trenches with a shovel and mixing tons of concrete by hand with no real issues. All that was with a 100% blockage in the LAD. If I had a desk job, maybe the collaterals would not have grown.
Perhaps demand is a major key.
I too believe that if I had not accepted beta blockers after my first stent and went straight back to work, I would have been fine. Since having 5 more stents and a triple bypass I feel a lot worse. I have thought about exercising a lot more but the discomfort gets too much very quickly so I'm in a catch 22. I can't exercise enough to grow any more collaterals and without them I can't exercise. Any ideas on how I might be able to get around that one? I've tried working through the discomfort but it really is impossible, I'm gasping for air, clutching my chest and feeling terrible pain in my throat.
Blank
159619_tn?1318997813

Qoute:
***********************************************************************************************
Some day someone (not the major drug companies, who love things the way they are) will develop a process whereby plaque can safely be removed from arteries, and this issue will become moot.  But most of us will be long gone by then.  Mainstream medicine still buys and peddles the lipid hypothesis, even though it's been largely discredited by many studies and physicians (Eades, Kendrick, Masterjohn, Taubes, among many others).  Studies such as JUPITER are a sham and a farce, funded by and promulgated for the pharmaceutical industry.  Alternative approaches to healing are sneered at, and studies of these approaches are never funded.  Virtually all elective admissions to hospitals today are the direct result of bad dietary habits and/or self-abuse or self-neglect.  This will probably never change, regardless of what healthcare "reforms" are passed.
************************************************************************************************

I couldn't disagree with this statement more.  I would ask you the same thing I ask everyone that makes this statement. Given what is known, would you be better off with a total cholesterol over 300 or under 200 as recommended? Of course, less is better, how low is the question open to debate. You make a fairly condemning statement about current treatment options but don't mention what your levels were prior to your surgery.

There is no reason to believe that the JUPITER study was flawed unless you want to implicate the FDA and The National Institute of Health both of which were also involved in the tracking of results as well as the funding. Even if JUPITER was flawed, there are many other studies that outline the benefits of statin therapies. I hear this so often but no one can ever show anything to back up the position that these trials were compromised, just conjecture.

One thing we do agree on is that people need to take responsibility for their own health, eat healthy and exercise. That would go far towards resolving this whole issue.

Jon
Blank
976897_tn?1379171202
"I couldn't disagree with this statement more."

I have an open mind on such issues because large sums of money make their way into many circles and affect lots of decision making people. In the UK health experts were telling the government for decades to concentrate on fighting the smoking habit in the general public. The government of course didn't want to listen because millions of pounds in taxes were gained every year in taxes from cigarettes. They agreed in the end to print warnings on the packets. Europe was far ahead, they had banned smoking in public places and educating children about the dangers of smoking. Health experts tried every way they could to convince the government but the problem was the tax gains. Even money spent in the health system on smoking related illnesses couldn't be used to persuade the government. 4 billion pounds is spent each year on smoking related illnesses, but smokers were paying 8 billion pounds a year in taxes on cigarettes. They were paying for their own treatment, plus the treatment of nearly everyone else who didn't smoke. It was only when the public began to be educated through leaflets etc that the changes occurred. The public became aware of what was going on and the government had no choice but to align us with Europe. We suddenly had cigarettes shoot up in price, public smoking bans and even fines if someone throws a butt on the floor in the street. Smoking has reduced a lot in the UK now, but the tax loss has to come from somewhere. It will come from proposals regarding global warming. We will all have to abide by a carbon footprint and pay taxes for anything over that limit. The UK accounts for less than 2% of carbon emissions in the world, yet our government claims we must show the way and set the example. Just excuses for the new set of taxes.
So if cigarettes have been so political, I see no reason why other drugs can't be in the same situation.
How much research is actually vetted? If a large company says it took a sample of 100,000 patients and carried out research, who spends a lot of money on checking that the research really took place? Or more importantly that the data has been given correctly and not manipulated? The only people who can afford such research are the drug companies themselves, will they produce results saying statins do not really work?
Everytime a Doctor or anyone stands up and says they don't seem to be doing anything to their patients, the big drug companies simply stand up and say "listen small fry, we have research which says it works for 100,000 people, so dont make yourself look silly, sit back down".
Like I said I have an open mind on this and especially with the way the economy is unbalanced at the moment, I wouldn't be surprised at anything.
Blank
159619_tn?1318997813
I too am open minded about the possibility of other treatment options. Where I draw the line though is at statements made from pure conjecture or personal opinion. Everyone certainly has a right to their opinion, but when people make accusations that they don't or can't back up I can't take them seriously.

I don't know how things work in the UK so I can't comment, but here you would have to include the FDA and more specifically, the National Institute of Health, a government agency that controls the FDA, in this conspiracy theory. The Fed's just don't have anything to gain by allowing false or incorrect data to be passed along to the medical community. The NIH is responsible for the auditing of all studies along with the data provided. It is the NIH that proposes action to the FDA. The part that doesn't make sense is why the Fed's would be involved, for what purpose? I hear about kick backs by big pharma companies (let's face it, with the size of the federal budget any kick backs would be as insignificant as a single grain of sand on the beach), so show me. The kind of dollars that get alleged would have to have some sort of paper trail, but no one can ever find it. I understand that the government collects taxes on the profits of these firms, but they would do so on any drugs being sold so that argument doesn't hold water either.

Can anyone give me any reason that the government would want to keep new treatments from those that need them? Or even why the government would participate or allow other influences to stop research? Can anyone prove this? I would love to see the back up if it exists but no one can ever provide more than conjecture.

I also don't see any evidence of the big pharma companies corrupting doctors so don't go there. I am around many and I have never seen any evidence of it. Do the reps try to sell their drug over another company's product? Of course, that's free enterprise (remember that). I'm sure there is a doctor or two out there that can be bought, but it's the same in any market. Lawyers can be bought, contractors cut corners to make more profit even the police can be influenced, why always pick o the medical profession?

Again, if you don't like a treatment option being offered, don't use it. No one is forcing anyone to do anything they don't feel comfortable doing.

Just my opinion.........

