Thanks Gil, The first video of yours was very informative, I felt my nutrition knowledge grew by 20%,i watched iit three times and the benefits increased to 30%. I have watched most of your videos more than once now which has increased my understanding by at least 90%.alas my absolute understanding of nutrition still around 30%.its increasing over the years thanks to you. Love what you are doing mate. Cheers Alan
Superlative explanation of a very important concept! I have listened to a few biostat lectures where they bring in the famous Lipitor ad showing a 36% (relative) risk reduction with a disclaimer in small print mentioning the absolute risk reduction to be just 1%. The presenters generally fail to explain this apparent contradiction and some even appeal to the 'evil pharma' theory. Nobody has considered the factor of time of exposure so far, which is why their explanations always seemed incomplete. Thanks a ton for educating me :)
That's the best explanation of relative and absolute risk I have ever heard. 👏 And a great explanation of how risks manifest over time. Sometimes I get sad at how underestimated well-run long-term prospective cohort studies are, because they do uncover long-term outcomes.
Well, its a nice try but doesnt go up fully i guess. In your example, you drive 1000 rounds in 1 year and you have 10 accidents, you have a 1% risk. But to have a 50% risk after 20 years you need to have a accident 50% of the time you drive around the block? So having higher LDL does compound risk, but within the driving example, you need to get a worse driver through the years? haha
@@coenfirmationbias7117 Your counter example is badly formulated. If you drive a route 1000 times over 1 year and have 10 accidents, you are a 1% risk driver. Assuming your driving skills remain the same, as a 1% risk driver, by driving the same route over 20 years you're expected to have 200 accidents. If the gadget is 100% effective, it will prevent 10 accidents in the first year and 200 accidents over 20 years.
Im waiting for part 2 on side effects. I read several books like "The Great Cholesterol Myth" that argued against statins because the all cause mortality was the same with or without statins...suggesting that the side effects negate any benefits
The great cholesterol myth.. is that it doesn't matter. I know I was fooled for a little while but now I know better thanks to Gil and Plant chompers. No more keto for me. Mediterranean sorta whole foods for now on..
Once again a phenomenal video Dr Gil. Great explanation of AR and RR and the importance of time of exposure. Looking forward to the rest of the videos in this series
My comment got removed: was it because I put in a link to a research study on stains and the elderly? Links not allowed in the comment section? I'll try again. I've been taking statins since 1997. I still do. However a study in a journal BMC Geriatrics. (Dec 28, 2017) title "Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: The study conclusion was LESS mortality in elderly with HIGHER cholesterol! 'Inverse" I was stunned. "The inverse association between high total cholesterol and reduced all-cause mortality in older adults is primarily due to non-cardiovascular mortality, especially among those who are not treated with cholesterol-lowering medications." So non statin users amongst the elderly - had lower mortality with higher cholesterol - then those with lower cholesterol - or those elderly taking statins (like me) Statins are so heavily prescribed - that those not taking - are they just showing better overall health - so they were not proscribed? Can't figure this one out What do you think?
yes sometimes YT removes external links, although not always, still haven't figured this one out :( otherwise links to studies always welcome, yes include the title as you did, that way people can find it easily we addressed the mortality Q at length here, it's an artifact of chronic diseases: ruclips.net/video/CxX51n2Z0vc/видео.html
Also Doc, try to explain why there is such a huge discrepancy in the quantum and severity of side effects reported in the trials vs the side effects that people you meet everyday or the reviews on online drug websites tell you. Almost everyone you meet in life other than the 65 years+ population tells you that statin side effects are very bad.
This is a good question because so many people rely on anecdotal evidence. It feels like it hits closer to home compared to line graphs or pie charts. This is a form of self-selection bias where the data you see is purely from the choice of the participants. There's been no criteria set to make sure that the collection of data has been controlled for factors that would skew what you're trying to measure. Just like the other commenter here said, people often comment when they feel emotionally compelled to. If you have a bad reaction to a drug, you might feel compelled to report this on a video that's contrary to your experience. If you're someone that had no adverse reactions, you might not feel the same motivation to comment. This is why looking at studies is so important because they actually tell you how they conducted their study and collected their data. You can decide for yourself the validity of the data but you can't do the same on a comment section of a public forum.
@@KevGoesRiding I had to stop statins because I’m a bodybuilder and after starting statins I was unable to pickup my 3 year old son due to the bad muscle pain from the statins. A week after stopping the statins the side effects slowly went away. I can lift very heavy weight but after starting statins I couldn’t even lift my 3 year old.
Great presentation as usual but I did not hear anything about “positive remodeling” of arterial walls when you’ve lowered cholesterol for a period of time. I had a scan of my arteries 12 years ago when I was 57. My calcium score was 256 and I had a lot of loose plaque. That scared me so I did some research and found Dr. Esselstyn’s book and started an eating regimen from the book. I had another scan of my arteries 1 year later. My calcium score went up to 565 but I had no loose plaque and everything was “positively remodeling - moving to the outside of the arterial wall” (the comment from my cardiac doc). I bring this up because in your video you mentioned that problems caused over time won’t change but positive remodeling does change the result. I may still keep the plaque but it’s been calcified and moved to the outside of the arterial wall allowing for better blood flow and a “healing of the endothelial cells” inside the artery. As I said, I enjoy your videos so please keep them coming. I truly enjoyed your video with Plant Chompers Chris MacAskill as I follow him as well. I hope your mother is doing well. Bill Krug
@@NutritionMadeSimple you mentioned in the video that statins help stabilise plaque, but there's "maybe also an effect of reduction with drugs, maybe with diet...". Could you elaborate on that? Are we talking about statins or other kinds of drugs? Great video, thanks!
