Meanwhile, cardiologists claim that patients are being regularly underdosed with statins. Instead of immediately prescribing a high intensity/dose statin, patients are prescribed a low and inadequate dose and then kept there long term.
FWIW, that has been my experience. I was prescribed 10mg/day atorvastatin, and even though my LDL kept creeping up through the years (last October LDL 146, TC 239 and sky high Lp(a)), my PCP keeps me on the same 10mg dose. But in his notes on my labs, he does urge me to cut back on saturated fat in my diet, although I’ve told him repeatedly that I’ve cut out my SFA as far as I possibly can without going vegan, my only real source of SFA is the 1-2 times a week salmon and/or sardines. And I’ve been prediabetic for years despite my best diet and exercise efforts - he’ll spring into action once I’m officially diabetic, until then, he urges cutting back on excess sugar (even though I repeatedly told him I have done that already for decades).
In other words, he’s a classic medicine 2.0 practitioner who will only act once I become diabetic or have a heart attack. Is it any wonder, that I have felt compelled to take matters into my own hands and don’t bother informing him about the meds I buy from India, as he absolutely refuses to prescribe anything outside of the SOC insurance guidelines. Telling him about the meds I take on my own would only have the effect of sabotaging my insurance and his likely dropping me as a patient. And I need the insurance in case of emergency, accident, or serious diagnosis like cancer. So I take full responsibility for my health and move in silence - gives a different meaning to “defensive medicine”; I call it “self defense medicine”
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I know there are some brilliant doctors out there, but sadly it’s a matter of luck for most people, and great numbers of doctors are effectively useless if you want preventative medicine.
Matt Kaeberlein in one of his recent presentations claimed that in the very near future, we will have available personal digital assistants that can guide us on our health with a few wearable sensors/trackers and combine available data from labs utilizing AI to vastly enhance our health journey. I don’t know if that is indeed our near future, or how far away it is, but surely better can be done than the plodding “care” one receives from the average medicine 2.0 doctor out there. If you rely on the latter, you better count on a lot of lucky genes.
Larger statin dosages urged for many with cholesterol, heart risks
“Co-author Dr. Charles Hennekens, the Sir Richard Doll Professor of Medicine and Preventive Medicine at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton, says his analysis of several major clinical studies of the new generation of highly potent statins, such as rosuvastatin and atorvastatin, shows that maximal doses are safe and sorely needed, but aren’t being prescribed.”
““The data indicate that over half of people who were put on a statin remain on the initial dose they’re given, so even though the intent may be to titrate it up, it’s not done in the majority of instances,” he said. “So, you get on a low dose of statin and you stay on it.””
Max-dose statins save lives—here’s why doctors are starting strong
“The researchers offer cautious views of adjunctive therapies such as ezetimibe and evolocumab, which tend to be used more widely than optimal. For example, in the IMPROVE-IT trial, the addition of ezetimibe to simvastatin showed only a minor benefit, while the FOURIER trial demonstrated evolocumab’s efficacy in secondary prevention only in patients with familial hypercholesterolemia already on maximal statin doses. While FOURIER was a completed trial of secondary prevention, ILLUMINATE is an ongoing trial in high-risk primary prevention patients with familial hypercholesterolemia.
“These findings suggest that such therapies may be more appropriately reserved for select high-risk patients who have not achieved LDL goals with statins alone,” said Hennekens.
The authors also discuss the role of omega-3 fatty acids, noting that earlier trials were positive but later tended to show no net benefit. The authors opine that this may have been due to widespread statin use. They note that in REDUCE-IT, a large-scale randomized trial, icosapent ethyl was the only omega-3 fatty acid to demonstrate significant added benefits when added to evidence-based doses of high potency statins. Patients assigned at random to icosapent ethyl, a purified form of eicosapentanoic acid, experienced a significant 25% reduction in major cardiovascular events, with a number needed to treat of just 21.”