Jon
Blank
976897_tn?1379171202
The main reason I keep an open mind is that you can't look at the companies as a whole. Each has departments and each has people who make the decisions and sign the paperwork. At the top of any organisation there are only a few people who have control. Budget or no budget, that money is not in their own bank accounts for them to spend, they get a salary to pay a mortgage etc like anyone else. Yes they get lots of money but the more money people get, the more they live above their means. Look how many millionaires go bankrupt, it's incredible. If each person was offered enough money to ensure a good retirement, then I'm sure for their families sakes, they would put pen to paper. By the time anything is found to be a problem, they will be long retired or even dead of old age, so why worry. So, again, I keep an open mind because corruption is very very easy.
Blank
976897_tn?1379171202
I know this has nothing to do with drug companies, but who can you trust if you cannot trust your own governnent, the body of people you vote in that promise to run the country in a way that will benefit you. I'm sure you have seen in the news about ministers in our government spending public taxes on their own properties etc. Hundreds have purchased second homes, hired cleaners and home helps, £500 lunches, long stays in top star hotels etc etc. This was all with public money which is supposed to be used to make our country a better place. While money was being cut in public sectors, and taxes were being increased, ministers were living a life of luxury on our money. One minister leaked this to the media and then all hell broke loose. Now most of them have to pay most of it back. It has been going on for years, estimated 25million pounds a year.
Some ministers have been forced to resign for taking bribes from companies and business associates, this has always happened and probably always will. This has made us more careful and very watchful and most of the british people have lost faith in any government system now. It's a real mess.
Perhaps Obama should run for prime minister :)
Blank
907968_tn?1292625804
It's the same here too and it's only recently when people are begining to do something about it.  Unfortunately it'll take quite a while to just scratch the surface of all the corruption.  Some of it is right out in the open and there are people who encourage it, so again, it'll take quite some time to get rid of it if at all.
Blank
Avatar_f_tn
Well, we've certainly got an interesting exchange going.  Jon, it's obvious to me that you're a supporter of the medical establishment, and can see no conspiracy in the drug-medicine relationship.  I don't see a conspiracy, but I believe much of the medical establishment simply acquiesces to the blandishments of the pharmaceutical industry.  The FDA is underfunded and inept, with ties to the pharmaceutical companies, and the NIH is reluctant to fund meaningful studies, ceding that task to the drug industry, which is why things are as they are today.

It's a fact that the pharmaceutical industry spent $19 billion  --  yes, billion --  in its attempt to influence physicians and health institutions in 2006, the last year for which I could find a number.  This was printed in US News & World report in 2008, and I have a copy of that article.  This expenditure included everything from free luncheon buffets to junkets to resort areas for conventions.  To doubt that there's any quid pro quo is to be credulous indeed.  

It's a fact that every physician, with one exception, involved in the JUPITER study had ties to, and had been paid by, the pharmaceutical industry.  In addition Dr. Ridker, who initiated the study, held the patent on the CRP test, along with the hospital involved, Brigham and Women's. This study purported to prove the efficacy of statins, but actually only proved that they seem to work for a small group.  And other statin studies have resulted in lowering cholesterol (I never doubted that), and lowering inflammation, but not a longer life  --  and at the possible cost of muscle pain and weakness, liver damage, sexual dysfunction, diabetes and dementia.  Not to mention the scores of billions in cost every year.  And this is the medical-pharmaceutical complex that brought you Vioxx, hormone replacement therapy, and scores of lesser-known drugs that did their damage and were then discontinued, all the way back to thalidomide.  And many studies that fail to prove what their backers intended to prove are never published, or the results are misstated or misinterpreted, a la JUPITER.  "(T)here is no evidence that statins provide any benefit in terms of decreased overall mortality to females of any age or to men over the age of 65 regardless of their state of health.  The only group that statins has shown to provide any benefit for in terms of decreased all-cause mortality (the only statistic that really counts) is men under the age of 65 who have been diagnosed with heart disease.  Even in that group, benefit is so small as to be questionable."  - from the blog of Dr. Michael Eades, 11/6/09.

The JUPITER study was flawed in several respects.  It used the much-absued "intention-to-treat" protocal, wherein dropouts are presumed to have completed the study.  It screened its candidates, limiting participation to patients whose cholesterol levels were below accepted limits, but whose CRP was 2.0 or greater.  Two major drug manufacturers (Pfizer and Bayer) passed on it before AstraZenika decided to conduct it, along with Siemens, the company that does CRP testing.  And while statins unquestionably lower LDL and inflammation, there is some evidence that low LDL causes or contributes to Parkinson's disease.  Statins also affect Vitamin D levels negatively.  And in JUPITER, deaths from fatal myocardial infarctions were higher in the statin-treated group, although you won't find that stated explicitly, for obvious reasons.  There were 9 fatal myocardial infarcs in the Crestor group and 6 in the placebo group  --  a jaw-dropping 50% more for the statin group.  

And with the increasing evidence that cholesterol is not the cause of coronary artery disease, the benefits of statins are even more questionable.  Lowering LDL doesn't necessarily lower the risk of CAD; more relevant factors are the density of the LDL, the presence of inflammation in the arteries, and probably stress.  This has been proven beyond question, I believe, yet many billions of dollars continue to be spent on statins.  Nicotinic acid (niacin, niacinimide) has actually been shown to halt, and sometimes reduce, plaque, but since it's a vitamin and unpatentable you'll never know it unless you seek out the information (Effects of High-Dose Modified-Release Nicotinic Acid on Atherosclerosis and Vascular Function, JACC, 11/3/09)  As opposed to statins, the side effects are minimal (possible flushing for a few minutes) to non-existent, and it's cheap.  For those who don't care to seek out the article, here's the authors' summary:

"In the NA-treated [niacin-treated] group, mean HDL-C increased by 23% and LDL-C was reduced by 19% at 12 months. Triglycerides, apolipoprotein B, and lipoprotein(a) were significantly decreased by NA compared with placebo. CRP was decreased by NA compared with placebo (p = 0.03 at 6 months, p = 0.1 at 12 months). Adiponectin was significantly increased at both 6 and at 12 months (p 3× the upper limit of normal for 2 weeks) were observed in any subjects. Fasting glucose did not change significantly, but glycated hemoglobin showed a small increase in the NA group versus placebo (p = 0.02 at 6 months, p = 0.07 at 12 months). Blood pressure and body mass index did not change significantly in either group."  Both groups were on statins.  This was a small study, but the results were startling to statin advocates, to say the least.