@@CharlieFader both statins and the newer cholesterol-lowering drugs like PCSK9 inhibitors. if you look into trials like ASTEROID, SATURN, GLAGOV etc it's fairly common to see some reduction in plaque volume with strong lipid reductions
A really clearly explained subject. Sadly, I had 3 strokes in 2020 and it was discovered that I have FH & Anti phospholipid Syndrome. Statins weren t suitable for me so now on Ezetimibe which obviously does something similar. I only wish I'd have known all this sooner but as you so wisely said-we can only move forwards. And I do! Thanks again for your help.
For your upcoming video on statin side effects please address study "toxicity of statins on rat skeletal muscle mitochondria". Also, investigate the depletion of CoQ10 (important mitochondrial antioxidant) and the claim that pharma companies initially fortified statins with it, but stopped due to expense. Also, people claim taking a CoQ10 supplement does not offset that depletion anyway. Also, note the similarities of statin side effects are similar to mitochondrial dysfunction (fatigue, muscle aches, etc)... But doctors seem to dismiss these statin side effects without really knowing the cause, which very well could be mitochondrial damage based on above study. Also, consumerlab states statins can trigger HMGCR IMNM, an autoimmune condition that causes muscle breakdown. I would love to hear some of these problems addressed as to what exactly the statins are doing to your body that causes these side effects and not just "oh you might have a few muscle aches" like some doctors say.
Coq10 is one of the supplements that I always found had an immediate and significant positive effect. Energy levels, morning wood, mental clarity much better
These videos are very much appreciated, Gil. I was put on a statin even though I am relatively young and thin. My ApoB was elevated, despite an excellent diet, and there is a history of early heart disease on my mother’s side of the family. I will take this medication for the rest of my life. My mother has averted major heart disease, and I plan to as well. You should do a video PCSK9 inhibitors and the benefit of blood sugar control (and, no, I don’t mean keto or loading up on saturated fats.) 🙏 Thank you.
@@timm285 I eat a lot of sashimi - all wild varieties- on an almost daily basis. I also eat a lot of vegetables and particularly like seaweed salads. I always have a glass of wine of some sake with a meal - and that’s the foundation of my diet.
First here!! Doc please make a separate video about the Diabetes causing effects of statins and if PSK Inhibitors are any better? This is the number 1 thing stopping me from going on statins since I'm only 22 and Diabetic effects are also exposure dependent
I’ve been on stains 20 yrs and my scans show zero plaque. My dad and his 2 brothers all died in their mid 70 s from heart attacks I’ve been watching so many videos on RUclips that say don’t take statins it’s only 1 percent effective that I was getting anxiety , but now you’ve explained what I’ve always thought; they do work for a lot of high risk people , but getting yearly blood tests on lipids and liver enzymes is an absolute must because there is a risk to the liver , but it does seem to be small from my research
Not that one person’s results proves that much, but I wish you would go on where there are people calling, statins poison, and tell them your experience.
Interesting but you don't mention if you have had a cardiac episode nor why you were put on statins in the first place? Great that you're getting your bloods done regularly if you are happy on them then that is all good for you 👍
What drives me nuts about these discussions is using terms like lower and higher. Example, those with lower cholesterol had fewer heart attacks. What is "lower"? What is "higher"? If you have a total cholesterol of 200 what is your absolute risk compared to the general population of men in America? If 200 is your total level and you take a statin that lowers it to 180 what is your absolute risk now? And numbers to treat needs to be discussed along with risk. How good is a drug if you need to treat 10,000 men in order to see a reduction of one heart attack?
yup there's a TON more detail that can be added to the discussion. context is very important as it determines absolute risk. we can definitely touch on NNT in future content (it's basically the same as ARR which is why we didn't go into more detail here)
I'd like to see you address the other effects of statins... sure they can make you live longer, but in many people they create muscle weakness and pains, there are some reports of cognitive side effects... statins may improve heart health, but at what cost to everything else? I'm not demonizing statins, but looking perhaps for a balance - - for trying to find the sweet spot that maximizes effectiveness but minimizes side effects. Perhaps some statins are better than others..? Perhaps a low, but still moderately effective dose may be better at preserving quality, as well as quantity of life?
My doctor wanted to put me on a statin even though my LDL was very low, triglycerides even lower. She didn't give me a convincing explanation, so I told her I'd have to do my research on the topic . Hey, presto! along comes your excellent presentation on Statins. Please keep them coming, I value your perspective and insight. Thank you.
Thanks for zooming in on the estamated cholesterol risk of 10 - 50 %. Nice to know ! It seems Braggs apple cider vinegar dropped my LDL cholesterol like a rock !
