Cholesterol Management Community

Who is this doctor, I would interested in his research ad background.

Jerry, you have every right to be confused and concerned.

The lipid hypothesis is a hot debate. Are serum cholesterol levels a risk factor for heart disease, heart attacks and strokes it is portrayed to be? That depends on who you ask.

The theory is widely accepted, but not all physicians buy into it. Nor do all patients buy into it either.

I have three personal friends who are physicians. None of which believe the cholesterol theory.

There is also a growing body of physicians, researchers and medical professionals who no longer believe in the lipid hypothesis.

I myself used to believe in it, but have taken a 180 degree turn as I personally no longer subscribe to the theory.

But to each his own. You will have to look at the evidence like you are on a Jury, then decide for yourself.

But be prepared for this to take some time. It took me several years to change my position. Finally the pieces of the jigsaw puzzle came together, and I no longer viewed cholesterol as a villain.

I wish you the best.

Bobby

Oh, I almost forgot to answer your question. Statins appeared on the market in 1987.

On the other hand, why risk your life? The National Institute of Health seems to believe it's a risk factor;

http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm

And then there's this;



Here's a link, the CDC attributes the number of deaths averted to the identification and control of risk factors including cholesterol.

http://www.nhlbi.nih.gov/news/spotlight/success/conquering-cardiovascular-disease.html

Seems pretty well substantiated to me, but that's just my opinion. It makes sense, but to each their own.

That's a great graph, but some data is missing to tell the entire story. America's cholesterol levels did not start diving in 1970. Only after 1987 when statins hit the market did we have an effective drug to lower cholesterol.

This graph is from the NIH. The red ink are my notations. Statins did nothing to enhance the rate of decline in heart disease. The rate of decline pre and post statins was unchanged.

Well, I don't think we can determine that. Again, the variables are too many, what risk factors were addressed and to what degree and at what point of the timeline. Statistically, you can not draw any conclusion based on this information as you don't know how statins entered the market and at what rate. Perhaps the first big change came with a collective lowering of BP as those meds have been on the market much longer and once that impact had been maximized people stopped smoking at a higher rate and when that impact had been maximized statins were introduced. It's the rule of diminishing returns and it creates a trend line eactly as you see it on the graph. Then you have to look at all the outside elements that may increase the incidence of heart disease and how it affected the population both when and how. These are the realities of statistical analysis. Without knowing all the variables all this chart represents is a trend and one can neither attribute or eliminate any one risk factor. The original purpose of the graph I posted by the CDC was to show how recognizing risk factors lowered the incidence of death, they draw no conclusion as to an individual risk factor, just explained the overall trend.

It is human nature to try to read more into graphs like these and it is very easy to see a potential to back any position when they are not used for the purpose intended based on the data used. Its a rule of statistics.

Iride6606 stated:
"you can not draw any conclusion based on this information as you don't know how statins entered the market and at what rate."


Completely false. Sales records document the rise in statin prescriptions.


We do know how statins entered the market. And we know Lipitor quickly rose to become the hottest selling drug of all time.


But its irrelevant because the graph clearly shows statins did NOTHING, ZIP, NADA to enhance the decline rate.


Nothing changed after statins.

Perhaps better stated, nothing changed on the above graph line after statins appeared.

Thank you bobby75703 and all others who took the time to answer. This does seem to answer the question as to when satins appeared but I am still interested when the Medical Community decided high levels could be a major influence on our health. Also at what point did the FDA become involved?
Again, Thank you.
Jerry

Again, perhaps I wasn't clear as this is my profession and I was not as specific as I should be. The law of diminishing returns:

The law of diminishing returns (also law of diminishing marginal returns or law of increasing relative cost) states that in all productive processes, adding more of one factor of production, while holding all others constant ("ceteris paribus "), will at some point yield lower per-unit return. The law of diminishing returns does not imply that adding more of a factor will decrease the total production, a condition known as negative returns, though in fact this is common.

Simply put, without knowing the impact of all variables against a known trend, you can not exclude any of the individual variables, it's statistical fact. One can certainly say that their opinion is that one was more or less inclusive, but it is just not a proveable fact given the data presented.

