#1

I corrected the link to the actual full paper on 09/17/2024 at 8:39pm EST

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#2

Conclusions and relevance: These findings suggest that treating 100 adults (aged 50-75 years) without known cardiovascular disease with a statin for 2.5 years prevented 1 MACE in 1 adult. Statins may help to prevent a first MACE in adults aged 50 to 75 years old if they have a life expectancy of at least 2.5 years. There is no evidence of a mortality benefit.

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#3

If I expect to live another 25 years then I guess we say “treating 100 adults without known cardiovascular disease with a statin for *** 25 *** years prevents *** 10 *** MACE 
”?

I admit to not having read the study. I am not completely convinced that we understand the mechanism of action for statins correctly (could be pleiotropic effects?), but one way or the other, they do seem to reduce the chances of a heart attack, so I do take one.

#4

I’m no expert, but that means you have 1 in ten chance over 25 years of avoiding an event. Non fatal. If you take the statin instead of not.

No evidence of mortality benefit at all.

I don’t think you can extrapolate like that because you may end up outside the 50 to 75 year old range.

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#5

Why do we keep having the same conversation over and over again?

2.5 years is not long enough to see a mortality benefit for arterial plaques that have been accumulating for half a CENTURY.

I don’t know why this point seems to repeatedly and selectively ignored until the next time someone re-posts the same study or another one just like it.

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#6

This is the first time this paper is posted on this form.

You do not like or agree with the conclusion.

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#7

One thing we might be overlooking is the potential for benefit at any point in time by reducing systemic inflammation, including arterial, to very low levels. Statins play a role here but other agents do as well and may do it better.

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#8

Then again, other meta-analysis do show a reduction in all-cause mortality with statins.

Overall, 54 studies were included: 21 in CVD, 6 in chronic kidney disease, 6 in chronic inflammatory diseases, 3 in cancer, and 18 in other diseases. The risk of all-cause mortality was significantly reduced in statin users (hazard ratio: 0.72, 95% confidence interval: 0.66−0.76).

Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies - PubMed (nih.gov)

Given the trends seen in studies like JUPITER, the longer you are on a statin the better and the NNT goes down with time.

On the basis of Kaplan–Meier estimates (Figure 1), the number of patients who would need to be treated with rosuvastatin for 2 years to prevent the occurrence of one primary end point is 95, and the number needed to treat for 4 years is 31. If 4-year risks are projected over an average 5-year treatment period, as has been commonly done in previous statin trials according to the method of Altman and Andersen,22 the number needed to treat to prevent the occurrence of one primary end point is 25.

Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein | New England Journal of Medicine (nejm.org)

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#9

It’s not linear, it’s exponential, if given enough time the absolute risk reduction intersects with the relative risk reduction of the prevalence of the disease, which is about 30%. Which means total prevention.

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#10

FWIW


Review the paper (a PDF copy) uploaded on another thread, this (reducing systemic inflammation, arterial stiffness, endothelial function, using multiple compounds) is discussed in that paper see posting;

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#11

So for primary prevention, there is according to these 8 studies a 0.4%/year risk reduction in MACE after 2.5 years of statin use compared to a placebo pill and no benefit on mortality. Another way of stating that is 99.6% of people taking a statin have no benefit for a drug that costs about $1200/year. The unwanteed direct effects are far more often then described by these drug company sponsored studies in my experience having seen them over the last 38 years in my practice.They accumulate over time and more aggressive statin dosing due to the misguided “the lower the LDL the better” mandra is also increasing them .

I think there are far more effective ways of reducing the risk of atherosclerosis progression including exercise, nutrient and hormone therapies, dietary changes, stress reduction, weight loss, etc. that cost less and have no downsides. But then everyone wants the magic pill! Sorry, statins aren’t it IMHO. Personally I think they age you faster due to the mitochondrial dysfunction they create, which everyone in the anti-aging field is trying to avoid.

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#12

New in here
Hi All

I did my blood work tests, and all seemed within the normal range exception of LDL a bit high at 104, and also Glucose a bit high at 104 also. Question what would be best remedy/meds to keep in check/lower LDL?

I have already decided to do Metformin in a low dose (to start) to keep Glucose in check. I must say the Hemoglobin A1C was normal at 5.3 (meaning not diabetic) but I see no downside on doing low dose of Metformin.

Anyway, here is a sample of my results below:

Actual Results Normal Range

Cholesterol, Total 166 mg/dL <199
Triglycerides 87 mg/dL 0-149
HDL Cholesterol 46 mg/dL >39
VLDL Cholesterol Cal 16 mg/dL 5-40
LDL Chol Calc (NIH) 104 High mg/dL 0-99
Hemoglobin A1c 5.3% 4.8-5.6
Glucose 104 70-99

thanks in advance.