Hi doc, my story: I actually discovered your channel when at age 41 I was diagnosed with extremely high cholesterol (4.8 mmol) despite being very healthy with BMI 21 and about 12% bodyfat. In discussions with my specialist and finding out that I had family history (my granddad died at 72 of a heart attack which i suspect had something to do with this, and my dad has elevated LDL and has been on statins for more than 30 years) I was prescribed statins (rosuvastatin 10mg per day) to control my cholesterol. I was initially full of hesitation and reluctance to get on the medication. All my lifestyle factors were under control (I dont drink or smoke, extremely healthy, low bodyfat, clean diet etc) and I have heard so many horrible anecdotes over the years of the high chance of being addicted to big pharma drugs and having all sorts of horrible side effects from being on lifetime medication like statins. So i set out to find the truth for myself and thankfully found your channel, which did so much to help me understand cholesterol, LDL, Apo B, and of course statins without all the unsubstantiated BS or fearmongering I have been on statins for about 6 months now and my LDL has dropped to 2.4. Zero side effects. Both my specialist, my dad, and I are very happy with the result. Incidentally my dad is now older than my grandad was when he died and is fit as a fiddle, thanks probably in no small part to making the decision to get on medication all those decades ago. Hopefully the same will also apply to me. Thank you for helping the average guy understand, it is saving lives...mine at least! Please dont stop!
I had my mom not be on statins and she is now 80. Both her parents didnt make it pass 65 and both died of heart attacks. my mom's brain is quite sharp as well. She eats and exercise moderately. Has a slight elevated blood pressure but feels great in her day to day life. The important supplements I have her on is Vitamim D3 30,000 IU (based on The Optimal Dose of Dr Judson Sommerville) when there us not much available sun but during summer, natural sunlight is her friend. Magnesium 400 to 600 mg, Vitamin K2 300mcg and Vitamin C. she has a green smoothie with B superfood powder everyday and eats the fish, meat and eggs she can have. Not obssessed with lab numbers. Her life now revolves on helping others and praying. She has outlived her dad and mom by 2 decades. She is living in borrowed time. She survived breast cancer in 2001. People should stop obsessing with numbers and studies and try to manage chronic diseases without too many synthetic drugs. Emergency drugs are a different story and for that they are awesome in saving lives.
@@NutritionMadeSimple Love your work. Can you dive into the Framingham study that showed that HDL was more important than LDL. By default someone with high native HDL has low Triglycerides so this would be consistent with the low TG:HDL ratio being cardioprotective. (is this theory wrong?) I heard you dismiss HDL as being cardioprotective on another video, however I don't mean an artificially derived HDL creating a non native particle so as that of Niacin or some drugs , i mean a native HDL such as that derived from genetics or exercise. Thank you.
It's interesting that in my more than a decade of working in a hospital that's also a stroke center, virtually everyone Ive seen with a stroke or heart attack was already on statins before they developed the stroke or heart attack.
thank you for this info. Due to all your fantastic presented evidence, I have decided to take statins for my genetically high cholesterol. I was previously scared of taking them. and now i can see that benefits can out weigh risks. I really appreciate this channel.
I remember a time when scientific meant truth based upon scientific facts and research..... Unfortunately nowadays even that statement is skewed from truth and facts because of politics..... At least Dr's like this are trying to get the best clinical medical information out to people so their not bullied by their Dr's cuz of corporate influence.... But ultimately the choice will be yours so educate yourself hopefully you'll find your optimum path for good health ❤
What I learned: Cholesterol is used as a MARKER for the VEHICLES carrying it which are the real culprits. To me, this is a great insight because I 'intuitively' tended to believe that cholesterol can't be all that bad, given its key roles making cell membranes, hormones, and vitamin D.
I am hoping my blood numbers are better. Going back June 20th for blood work. I change my diet after watching several of your videos. Thanks for bringing facts.
I’m a Dr from London, been on one for years (45 year old type 1 diabetic), currently on Rosuvastatin 10mg nocte as LDL stayed at 2.0mmol despite doubling the Atorvastatin to 40mg OD. Rosuvastatin is more potent but let’s see next week when I get bled 🤷🏻♂️
No side effects; thought I had some muscle pain in the quads on and off over the years (mild), but it also seems to settle after I went from 20mg to 40mg so make of that what you will 🤷🏻♂️
Great communication, doctor! Very, very helpful to understand the long term impact of statins as life savers. There are some side effects though, but manageable! I think you'll also tell us how to manage those in a video to follow. 😊🙏
My goal was to get off my Statin and I worked with my doctor to monitor my bloodwork every quarter. I was only off the Statin a single quarter and I had seen a quite large jump in my APO B. So while Statins may not reduce risk for everyone, it certainly works for me. FYI, I had a triple bypass which is why I started Statins.
The problem is that even a statement about risk reduction is hard to comprehend for most. Tell patients the amount of expected years gained if they take the said drug from now on every day, and weigh that up against risks and or side effects of taking said drug.
What is the life extension between those with high cholesterol being treated with statins compared to those not being treated with statins but with life style interventions?