But most physicians continue to push statins, and when I became sufficiently convinced of the potential harm versus the limited benefits (if any) of taking them, and experienced some of the side effects, I stopped taking them.  My internist of 25 years and I then parted company, as she didn't want a patient who took charge of his health.  I also discontinued Januvia, a drug that was insufficiently tested (in my opinion) and rushed to market to treat diabetes.  Many studies have shown that Type 2 diabetes can be controlled by diet and exercise, period, and that's what I'm doing.

I know there are many prescription drugs that are beneficial to mankind.  But there are many others that are harmful on balance because of their side effects, and in many instances there are natural substances that accomplish the same result without doing concomitant harm, such as niacin.  But the pharmaceutical industry has such a stranglehold on medicine that the vast majority of physicians' response to most problems is to write prescriptions and hurry on to the next patient.  And when you're being guided by an industry that is continually being sanctioned for abuses (see. Pfizer's recent $2.3 billion fine in 2009, Merck's $650 million fine in 2008 and scores of others), it isn't hard to understand what's happening.

The long-term damage of regular statin use isn't yet known, but several companies were forced to discontinue their versions because of adverse effects.  And the sad truth is that virtually all coronary problems can be addressed without the use of drugs, but few people are willing to make the lifestyle changes required.  

Sorry to have run on so long, but I feel very strongly about these issues.  And I'm sure there will be many who disagree.  That's what forums are about.
Blank
159619_tn?1318997813
Well, we're not going to agree. It is till just conjecture to make statements concerning a corrupted medical community. All companies selling a product spend money promoting their products and with all the different statin meds on the market it is not surprising see money spent to do the same thing. To look at those dollars and link it to a corruption of the system is a little bit of a leap. It's easy to look at JUPITER and say it was flawed, but please prove that point to me, show me it's flawed. Don't tell me about the participants and say because they are tied to pharmas it must be the result of improper protocol due to corrupt interests. It's simple, just show me, don't make vague statements that mean nothing to the data collected. Show me where the NIH has mismanaged the study and how. Anything, something........ it's never there.

My other issue with these conversations is that anti statin activists are quick to point out problems concerning statin use but slow to recognize those that benefit from them, like me. I had high cholesterol and even after losing a significant amount of weight and changing my lifestyle including diet an exercise, I still could not lower my cholesterol. After a few months on a simple statin my numbers are way down and over 5 years I have experienced no side effects and there are many just like me.

I can quote you article for article, study for study and we won't change either of our opinions. When is comes down to it, for me it's simple. No matter what other mechanisms are involved with CAD, cholesterol will play a part and less is better, just that simple. If it's inflammation in the arteries causing cholesterol to be trapped, less is better. What ever the mechanism, plaque is made up of cholesterol and the less I have the better. Until someone can prove otherwise with hard data from a well managed study, I'll stick to my thinking.

It's ok to disagree.

Jon
Blank
976897_tn?1379171202
In the next few years it will be interesting to see just how many people end up in hospital after long term statin use. I hope the drug companies have a lot of money in reserve for law suits if their claims are false.
Blank
159619_tn?1318997813
That remains to be seen. Statins have been on the market since 1987, that's 23 years. That's long enough to see what long term consequences there are if any.

I will agree that since 1987, there has been a shift in the demographics. It's no longer the average middle aged person taking statins, they have been prescribed to younger and younger people, which may be a poor decision in the long run, we'll have to see how it plays out.
Blank
976897_tn?1379171202
Yes and today they are trying to claim in the UK that everyone would benefit if they take statins, whether they have heart disease yet or not. I know statins lower cholesterol, they dropped mine dramatically. I know heart disease is increasing at an alarming rate, so in another decade nearly everyone will have it. Maybe prescribing statins to everyone will slow the disease rate down. I would prefer it though if they found the real cause to stop it. There must be something common between so many people. Not all of them smoke, not all eat unhealthy diets, not all don't exercise and not all have stress, not all have high cholesterol. I hope one day they manage to find what the culprit is.
Blank
Avatar_f_tn
I understand your feelings, but as you note, we disagree on many points.  Others far more qualified than I am have pointed out the many flaws in JUPITER.  I noted several, but there are issues with the approach, the population and the funders, as well as those I noted.  For a complete critique, see www.proteinpower.com/drmike/cardiovasculer-disease/1853/.  And there are many others.  The J stands for "justification," which is a strange objective for an honest study.

Your experience with statins has been positive so far.  Mine was not.  There is a book by a physician who believes they destroyed his memory.  There is no disputing that they lower cholesterol, but there is wide dispute about whether that matters.  Cholesterol alone is but one small factor in CHD.  All cells in our bodies contain it, and many require it.  It's regulated by the liver, and the arbitrary limit of "acceptable" levels has been lowered since I first had mine tested; acceptable was then 300.  And half of all heart attacks occur in people with acceptable levels.  In another decade or so the lipid hypothesis will be totally discredited, I believe, and the focus will be on inflammation,LDL density and stress.  No one denies that statins can benefit some patients, but the negatives outweigh the positives in my case.  Besides, statins do nothing that a sensible diet, exercise, niacin and l-arginine can't do, at no risk and far less cost.

I never said all physicians are corrupt; in fact I never used that term, or a synonym.  I believe that as physicians enter practice they come to believe in pharmaceuticals, even though most of them treat symptoms rather than problems.  And the influence of the drug companies is powerful and pervasive, influencing Congress, the NIH, the FDA and virtually all studies.  For every Dr. Michael Eades there are hundreds of physicians in practice who never question whether the pharmaceutical industry has the patients' interest at heart, or making more money.  If JUPITER is accepted as a valid study the benefits to all statin makers will be counted in the tens of billions every year, and millions of patients will be exposed to statin side effects, when they could remedy their problem by changing habits.  If you equate low cholesterol with immunity from CHD you are fooling yourself.