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#13

Where do statins cost $1200 per year? And why do you calculate per year instead of per decade for ASCVD benefit? Also, my meta-analysis which included far more studies did show a mortality benefit.

The unwanteed direct effects are far more often then described by these drug company sponsored studies in my experience having seen them over the last 38 years in my practice.They accumulate over time and more aggressive statin dosing due to the misguided “the lower the LDL the better” mandra is also increasing them .

Pure speculation based on absolutely nothing but your hate for statins.

I think there are far more effective ways of reducing the risk of atherosclerosis progression including exercise, nutrient and hormone therapies, dietary changes, stress reduction, weight loss, etc. that cost less and have no downsides.

Good food, gym etc cost faaaaar more than statins and all have huge side effect profiles. In the gym you can injure yourself and die. Food has so many chemicals in it that can cause various diseases such as diabetes. So many downsides.

Personally I think they age you faster due to the mitochondrial dysfunction they create, which everyone in the anti-aging field is trying to avoid.

Good thing that the ITP did actually test very high dose atorvastatin in mice and found no statistically significant difference in mortality rates between them and the placebo group, indicating that muh mitochondrical dysfunctional is either not a real thing or not a factor for lifespan. So your speculation, once again based on nothing but your hate for statins, is proven wrong. And remember that mice do not ever develop artherosclerosis.

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#14

Statins > PCSK9 inhibitors > bempedoic acid > lowering satured fat in diet > ezetimibe > diet high in (liquid) fiber > lower body fat

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#15

Oh come on
I support your statements about cost is negligible and that 2.5 years is way too short to judge benefits of statins, but attacking the cost and side effects of good diet and gym use is ridiculous. Stick to the arguments that make sense.

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#16

Also it’s a moot point looking at absolute risk over 2 years, if you’re aiming for true primary prevention. In the long-run - decades - absolute risk approaches relative risk, so to speak. And RR for statins is convincing.

As for sports
 I would’nt discourage anyone from being active. But for most people it actually is more burdensome than popping a pill in the evening (time spend exercising, mental load during a stressful week, potentially gym membership and commute). So the “effort-benefit-ratio” purely for ASCVD likely is better with statins. Though obviously exercise got benefits above and beyond that.

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#17

Most of your numbers are in normal range. LDL is just a little high. I wouldn’t do anything besides changing a diet a little ( avoid foods that elevate LDL).

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#18

In order to properly assess one needs to know your age, do you have vascular disease (known or not yet known), what is your ApoB, Lp(a), blood pressure and other vascular risks.

If you are 80 years old, have verified no significant vascular disease at all 
 power on. If you are 55 and have evidence of some vascular disease and a Lp(a) positive 
 get on it seriously and treat aggressively.

This is why seeing a physician who understand the nuance (or just getting super well educated yourself) and how to assess is helpful. Listening to Dr. Dayspring’s discussions with Simon Hill on the proof is a great education in this topic.

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#19

Thanks @DrFraser and @LaraPo .

I am at the tender age of 58 lol, no known vascular disease, don’t know apoB and Lp(a) never measured, BP always normal/low (105to108 over 62-65) and I took it upon myself to become my own physician :joy: so I’m doing Rosuvastatin 5mg daily (20/4), Empa 6mg daily (25/4) and Metformin 250mg in AM and 250 or 500 mg(depending on carb meal, or regular meal) PM. I intend to increase dose of both EMPA and ROSUV to 10mg after a month or so on the low dose.
My anecdotal observation, I love how I feel on Meformin (did only metformin initially for a while and loved the feeling). however, when i added Empa and Rosuvastatin I think I might feel a bit weaker than usual. I suspect it could be EMPA but then again it could be the combination of both EMPA and ROSUV. No other side effects.

I also do a 2.5Mg Cialis daily for prostate health though not a concern at PSa 0.8

I also (for those interested) do a daily L-Dopa 500mg (Via Mucuna Pruriens) and absolutely love it (I think I need to thank @desertshores for this, as he had suggested it on an old forum). It does something good with the mood, but then also does something else which makes me feel very strong, or at my best (if you like). My Testosterone went up by about 100 also and i think it is the result of the Mucuna pruriens/L-dopa but could be other things also.

I also do at times Yohimbine at 2.5mgs and it seems to help with inflammation and helps a lot with something else (not suited for these boards), but unfortunately it gives me anxiety even at that low of a dose.

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#20

You should add ezetimibe 5-10mg per day as it brings you another 10-15% LDL-C reduction.

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