It would depend on the relative success fo the lifestyle intervention vs effect of the drug. Many of my patients are already vegetarian, d/t their genetics may need statins
Excellent video. Thankfully this is going to be a extended series as there is much to learn about statins. During one of this series I hope you will cover what statins can do for our existing 40% or greater "vulnerable" volatile plaque areas, Possibly transforming those fatty plaques into safer fibrous natures with greater cap thickness., Making them much less likely to rupture, thereby setting up a thrombosis (clot) leading to a full heart attack. My understanding is that, aside from slowing progression of plaque, that changing the makeup of existing plaque may be the key factor in preventing deadly events.
I have been exposed to the argument that reporting relative risk is misleading, and always intuitively felt the argument was silly. If my risk is 1% and something lowers it to 0.33%, then it seems fair to say that my risk was lowered by 67%. What I didn't understand was why we were making a big deal about CVD if the risk was so low. This video made it very clear that the risk can be much higher in certain contexts, and that relative risk reduction is a value whose meaning is transferable between contexts, making it more meaningful than absolute risk reduction.
Both numbers are important. For example you could have an absolute risk reduction from 90% to 70% that is sizeable bigger than the relative risk reduction and more meaningful for that situation.
Hi Gil - I was wondering if you were able to do a video on seed oils like canola, rice bran, and sunflower. It is something I see a lot of people talking about. On the cons sides there are a lot of conspiracy pushers who seem to claim these are to blame for the emergence of diabetes/heart disease and cancers (saying the uptick in these diseases is strongly correlated with an increase of seed oils in our diet) whilst proponents seem to say 'they can be bad, but aren't generally terrible for you'. I love watching your videos because I'm a statistician and economist by education but am interested in learning more about health/nutrition and biology from as critical a lens as possible. Having someone walk through peer-reviewed papers and their findings really hits the spot for me, because I simply do not have the time to educate myself on the fundamentals of biology and nutrition at present.
I was bizarrely offered statins in 2019 based on a Qrisk heart health calculator that cares more about postcode than lifestyle or even measurable metrics.
That’s because postal code has a huge effect on overall mortality rates. You lose about 10-12 years of life in the US if you live in an economically depressed neighborhood.
40mg of Atorvastatin, a vegetarian diet, and regular strenuous exercise helps me keep my LDL and triglycerides in the 50s. I think I need these extra low because I have extremely high lipoprotein(a) which is very "sticky" and more or less unaffected by diet and lifestyle and there are currently no drugs to treat it.
I think another area where people get conflicting info about statins is the risk of cardiovascular events vs all cause mortality. I have seen some studies that show statins do reduce the risk of heart disease but increase the risk of all cause mortality.
I take a statin for bp and another for cholesterol. I have a decent diet and I exercise. Every so often I seem to think that I don’t need them anymore and quit taking them. Two months later I check my bp and it’s shy high. A lab test on my blood and confirmed…cholesterol is high! Statins work.
The way you present the difference between absolute and relative risk is somewhat inflated in favor of relative risk. Realistically,... if the relative risk reduction is 23% when the absolute risk is 4%. It means your risk went down from 4% to 3.08%. On a group of 1000 people, it means the number of people with an event went from 40 to 30. Not exactly an impressive result. It's worse in larger groups. On 1 million people it would be a reduction from 40000 people with an event to 30000 people with an event. You can say you saved 10000 lives, but you can also say you failed to save 30000 lives. These numbers aren't great. But in the question of what causes CVD, none of this explains it. Or we assume that plaque build up is just part of life, to which LDL determines the rate of progression, or we have to look somewhere else for the cause of CVD. The problem is that there are many people without any CVD. That means plaque build up is not just part of life. It's part only of some people's lives. I want to know what's different in those people. You are right with everything you're saying in this video. But reducing LDL/Apob isn't a solution to the problem. It just reduced the problem a little bit. But CVD is still the main cause of death. From that point of view nothing got better. And that's impressive if you consider how many other chronic diseases got way worse during the same time that CVD event survival rates went up big time.
You make good points, but arterial plaque is quite common and a precursor of certain CVD symptoms. Having a modicum of plaque build-up isn't equal to having CVD. Otherwise you are right that for a part of the studied group, the statins do not seem to do anything in the absolute sense. This is sadly a common occurence in medicin. ApoB is a strong predictor of CVD, but not the sole causative agent. Genetics and other lifestyle factors play a role as well, and those are not addressed by the statin. Perhaps Gill should have briefly explained what the pharmaceutical target of a statin is, which is to inhibit the body's own ability to make molecular cholesterol, which in turn lowers LDL-c and ApoB. On the other hand, that'd be a side track, as for patients the clinical outcome is much more relevant.
I think that the difference is that cardiovascular disease should be considered like a 60 year disease. The absolute risk over five years might be 4%, but the absolute risk over 60 years might be 48%. Those numbers aren't accurate, just indicative.
@@brucetattrie7341 They are that high, considering that most people die of CVD. I just wonder about what causes it. I don't think LDL or ApoB is causal. It is part of the disease of cource and when you lower it with medication, progression goes slower. But there is a reason that it starts and there is a reason that it progresses. And I don't believe that the existence of LDL or ApoB is the reason.