Here is the final paragraph of Dr. Eades' analysis of JUPITER:

"But, let’s assume I’m taking this study at its absolute worst.  Let’s look at it in the best light possible.  If we do, we find that a small group of unusual patients – those with low LDL-cholesterol AND high C-reactive protein – may slightly decrease their risk for all-cause mortality by taking a drug that costs them almost $1,300 per year and slightly increases their risk for developing diabetes.  That’s the best spin possible given the data from this study.  Compare that to the spin the media is giving it."

And even the JAMA recognizes that the lipid hypothesis is dead.  The 11/18/2009 issue of the Journal of the American Medical Association (JAMA) has an article titled "Trends in High Levels of Low-Density Lipoprotein Cholesterol in the United States, 1999-2006" that puts another major dent in whatever validity remains of the lipid hypothesis of heart disease.

I also disagree with your statement that less cholesterol is better.  Nobody ever died from too high a level of serum cholesterol, but many have died because of too low a level.  And many more have suffered non-fatal but serious damage to their brain cells, which require it in sufficient levels, and to other organs.

But it comes down to this:  If you believe that high serum cholesterol causes heart disease, and you have a high level and want to lower it, then statins are for you.  When I had my heart surgery in 2001 all of my test results were fair or good.  But I was an indiscriminate eater, and I have no doubt whatever that my high consumption of baked goods, sugar and high glycemic index foods resulted in my blockages.  So after my recovery I (foolishly, without investigating) bought into the idea of a low-fat, high-carbohydate diet recommended by my physician.  My numbers worsened and I gained weight, and I couldn't understand how that could be if the low-fat diet worked.  Well, it doesn't.  "Protein Power," "Good Calories, Bad Calories" and a host of other readings convinced me of that.  

I now eat a very-low-carb, high-protein, high-saturated fat diet, keeping total carbohydrates under 50 grams/day  --  far under on most days.  I eat no baked goods, no sugar and no high-glycemic-index foods at all.  I eat everything sparingly.  And my numbers are superb (unless you're a lipophobe):  Total cholesterol - 220, Triglycerides - 66, HDL-C - 66, LDL-C - 132, A1C - 5.8, CRPh - .06.  I am no longer a Type 2 diabetic.  I weigh 163 and am 6 feet.  At 74 I can do virtually everything I did 20 or 30 years ago, although maybe not quite as well.  And I feel wonderful all the time.  I take only two mids for BP, and control it.  I exercise daily.  My arteries are clear, doubtless due to my diet and the daily dose of niacin I take. The establishment is belatedly beginning to recognize that saturated fat is a lot different than the unsaturated version.  The study titled "Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease" is not a study per se, but a meta-study, many of which I find inconclusive.  But the American Journal of Clinical Nutrition published it, so the fact that they were willing to change their position on saturated fat is eye-opening to many adherents of low-fat diets.  It's all about the way the different types of fats are metabolized, as Dr. Atkins proved.  But decades later it's still not the establishment position.

It's unrealistic to expect a study that proves how harmful statins are, since the only people funding studies of any size are the drug makers.  But in spite of that there is ample evidence of the harm statins do, if you'll look for it.

I think i've addressed your major points and comments.  You are happy with your statin use, and I'm happy without statins.  I only hope you don't discover down the road, when it's too late, how much damage they can do.  Many Vioxx users and many HRT believers are now dead from those approaches, and untold millions are putting themselves at risk by taking statins with no questions asked.  Yes, statins have been around since 1987, but they haven't been in wide use nearly that long, and there are thousands of horror stories about their effects.  Here's one man's experience: "Statin Drugs Side Effects and the Misguided War on Cholesterol," by Dr. Duane Graveline, M.D.  Although Dr. Graveline had been a flight surgeon for the U.S. Air Force, conducted space medicine research, been a NASA astronaut, practiced as a family physician for 20 years, and had written eight books during his retirement, he remembered none of these experiences during his second bout with Lipitor-induced amnesia.  

Scary.


Blank
159619_tn?1318997813
Thanks for sharing your view. I have read much of the anti-statin material out there, I'm just not sold. I guess my issue is why all these people that are anti-statin don't just conduct a study to prove their point? Look at all the money these guys are making off their book sales, it wouldn't take much to conduct a study. The NIH is required to provide grants for medical research and studies if they have merit. The money is there, let's see some data.

Anyways, I respect your opinion and I appreciate your candor and cordial behavior while discussing the issue, too often that is not the case.

Thanks!

Jon
Blank
976897_tn?1379171202
There must be 'something' in the side effect claims because in the last year the 'normal' cholesterol levels for heart disease victims has been raised. Now, if it was originally believed the lower the better, why raise it? Nobody seems to have the answer.
Blank
159619_tn?1318997813
Why would that have anything to due with side effect claims? Also, I'm not aware of anything here concering raising recommended cholesterol levels here, are they making changes in the UK?
Blank
976897_tn?1379171202
When I went to cardiac rehab in 2007 the recommended level for LDL was 3 mmol/L or less. In 2009 it had raised to 4 mmol/L. Questions immediately entering my mind were....

1) What is the minimum that the body requires to survive healthily
2) If the miminum is unknown, then who can decide a limit for CHD patients
3) why the sudden increase in allowance. Is it because 3 is too low for health reasons
    or is it so fewer patients need to take statins.

Having familial hypercholesterolemia, I have no choice but to take statins and they certainly have lowered my LDL cholesterol to around 2.8 mmol/L . Nobody has contacted me regarding the new limits and so will make an appointment with my GP to see if I can reduce my 40mg of daily Atorvastatin to 30mg or even 20mg.

Blank
Avatar_f_tn
Nor have I heard of a raising of the acceptable level of serum cholesterol, Ed.  It wouldn't concern me if it happened, because I'm convinced beyond question that the total cholesterol number is meaningless.  

Professor Harlan Krumholz of Yale University did a study in 1994 on this topic.  He concluded that "people with high cholesterol levels live longest."  He also determined that the elderly die twice as often from heart disease if they have low cholesterol rather than high cholesterol.  A similar result was reported by Dr. Gregg Fonarow of UCLA following a 1,000-patient study.  Needless to say these finding were ignored or ridiculed by the establishment.  