For example, perhaps the trend line represents all improvements in treating heart disease, some worked well some did not, yet they still had a positive effect of the trend line. One treatment is replaced by a new one, the trend lone continues. Personal lifestyles improve while outside influences work as a negative force, the trend line continues and so on. In this theory the trend line is a coincidence.

You can disagree with my opinion, but my rationalisation is correct. This is how I earn a living and I am immersed in this logic daily.

So here's how it works. It's not really the FDA directly. They are part of the Department of Health and Human Services and they oversee the National Institute of Health which includes the National Cholesterol Education Program which was founded in 1985 to over see the NIH's cholesterol education program as well as communicate guidelines instituted by the NIH. Here's a link that will explain it.

http://www.nhlbi.nih.gov/about/ncep/ncep_pd.htm

Jerry,

Ancel Keys who back in the 50's and 60's was famous for his "seven countries study" believed cholesterol levels were associated with the development of Cardiovascular disease.

He set out to show consumption of saturated fat led to higher serum cholesterol and thus induced arterial blockages.

Although the theory was around back in early 1900's, Ancel keys is considered the father of the lipid hypothesis because he propelled it into mainstream acceptance.

Keys famous seven country study compared seven nations and their saturated fat intake/ cholesterol levels against deaths from Heart disease.

Keys documented his findings on graph showing the relationship between the 7 countries saturated fat intake and heart disease. He won a huge prize and got his picture on the cover of a national magazine.

Just one minor problem. The world has 200 countries. Keys only looked at seven. Data was available on 22 countries at the time, but keys kicked out the data that didn't support his hypothesis.

If we include the kicked out data on key's 7 country graph, the theory crumbles into dust. The dots don't line up.

Today we now know half the heart attacks happen to people with lower cholesterol, while the other half happen to people with higher cholesterol. Using total serum cholesterol as a predictor of heart attack risk is a 50/50 gamble. Like tossing a coin. Heads you might, tails you might.

So if cholesterol levels are to blame in developing heart disease, which do we blame? The higher or the lower?

http://en.wikipedia.org/wiki/Framingham_Heart_Study

Major findingsMajor findings from the Framingham Heart Study, according to the researchers themselves:[15>
1960sCigarette smoking increases risk of heart disease. Increased cholesterol and elevated blood pressure increase risk of heart disease. Exercise decreases risk of heart disease, and obesity increases it.1970sElevated blood pressure increases risk of stroke. In women who are postmenopausal, risk of heart disease is increased, compared with women who are premenopausal. Psychosocial factors affect risk of heart disease.1980sHigh levels of HDL cholesterol reduce risk of heart disease.

Today we now know half the heart attacks happen to people with lower cholesterol, while the other half happen to people with higher cholesterol. Using total serum cholesterol as a predictor of heart attack risk is a 50/50 gamble. Like tossing a coin. Heads you might, tails you might

This is actually statistically incorrect. From researchers at Harvard Med;

[a style="color: rgb(0, 0, 0); text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; orphans: 2; widows: 2; background-color: rgb(255, 255, 255); -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" name="#top">This myth is often quoted, and, if it were true, would have a frightening implication: Any of us, anytime, could be suddenly stricken down by a heart attack. For a generation of aging baby boomers, the logical next step is a search for further information that might provide reassurance that this is not going to happen to me!

The kind of "next steps" that many people are taking include getting electron-beam CT scans of the heart, exercise tests and echocardiograms and blood tests — all in search of that "clean bill of health." These tests are expensive, and rarely give that complete reassurance that is desired. In fact, they often lead to sleepless nights and even more tests.

Medical studies on several hundred thousand people have found that 80% to 90% of people who developed heart disease, and more than 95% of patients who died of heart disease, had at least one of the four major cardiac risk factors.

In other words, of people who "drop dead" from a heart attack, fewer than one out of 20 had no warning because they had none of these four risk factors. So if you do not smoke, do not have diabetes, have normal blood pressure, and your lipid levels are not at high-risk levels, your heart disease risk is really quite low.


The reality is that of those that die with a normal cholesterol levels, the vast majority have at least one risk factor for heart disease, including high cholesterol.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/35320/35324/370063.html?d=dmtHMSContent