Awesome vid! Can you make a video on food and immunity. Which foods to avoid for a weakened immune system and which foods to consume to promote a strong one
Doc, please explain in your next video if it is okay for young people to take Statins. Almost no long term statin clinical trials exist for teens. Also, Medical bodies don't have any recommendations for teens except familial hyperchoestomia ~ 300+, what about teens who have 200-250 points cholesterol? Should they wait till 40 years of age or should they initiate treatment at an early age?
For ordinary teens (with no Familial Hypercholestrolemia), they mainly advice lifestyle and dietary changes. For some reason, they don't prescribe statins for them.
Great Video as always, but lacks quite a bit of information. How come you haven't mentioned all cause mortality? Cholesterol is everywhere in our body and it's level affects different organs and systems. And while cardiovascular risk may come down when cholesterol is lowered, other risks may come up. For example some brain degenerative diseases are linked to lower cholesterol levels and even some types of cancers. So the real benefits of lowering cholesterol should be measured in terms of all cause mortality imho.
So from this I understand that taking statins to reduce high LDL is generally the right choice. But how about people who exercise regularly, have normal blood pressure, ideal BMI, eat healthy etc? Is it necessary to take statins to lower high LDL for people who fall into such "healthy lifestyle category" ?
high ApoB will still mediate risk in the absence of other risk factors, so it would be advisable to try to bring it to the healthy range. for some people that might mean meds while for others a healthy lifestyle may suffice to have healthy lipids
This was answered in his previous interview with Dr. Ovadia. There is plenty of data showing that independent of other risk factors, lowering LDL-c with statins does show a reduction of risk for CV events. Obviously your risk is higher when you have multiple risk factors compounding each other, but ApoB specifically seems to how evidence that it's a singular causal risk factor for CVD (we infer ApoB from measuring LDL-c).
My cholesterol was 350, triglycerides 375 and LDL is 100, these numbers after 5mg Riboflavin 140/150/160. My father had similar bad numbers and had numerous TIA strokes in his retirement making him a cripple! I will stick with it but if I had slightly higher than average numbers I wouldn’t take the meds.
You're killing it with these videos. Such a good demonstration about AR vs RR. Statistics is something humans are naturally very poor at from an intuitive standpoint. It's funny to me that that there would be doctors that are hesitant or even resistant to using statins when a patient is clearly headed toward a future crisis yet at the same time, would probably agree that the risks of giving a child chemo therapy would be very obviously worth it if the child is shown to have a malignant cancer. Even though chemo has its own significant risks, side effects and possibility of not working, there's enough data from science to show that it's one of the best interventions we have and few parents and doctors would decide against it in such a scenario. I don't know why we can't take a similar approach to prevention when data is just as clear. I worry much less about industry funding of scientific studies than I do about profits to be made in spreading misinformation by some "guru" in the next diet fad.
Many studies have found inverse relation of cholesterol vs Mortality rate. In the study it is found that highest mortality is when total cholesterol is less than 120. Mortality is the lowest when the total cholesterol level is between 240-260 which is far from the guideline. As per the finding the total cholesterol of 280 is actually better than 160 in terms of mortality rate. One such study - Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults Another study is - Towards a Paradigm Shift in Cholesterol Treatment
I don't think this one works so well Gil. All the benefits you list are the benefits of lowering LDL-cholesterol (or having a low level) not the benefits of taking statins. Sure statins may be a good way of lowering LDL-cholesterol or may even the best way but combining the two questions is what confuses people. 1) Does lower LDL-cholesterol (apoB whatever) indicate/cause lower risk of heart disease? Yes. No debate. 2) Are statins the best way for you dear viewer to lower your LDL-cholesterol? Maybe, depending on your age, current LDL-cholesterol level, lifestyle and desire/ability to change. I think it is combining these two questions that gets everyone confused and polarised. If you walk people down the path of lower LDL-cholestrol being good and THEN ask what the best way to get there is people might decide it is statins. Maybe you were trying to do that and I misunderstood.
Are you suggesting starting taking statins from birth?! Anyway, body produces cholesterol for a reason (for brain, for cell regeneration etc.), reducing cholesterol may lower risk of cardiovascular events, but make your life miserable because of side effects. Especially long term.
It seems to me that elderly people trying to decide whether or not they should start a statin would have little use for relative risk reduction measures, since many studies are long enough to match pretty well their remaining life expectancies. That is, they (we) can apply absolute risk reduction directly to their situation, without undue worry about what may happen many decades in the future. Also, how the example from tobacco explains the difference between absolute and relative risk isn't clear. I think it's because you consistently confounded age and/or years of treatment with longitudinal trial duration. The tobacco function would look different for people who started smoking in different decades of life, for example, or if the followup began at different points in people's smoking careers.
I'm also interested in plant sterols. This is often advised as a way to conteract cholesterol, but I've also heard that depending on your body, these can just be replacing one problem with another. I find it rather confusing!