And here's an interesting summary of a four-year study done in Italy in 2007, funded by the manufacturer of rosuvastatin (Crestor):

"Results from this large, randomized study corroborate those of the earlier CORONA study (JW Nov 29 2007): Rosuvastatin did not lead to longer survival in patients with heart failure. Although these findings raised no safety concerns about rosuvastatin, the authors recommend against routine use of statins in this population. However, ω-3 polyunsaturated fatty acids appear to confer a small but significant survival advantage and might merit routine use along with other established therapies for heart failure."

In other words, the death rate from cardiovascular disease was higher among those taking rosuvastatin than among those who weren't taking it.  And of course Vytorin has been a huge disappointment, and is considered a treatment of last resort by most physicians.

In crime, the wise detective asks "Cui bono," i.e., who benefits?  And while pushing statins on an ignorant patient population isn't a crime, it has the potential to do immense harm.  It's clear to me why physicians with ties to pharma, the pharmaceuticals themselves, and an uncritical body of mainstream medicine has accepted the lipid hypothesis.  But why do so many scientists and physicians oppose statin use?  It can only be because they've seen enough evidence to sound the alarm.  They have no conceivable way of benefiting from the discontinuance of statins.  

This whole arena mystifies me.  In the mid-19th century a few alert physicians and scientists began correlating obesity with diet composition, not just calories, and determined that those obese invidiuals consuming a high-refined-carbohydrate diet, (wheat and sugar products, potatos, rice, pasta, beer) regardless of quantity, gained weight and/or became diabetic.  This was accepted until the 1950s and 60s, when heart disease supposedly became epidemic, and the culprit was (wrongly) perceived to be a high-fat diet.  Thus was born the low-fat diet and the infamous food pyramid, which lowered the "acceptable" levels of protein foods and increase the levels of carbohydrates.  In actuality the two driving forces for a high-carb, low-fat diet were both erroneous:  There was no epidemic of heart disease, just much better reporting and people living longer because of the virtual elimination of other causes of death, and there was no basis for the incorrect assumption that people were eating more fats.  But Ancil Keys and his adherents, along with Paul Dudley White, triggered the stampede to a low-fat diet.  It persists to this day.

But heart disease declined only modestly and obesity and diabetes continued to increase despite the so-called "heart-healthy" approach to eating.  And they continue to grow to this day, with about one-third of the country obese and no significant reduction in cardiac-related deaths despite the vastly increased use of statins.

But in spite the rigid posture of the powers-that-be in this area (FDA, NIH, AHA, AMA, med schools, medical journals, pharmaceuticals), truth will out.  There are already thousands of physicians and clinicians who recognize the problem and are doing something about it.  Ronald Krauss and his research over the past 15 or so years identified the various sub-particles of lipoproteins, and determined that particle size, not quantity in the bloodstream, is key to the effects of LDL, VLDL and IDL.  The denser the particles the greater the danger.  

In most labs, lacking a ultracentrifuge, LDL isn't measured; it's calculated from total cholesterol, HDL and triglycerides, using the Friedewald formula.  In some labs LDL direct testing is done, but it isn't any better, since it also lumps in IDL, VLDL and lp(a).   In my situation, with very low triglycerides, the accuracy of the Friedewald result is unclear.  Also, what's listed as LDL  is actually LDL, IDL and lp(a).  And even if the calculation is near correct, the most important factor  --  viscosity  --  isn't measured except in advanced blood testing, which is not widely available.  Shameful.

We've gone far afield from the original question, but everything we've discussed is relevant to the blocked arteries of Max's father.  If he were my father I'd suggest a very-low-carb, high-protein diet, 4 or 5 grams of niacin per day, aerobic exercise to better develop the collaterals, advanced blood testing and lots of research.  And a cardiologist who isn't blindly committed to statins.

It's working for me.
Blank
159619_tn?1318997813
Your comment;
**************************************************************************************************
"Results from this large, randomized study corroborate those of the earlier CORONA study (JW Nov 29 2007): Rosuvastatin did not lead to longer survival in patients with heart failure. Although these findings raised no safety concerns about rosuvastatin, the authors recommend against routine use of statins in this population. However, ω-3 polyunsaturated fatty acids appear to confer a small but significant survival advantage and might merit routine use along with other established therapies for heart failure."
*************************************************************************************************

I have read this argument before, it's posted on all the anti-statin sites. You really can't use this conclusion as this study was aimed at people who are already in heart failure so it really can not be used in a discussion concerning the general population. It's just apples and oranges.

**************************************************************************************************
And of course Vytorin has been a huge disappointment, and is considered a treatment of last resort by most physicians.

***************************************************************************************************

Also not completely true. As you most likely know, Vytorin is simply simvastatin and Zetia. This combination has not been more effective than simvastatin alone, but also has not seen any additional harm. Most doctors (including mine) have switched to simple simvastatin plus a fenofibrate as it is more effective than Vytorin. This is not to say that Vytorin does not lower cholesterol, just that the addition of Zetia does not provide any further benefit so to say it is a disappointment is true to an extent, but it still is effective in lowering serum cholesterol. It is the addition of a non-statin that is the disappointment in clinical findings so it really is not related to the statin used.

**************************************************************************************************
In crime, the wise detective asks "Cui bono," i.e., who benefits?  And while pushing statins on an ignorant patient population isn't a crime, it has the potential to do immense harm.  It's clear to me why physicians with ties to pharma, the pharmaceuticals themselves, and an uncritical body of mainstream medicine has accepted the lipid hypothesis.  But why do so many scientists and physicians oppose statin use?  It can only be because they've seen enough evidence to sound the alarm.  They have no conceivable way of benefiting from the discontinuance of statins.  

*************************************************************************************************

Again, show me the data to back up this statement. I welcome an opposing point of view, I am here to learn as well but I prefer fact over conjecture. Every drug has side effects and the potential to do harm. Again, what about the masses that take statins without side effects and get a true benefit? I have read both sides of the argument so I am aware of the position you are taking. There is still much to be sorted out, I think we both agree on that.

I can certainly see your passion for this, you are definitely well informed.

thanks!

Jon
Blank
976897_tn?1379171202
I think I need to have a serious discussion with my GP about medication and my cholesterol to get her view point and explanation on a few matters. My personal experience has been,
1. High blood pressure since a child yet no GP did anything about it.
2. Atherosclerosis problems started when I began a very stressful period in life (age 44).
3. My cholesterol has always been high. 8.9 mmol/L which is 343.63 mg/dl.
4. Lots of arteries have been scanned and the only ones which apparently seem affected
    are the coronary arteries, well, the LAD and RCA. Circumflex is clear.

So, with such a high cholesterol level, and cholesterol being the cause of Atherosclerosis, I have to ask some questions.....

1. With my cholesterol being so high for all my life, why aren't my arteries in much more
    of a mess. I have seen people with normal cholesterol with worse coronary arteries.
2. It is fact that cholesterol is not the first phase in atherosclerosis, the lining of the
    artery being damaged is the first phase. So with this in mind, if my blood pressure
    is controlled with medication, why would I need to lower my cholesterol?

In my opinion my blood pressure is still high. When I went to have my recent stress echo, my BP was 148/112. They commented on how it was far too high and would be retaken a few minutes later. After 30 minutes the test was repeated. It then read 140/99
and I was told "oh that's much better, that's lovely now". 99 is good? I don't think so.
I believe I am at much more risk of more disease from this than I am from cholesterol.

If nobody can tell me why my arteries are in good shape apart from the heart when I had such high cholesterol, then I have to conclude that I don't need statins because the cause was obviously from something else.

I will see what my GP says and let you know.
Blank
Avatar_f_tn
Ed, it's frightening that your GPs never addressed your BP, although the readings you cite are perfectly acceptable to many physicians, depending on your age.  Like blood sugar readings and cholesterol levels, mainstream medicine has been prodded by the lobbyists and drug makers to continually lower the "acceptable" levels, rather than address the underlying causes of the readings.  Many enlightened physicians now focus on pulse pressure (systolic minus diastolic reading) rather than the raw numbers themselves, and ideally it should be around 40.  Since yours is, I wouldn't be terribly worried.  And it's hard to say why you haven't more plaque in your arteries, but as you note, the first step in atherosclerosis is endothelial damage, and you seem to have avoided that  --  probably because of your diet.  I'm sure you're aware that the body manufactures cholesterol daily, and the amount manufactured is several times more than you consume  --  another reason that the lipid hypothesis is absurd.  One's cholesterol level, in the absence of a severe diet, is thus a function of one's body and of the liver's ability to regulate it.  And another factor is insulin level, and how much starchy and sweet food you consume.  Good luck when you meet with your GP.

Jon, I hope it's clear that anything I write is simply my opinion, unless I cite a source.  But there are sources for everything I've come to believe; otherwise I'd still be a medical sheep, following the mainstream line like I did for about 40 years, leading up to my heart surgery.

Regarding the Italian study and the CORONA study, which you dismiss as having been done on people subsequent to heart problems:  It's the mainstream statin position that all people who've experienced heart problems SHOULD be on statins, period.  So dismissing those results seems imprudent if you believe statins work.  Wouldn't you be taking them if you'd experienced heart failure?

I agree with your comments on Vytorin, but again, while the statin component of Vytorin may lower serum cholesterol, if cholesterol per se isn't the problem, so what?  My point is that drugs are approved at the behest of the makers, without having been adequately tested in many cases.  I mentioned Januvia earlier; it was brought to market in two years, and couldn't have been thoroughly tested, although the testing continued after it was approved.  And there are many other examples.  Here's the latest on Vytorin:

"The makers of the popular cholesterol drugs, Vytorin and Zetia, have agreed to pay $41.5 million in a Vytorin class action lawsuit.  Merck and Schering-Plough were accused of withholding unfavorable study results about the pharmaceutical blockbusters, Vytorin and Zetia, which showed that the drugs were not as effective at unclogging arteries as other less expensive alternatives. The study - completed almost two years prior to the release date - is one of several recent studies that has questioned the effectiveness of the drugs."

Three studies also showed that Vytorin may cause cancer, and numerous studies showed that adding the ezetimibe (Zetia) to Zocor had no beneficial effect.

The third quote you dispute is of course my opinion, but it's incontestible that there are many scientists and physicians, and an increasing number of medical journals, that are coming to realize that cholesterol itself is not the cause of heart disease; that diet has everything to do with health, cardiac and otherwise; that statins do nothing that can't otherwise be done without their risk and expense; and that saturated fat is not an evil to be banished.  The culprit in today's diet is the absurdly high level of sweets and high-starch foods, most loaded with unhealthy fats, which is principally responsible for diabetes and obesity, both of which can lead to coronary artery disease and related problems.

Ed, it's ironic that you cite stress among your issues.  Your countryman, Dr. Malcolm Kendrick, in his book "The Great Cholesterol Con," blames stress (and inflammation) instead of cholesterol for causing the endothelial damage that results in arterial problems.  And here's a URL to a site that addresses cholesterol much better than any I've seen:  www.cholesterol-and-health.com.  As Chris Masterjohn states on the first page, science should be a search for truth, not a war, and he presents a fascinating and enlightening variety of facts and opinions about cholesterol.  He's also posted reviews of all the current books on the topic.

Jon, thanks for the kind words at the end of your posts.  Discussions like this one make all parties involved do investigating and research, and can only be beneficial to all.  And I certainly appreciate and respect your tone, too.