Thanks so much for this video. This is super on-point for me. It would be great if you could address some of the below arguments that are made by the statin naysayers. Naysayers say that statins reduce cardiovascular events per studies, but they DO NOT reduce mortality, which is what really matters. They argue that the reason for this is that while you do ward of cardiovascular events to some extent, you expose yourself to a bunch of other health problems at the same time. (I am not sure which studies are used, but the argument has been stated in multiple places, I believe.) In addition, naysayers say that LDL particles are NOT BAD, and in fact are critical to proper body function. They say that doctors have become overly focused on LDL particles as a cause for CVD. However, in fact, the LDL particles carry critical cholesterol needed to repair tissues, including tissues needing repair inside our arteries. Essentially, LDL particles are the “police” that show up at a crime, but that doesn’t mean they caused the crime or contributed to it. Thus, if you artificially change your LDL with a statin, you are making changes in this critical function of the body, which can have all kind of negative side effects that we don’t understand well. A statin-induced malfunctioning lipid and cholesterol-carrying system causes problems like diabetes, dementia and muscle-aches. LDL also carries lipids which are an energy source, so if you artificially muck with the LDL you are changing the way the body is metabolizing energy sources…which is probably not good. Summarizing, Naysayers will often admit that taking a statin can have a small positive impact on the degree atherosclerotic activity in the arteries, but say that reduction is not worth it because of all the other things that you will have destabilized in the body (this dovetails to the “no-reduction-in-mortality” argument). They also may admit that statins can make sense for secondary prevention (i.e., after a first cardiovascular event), as those people need an intervention urgently…. but they are not appropriate for the vast majority of people that never had a cardiovascular event, especially if they have a calcification score of zero. A couple more separate questions follow. How should my LP(a) levels impact my decision to take a statin? If my LP(a) is high, does that mean I should “work” harder to reduce LDL (possibly with a statin), even though statins don’t impact LP(a)? Which statins are best? Are hydrophilic statins better/safer because they carry less risk of dementia? There was an article in Nature that said “Subgroup analysis showed the use of hydrophilic statins were associated reduced risk of all-caused dementia.” Finally, I have this question, which is probably subject for an entire video. What impact should my DNA testing have on my decision to take a statin? In my case, I am in the 100th percentile for risk of stroke. Both my grandfathers died of stroke. This makes me worry more that I need to get my cholesterol down to safe levels. Should it? (My DNA analysis is from Nebula.org.). THANKS!!
The question isn't simply do they work, it's should we use them in the 1st place? They are so dangerous that they cause far more harm than good. It is a great money maker for the pharmaceutical industry, but in reality, people with higher cholesterol live longer.
Thanks Gil,
The first video of yours was very informative, I felt my nutrition knowledge grew by 20%,i watched iit three times and the benefits increased to 30%. I have watched most of your videos more than once now which has increased my understanding by at least 90%.alas my absolute understanding of nutrition still around 30%.its increasing over the years thanks to you. Love what you are doing mate. Cheers Alan
Superlative explanation of a very important concept! I have listened to a few biostat lectures where they bring in the famous Lipitor ad showing a 36% (relative) risk reduction with a disclaimer in small print mentioning the absolute risk reduction to be just 1%. The presenters generally fail to explain this apparent contradiction and some even appeal to the 'evil pharma' theory. Nobody has considered the factor of time of exposure so far, which is why their explanations always seemed incomplete.
Thanks a ton for educating me :)
That's the best explanation of relative and absolute risk I have ever heard. 👏 And a great explanation of how risks manifest over time. Sometimes I get sad at how underestimated well-run long-term prospective cohort studies are, because they do uncover long-term outcomes.
Well, its a nice try but doesnt go up fully i guess. In your example, you drive 1000 rounds in 1 year and you have 10 accidents, you have a 1% risk. But to have a 50% risk after 20 years you need to have a accident 50% of the time you drive around the block? So having higher LDL does compound risk, but within the driving example, you need to get a worse driver through the years? haha
@@coenfirmationbias7117
Your counter example is badly formulated.
If you drive a route 1000 times over 1 year and have 10 accidents, you are a 1% risk driver.
Assuming your driving skills remain the same, as a 1% risk driver, by driving the same route over 20 years you're expected to have 200 accidents.
If the gadget is 100% effective, it will prevent 10 accidents in the first year and 200 accidents over 20 years.
Have you heard of The Jupiter Trials? Look it up. Enough said.
One of the best explanations about cholesterol and statins I have ever seen 🙏
Im waiting for part 2 on side effects. I read several books like "The Great Cholesterol Myth" that argued against statins because the all cause mortality was the same with or without statins...suggesting that the side effects negate any benefits
part 2 coming soon! :) hopefully this month
the all cause mortality Q is pretty clear: ruclips.net/video/CxX51n2Z0vc/видео.html
The great cholesterol myth.. is that it doesn't matter. I know I was fooled for a little while but now I know better thanks to Gil and Plant chompers. No more keto for me. Mediterranean sorta whole foods for now on..
@@mikafoxx2717fooled by what? I'm still trying to figure this thing out.
@@maverickofsouth4534 Fooled by the cholesterol deniers like the majority of the keto crowd on RUclips.