Blank
976897_tn?1379171202
One thing which concerns me and has not yet been mentioned is the way research is run. It seems to hone in on diseased patients, checks their cholesterol, puts them on drugs and re-checks their cholesterol. However, what about the real big picture?
If I take the UK alone, heart disease has seriously increased with each passing decade and continues to do so at an alarming rate. I read somewhere that by 2020-2030 it will be difficult to find anyone without the disease. I really can't believe that our diets are changing that much each year to explain this. There are fewer smokers in the UK now compared to decades ago and yet the disease is still increasing. This is an argument being pushed by drug companies, saying "get everyone on statins now before it's too late". One thing which research has shown is that particular behavioural types of people tend to more easily get atherosclerosis. Particularly those who feel they thrive on stress, liking the 'buzz'. I think the modern term is 'adrenaline junky'.
Since the 70's in the UK the economy has never really been good for the middle/lower class person, even though the government still claims lower class no longer exists. Job security doesn't exist anymore, people worry every single day if they can continue to pay the mortgage tomorrow and even if they can put food on the table for their children. The poorer areas of the UK have by far the higher instances of heart disease and of course this was automatically assumed to be due to poor diet. Poor people don't know how to cook and eat properly. I think the obvious answer to this is that poor people suffer far more stress. Desperation for survival in poorer areas shows itself with higher crime rates. But rather than help those people to overcome poverty (which the government doesnt believe exists), they invest more money into the police force and cctv.
Child benefit in this country is £73 and each parent receives £89 per week. Out of that money they have to pay rent and local government tax each week. Water rates, gas, electricity, food, clothing, school trips when appropriate, school equipment and uniforms, and obviously the list goes on and on. There is also a television licence which has to be purchased every year costing around £5 a week on an easy payment scheme.
Things break down, and repair costs here for a washing machine as an example are around £90 for the first hour then £40 for each hour after that, excluding materials.
Most people on benefits have to use a payasyougo mobile phone, they have no hope in a home land line. To get an idea of costs here, a pack of 4 toilet rolls would cost you in the region of £2.29 unless you are willing to use cardboard. A tin of baked beans is £1.
There is not enough money to survive, and yet the government states this is adequate and there would be a surplas each week. We have often told our members of parliament that they should try it for a month, show us how it's done.
Stress is incredibly high in those poorer areas and yet it's supposed to be due to cholesterol?
When my wife and I heard the bad news that she had cancer, my health went down hill very quickly. Three years later I was having heart attacks. Coincidence? maybe.
Blank
159619_tn?1318997813
Your comment;

**********************************************************************************************
Regarding the Italian study and the CORONA study, which you dismiss as having been done on people subsequent to heart problems:  It's the mainstream statin position that all people who've experienced heart problems SHOULD be on statins, period.  So dismissing those results seems imprudent if you believe statins work.  Wouldn't you be taking them if you'd experienced heart failure?
**********************************************************************************************

You are correct, I would want to be on a statin if I were in heart failure. My only point was the fact that you can't compare the results seen by a control group of individuals with heart disease to the results seen by the general population.

I hope others jump in on this thread..........

Jon
Blank
Avatar_f_tn
Ed,

You make life in England sound very harsh.  Of course life is harsh and unfair everywhere for those at the lower end of the economic scale.  I feel great compassion for those who can't move upward despite trying desperately to improve their lot, for whatever reason.  But I have no patience for those who could improve things with some effort, but who are instead content to live on the dole, i.e., at the expense of those who work.  But that's another issue.

Stress is believed by many in medicine to be a primary cause  --  possibly the greatest cause  --  of heart disease.  And the poor eat diets heavy in carbohydrates and very light on protein, which usually means weight gain, diabetes and eventually heart disease.  They also tend to be generally less healthy than the middle and upper class, partly due to inferior or no medical care, ignorance about diet, and a lifestyle that tends to foster inflammation in their bodies.  Certainly their lives are perpetually stressful.  So Dr. Kendrick's formula for heart disease  --  stress and inflammation  --  are very often present in the lives of the poor, and often in the lives of the other classes as well.  

You may recall the sudden death of Tim Russert, 58-year-old moderator of "Meet the Press," in 2008.  He was following all the dictates of mainstream medicine.  In fact he had worked out on the morning of the afternoon he dropped dead suddenly.  His cholesterol and other readings were well within the accepted guidelines, but he had a high-stress occupation, and died from plaque rupture and the clot that resulted.  He'd had a stress test two months earlier, which he passed.  He was slightly overweight, and his coronary artery disease was supposedly controlled by diet and medication.  Yet he had vulnerable plaque, and when an inflamed section broke away, causing a coronary occlusion in his LAD (the "widowmaker" artery) he died suddenly.  

Thus despite being on statins, following accepted guidelines for diet and exercise, and being under the care of an eminent cardiologist, he died abruptly.  His numbers were deceptively good.  But I could find no mention of his C-reactive protein readings, which measures inflammation, nor of his blood viscosity (thickness),  Doubtless he was on aspirin therapy or some other blood thinner, but that didn't save him, nor did three attempts to revive him with defibrillation.  I suspect a combination of stress and inflammation led to his untimely and sudden demise, but no one will ever know.  And despite him and thousands of others dying each year who have "good" numbers and are following the guidelines, cholesterol will get the blame for their deaths, when it plays a very minor role at best. Here's a fascinating quote I discovered while researching this:  "If he had significant coronary disease, as apparently he had, very aggressive treatment with statins, ACE inhibitors, aspirin, beta-blockers, are indicated."  This was said by a cardiologist who was interviewed following Russert's death.  Two things struck me:  1) Mr. Russert was apparently getting that very sort of care, and 2) no mention is made of addressing the underlying problem, but merely of treating the symptoms.

Here's another fascinating quote.  One of the greatest nutritionists of the century, George Mann, M.D., the co-director of the Framingham Heart Study, said, “The diet-heart idea [the notion that saturated fats and cholesterol cause heart disease] is the greatest scientific deception of our times. This idea has been repeatedly shown to be wrong, and yet, for complicated reasons of pride, profit and prejudice, the hypothesis
continues to be exploited by scientists, fund-raising enterprises, food companies and even governmental agencies. The public is being deceived by the greatest health scam of the century.”  The Framingham Heart Study is the largest, most comprehensive study ever undertaken.  Begun in 1948 with about 5,200 participants, it continues today, and now includes second- and third-generation participants.  (As a side note, I lived in that area in 1974-80, and was a neighbor of one of the leaders of the study, Dr. William Castelli.)  Here's a chart that I find very enlightening:

Table I: Cholesterol intake - The Framingham Heart Study  
                                     Blood Cholesterol  
  
                   Cholesterol                 Below Median         Above Median
                       Intake                          Intake                      Intake  
                      mg/day                         mmol/l                     mmol/l  
Men            704 ± 220.9                        6.16                         6.16  
Women       492 ± 170.0                        6.37                         6.26  

As Table I shows, although subjects consumed cholesterol over a wide range, there was little or no difference in the levels of cholesterol in their blood and, thus, no relationship between the amount of cholesterol eaten and levels of blood cholesterol was found. (Although it is interesting that women who had the highest levels of cholesterol in their blood were ones who had eaten the least cholesterol.)