THAT'S ABSOLUTELY ACCURATE
Once again a phenomenal video Dr Gil. Great explanation of AR and RR and the importance of time of exposure. Looking forward to the rest of the videos in this series
Wow. Humblingly informative. To have someone take on the criticism of statins in such a credible way is invaluable. Thank you.
Clear explanation about relative and absolute risk. Thanks.
glad to hear it!!! wasn't sure it was clear...
Perfect explanation. Crystal clear. Good job. Thanks for your work.
My comment got removed: was it because I put in a link to a research study on stains and the elderly? Links not allowed in the comment section?
I'll try again. I've been taking statins since 1997. I still do. However a study in a journal BMC Geriatrics. (Dec 28, 2017) title "Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: The study conclusion was LESS mortality in elderly with HIGHER cholesterol! 'Inverse" I was stunned.
"The inverse association between high total cholesterol and reduced all-cause mortality in older adults is primarily due to non-cardiovascular mortality, especially among those who are not treated with cholesterol-lowering medications."
So non statin users amongst the elderly - had lower mortality with higher cholesterol - then those with lower cholesterol - or those elderly taking statins (like me)
Statins are so heavily prescribed - that those not taking - are they just showing better overall health - so they were not proscribed? Can't figure this one out
What do you think?
yes sometimes YT removes external links, although not always, still haven't figured this one out :(
otherwise links to studies always welcome, yes include the title as you did, that way people can find it easily
we addressed the mortality Q at length here, it's an artifact of chronic diseases: ruclips.net/video/CxX51n2Z0vc/видео.html
Thanks for the link to your video that addresses this issue - I had not seen it. Will watch now.
Also Doc, try to explain why there is such a huge discrepancy in the quantum and severity of side effects reported in the trials vs the side effects that people you meet everyday or the reviews on online drug websites tell you. Almost everyone you meet in life other than the 65 years+ population tells you that statin side effects are very bad.
Could it be that people without side effects (like me) don't go onto online websites to report that?
This is a good question because so many people rely on anecdotal evidence. It feels like it hits closer to home compared to line graphs or pie charts. This is a form of self-selection bias where the data you see is purely from the choice of the participants. There's been no criteria set to make sure that the collection of data has been controlled for factors that would skew what you're trying to measure. Just like the other commenter here said, people often comment when they feel emotionally compelled to. If you have a bad reaction to a drug, you might feel compelled to report this on a video that's contrary to your experience. If you're someone that had no adverse reactions, you might not feel the same motivation to comment. This is why looking at studies is so important because they actually tell you how they conducted their study and collected their data. You can decide for yourself the validity of the data but you can't do the same on a comment section of a public forum.
@@chandebrec5856 To add to the (low value) anecdotal evidence, no side effects for me either.
I am 41 and totally no side effects from statins at all. Be careful what you read on the internet
@@KevGoesRiding I had to stop statins because I’m a bodybuilder and after starting statins I was unable to pickup my 3 year old son due to the bad muscle pain from the statins. A week after stopping the statins the side effects slowly went away. I can lift very heavy weight but after starting statins I couldn’t even lift my 3 year old.
Great presentation as usual but I did not hear anything about “positive remodeling” of arterial walls when you’ve lowered cholesterol for a period of time. I had a scan of my arteries 12 years ago when I was 57. My calcium score was 256 and I had a lot of loose plaque. That scared me so I did some research and found Dr. Esselstyn’s book and started an eating regimen from the book. I had another scan of my arteries 1 year later. My calcium score went up to 565 but I had no loose plaque and everything was “positively remodeling - moving to the outside of the arterial wall” (the comment from my cardiac doc). I bring this up because in your video you mentioned that problems caused over time won’t change but positive remodeling does change the result. I may still keep the plaque but it’s been calcified and moved to the outside of the arterial wall allowing for better blood flow and a “healing of the endothelial cells” inside the artery.
As I said, I enjoy your videos so please keep them coming. I truly enjoyed your video with Plant Chompers Chris MacAskill as I follow him as well. I hope your mother is doing well. Bill Krug
yes statins help stabilize existing plaque so as to reduce risk of rupture, it's 1 of the positives
This is what Dr Ford Brewer says as well.
@@NutritionMadeSimple you mentioned in the video that statins help stabilise plaque, but there's "maybe also an effect of reduction with drugs, maybe with diet...". Could you elaborate on that? Are we talking about statins or other kinds of drugs? Great video, thanks!
@@CharlieFader both statins and the newer cholesterol-lowering drugs like PCSK9 inhibitors. if you look into trials like ASTEROID, SATURN, GLAGOV etc it's fairly common to see some reduction in plaque volume with strong lipid reductions
@@NutritionMadeSimple so they can do both, but mostly plaque stabilization. That sounds complicated 😛 Thank you for the response!
A really clearly explained subject. Sadly, I had 3 strokes in 2020 and it was discovered that I have FH & Anti phospholipid Syndrome. Statins weren t suitable for me so now on Ezetimibe which obviously does something similar. I only wish I'd have known all this sooner but as you so wisely said-we can only move forwards. And I do! Thanks again for your help.