This result should demolish the absurd notion that cutting down on cholesterol foods will affect serum cholesterol levels, but it didn't.  Mainstreamers and those with an agenda that's advanced by the "low-fat, high-carb-diet-is-good" myth simply ignore results that prove it wrong.

Another result of the Framingham Study was ironclad proof that more than one-third of patients with CHD have total cholesterol levels under 200, and two-thirds have levels under 250.  (This and many other slides based on the study are available at www.lipidsonline.org.)

The bottom line:  Eat all the saturated fat you desire; it won't harm your heart.  Exercise.  Avoid carbs, especially the high-glycemic ones, and unsaturated fats.  Keep your immune system at top efficiency, thus preventing or vastly decreasing inflammation.  Address the stressful aspects of your life.  And live a long, enjoyable, healthy existence.  
Blank
976897_tn?1379171202
talking of saturated fats, both sets of my grandparents lived to be 90 and above. They used to cook all their food in suet or lard, never oil. I remember how everyone used to have dripping on toast or bread. For those who dont know what beef dripping is, its the fat from unusable parts of the carcass. It's allowed to set hard and forms into a substance like lard. Fish and chips used to be traditionally fried in it. With the diet in those days, they shouldn't have lived more than 40 years if dieticians are to be believed. I wish my grandparents were still here, I would love to hear them responding to the beliefs today. Stress levels weren't the same in those days. Even though one set of grandparents had nine children and the other had eleven, life was about sharing in the community with a nice spirit. They could go shopping and leave the front door open to air the house, knowing neighbours would be watching for strangers. What are we taught in todays society? shut your door, be alone, trust no one, report anyone suspicious etc.
I remember as a kid, I used to walk from one end of my road to the other every sunday and at least ten families would invite me in for cake and juice. Every house stunk of smoke from cigarettes, or more commonly, pipes, but I loved that smell. There were always open fires with smoke bellowing into the room. I remember I loved the small of fresh coal too, I would shut myself into the coal shed and just sit there sniffing the lovely odour. Grief I was odd lol.
Just thinking about it makes me realise how unhealthy their lifestyle was. They did exercise a lot, cars were for the very rich, but that smokey environment sheesh.
I remember reading an article a while back about how asthma is increasing in children. Some experts blame the parents, saying we keep them in a sterile environment too much, not allowing their immune system to strengthen. I've seen pictures of my parents and grandparents from when they were young children, they were filthy, allowed to play in the garden. Kids nowadays are put into playpens in a sterilised room, given some toys and left alone to get on with it. I was thrown into the garden, on the lawn with my brothers and left to explore nature. Perhaps there's such a thing as trying to be too healthy. We analyse the body believing we understand what it needs and what it doesn't, but perhaps we are trying too hard. Maybe I should make some beef dripping, buy some coal, chop some wood for an open fire, smoke a pipe and I will feel much better :)
Blank
Avatar_f_tn
You make some excellent points, Ed.  But remember, at the start of the 20th century the life expectancy was around 50 years of age, and today it's about 50% longer.  Change is what existence is all about, and while nostalgia is pleasant, we tend to remember the good parts and gloss over or forget the bad.

And today anyone who's willing to take the trouble and time to educate themselves about their health has a wealth of information at their fingertips  --  literally.  Of course there is lots of bad information in cyberspace too, and it isn't always clear what's good and what's not.  The megabusinesses, such as the pharmaceutical  and insurance companies, have their agendas, the government agencies are either tied to business or overwhelmed and underfunded, and much of mainstream medicine is unable or unwilling to look at the other players with a critical eye and an open mind.  

Thus we have a multi-billion-dollar cost for surgical procedures that aren't essential, scores of billions spent on drugs that often don't work and are sometimes harmful or deadly, and dietary information that's just flat wrong.  And bucking this megalith is difficult, costly and mostly to no avail.

But despite the best efforts of those who benefit greatly from the status quo, the truth will eventually emerge.  And thanks mostly to the Internet, I have altered my lifestyle radically, and am healthier than ever eight years after my heart surgery.  And anyone who wants to can do likewise.  Good health begins with the individual, not medicine, business or government.

Blank
367994_tn?1304957193
Blank
Post a Comment
To
Top Heart Disease Answerers
976897_tn?1379171202
Blank
ed34
watford, United Kingdom
63984_tn?1385441539
Blank
Flycaster305
97303, OR
Avatar_f_tn
Blank
skydnsr
159619_tn?1318997813
Blank
erijon
Salt Lake City, UT
329165_tn?1412685860
Blank
Smiley2000
Australia
Avatar_m_tn
Blank
Occupant
IL
MedHelp Health Answers
Blank
BloodPressure Tracker
Monitor Your Blood Pressure
Start Tracking Now
Blank
HeartRhythm Tracker
Track your Heart Condition
Start Tracking Now
Recent Activity
Avatar_m_tn
Blank
Paxiled commented on Important Factors Typ...
1 hr ago
Avatar_n_tn
Blank
MickDamphousse commented on When Your Cold Is Not...
17 hrs ago
Avatar_m_tn
Blank
Valkry commented on Important Factors Typ...
Oct 23
Heart Disease Community Resources
RSS Expert Activity
469720_tn?1388149949
Blank
Abdominal Aortic Aneurysm-treatable... Blank
Oct 04 by Lee Kirksey, MDBlank
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
Top Heart Disease Answerers
976897_tn?1379171202
Blank
ed34
watford, United Kingdom
63984_tn?1385441539
Blank
Flycaster305
97303, OR
Avatar_f_tn
Blank
skydnsr
159619_tn?1318997813
Blank
erijon
Salt Lake City, UT
329165_tn?1412685860
Blank
Smiley2000
Australia
Avatar_m_tn
Blank
Occupant
IL