For your upcoming video on statin side effects please address study "toxicity of statins on rat skeletal muscle mitochondria". Also, investigate the depletion of CoQ10 (important mitochondrial antioxidant) and the claim that pharma companies initially fortified statins with it, but stopped due to expense. Also, people claim taking a CoQ10 supplement does not offset that depletion anyway. Also, note the similarities of statin side effects are similar to mitochondrial dysfunction (fatigue, muscle aches, etc)... But doctors seem to dismiss these statin side effects without really knowing the cause, which very well could be mitochondrial damage based on above study. Also, consumerlab states statins can trigger HMGCR IMNM, an autoimmune condition that causes muscle breakdown. I would love to hear some of these problems addressed as to what exactly the statins are doing to your body that causes these side effects and not just "oh you might have a few muscle aches" like some doctors say.
Coq10 is one of the supplements that I always found had an immediate and significant positive effect. Energy levels, morning wood, mental clarity much better
And in saying all of this MOST ppl forget, the heart is a muscle, the very subject it claims to assist!
My experience was that taking 100mg Ubiquinol had little effect, but when Increased to 200mg/day it became more useful.
@@tudvalstonewhile on statins or off?
Awesome Doctor shows up again 🤗
These videos are very much appreciated, Gil. I was put on a statin even though I am relatively young and thin. My ApoB was elevated, despite an excellent diet, and there is a history of early heart disease on my mother’s side of the family. I will take this medication for the rest of my life. My mother has averted major heart disease, and I plan to as well.
You should do a video PCSK9 inhibitors and the benefit of blood sugar control (and, no, I don’t mean keto or loading up on saturated fats.)
🙏 Thank you.
What is your “excellent diet”?
@@timm285 I eat a lot of sashimi - all wild varieties- on an almost daily basis. I also eat a lot of vegetables and particularly like seaweed salads. I always have a glass of wine of some sake with a meal - and that’s the foundation of my diet.
@@arielmalanga Were there any symptoms and then you decided to test your ApoB?
Or given your family history you tested your ApoB, but no symptoms?
@@arielmalanga you need to add more fiber
@@frankmedrisch7451 I eat lots of vegetables. How much more fiber?
First here!! Doc please make a separate video about the Diabetes causing effects of statins and if PSK Inhibitors are any better? This is the number 1 thing stopping me from going on statins since I'm only 22 and Diabetic effects are also exposure dependent
yup will be covered in the follow-up on side effects :)
I’ve been on stains 20 yrs and my scans show zero plaque. My dad and his 2 brothers all died in their mid 70 s from heart attacks I’ve been watching so many videos on RUclips that say don’t take statins it’s only 1 percent effective that I was getting anxiety , but now you’ve explained what I’ve always thought; they do work for a lot of high risk people , but getting yearly blood tests on lipids and liver enzymes is an absolute must because there is a risk to the liver , but it does seem to be small from my research
Not that one person’s results proves that much, but I wish you would go on where there are people calling, statins poison, and tell them your experience.
Interesting but you don't mention if you have had a cardiac episode nor why you were put on statins in the first place?
Great that you're getting your bloods done regularly if you are happy on them then that is all good for you 👍
What drives me nuts about these discussions is using terms like lower and higher. Example, those with lower cholesterol had fewer heart attacks. What is "lower"? What is "higher"? If you have a total cholesterol of 200 what is your absolute risk compared to the general population of men in America? If 200 is your total level and you take a statin that lowers it to 180 what is your absolute risk now? And numbers to treat needs to be discussed along with risk. How good is a drug if you need to treat 10,000 men in order to see a reduction of one heart attack?
yup there's a TON more detail that can be added to the discussion. context is very important as it determines absolute risk. we can definitely touch on NNT in future content (it's basically the same as ARR which is why we didn't go into more detail here)
play with the AHA risk calculator and you can see how the different risk factors play off each other
I'd like to see you address the other effects of statins... sure they can make you live longer, but in many people they create muscle weakness and pains, there are some reports of cognitive side effects... statins may improve heart health, but at what cost to everything else? I'm not demonizing statins, but looking perhaps for a balance - - for trying to find the sweet spot that maximizes effectiveness but minimizes side effects. Perhaps some statins are better than others..? Perhaps a low, but still moderately effective dose may be better at preserving quality, as well as quantity of life?
side effects will be covered at length in the followups :)
@@NutritionMadeSimple Looking forward to this
My doctor wanted to put me on a statin even though my LDL was very low, triglycerides even lower. She didn't give me a convincing explanation, so I told her I'd have to do my research on the topic . Hey, presto! along comes your excellent presentation on Statins. Please keep them coming, I value your perspective and insight. Thank you.
why would the doctor want to put you on statins when you have low ldl?
@@jerppazz4525 $$$
Get your apoB checked.
Hi Chris, did you check your ApoB?
What was the doctor’s explanation that didn’t convince you?
Thanks for zooming in on the estamated cholesterol risk of 10 - 50 %. Nice to know ! It seems Braggs apple cider vinegar dropped my LDL cholesterol like a rock !
Hi doc, my story:
I actually discovered your channel when at age 41 I was diagnosed with extremely high cholesterol (4.8 mmol) despite being very healthy with BMI 21 and about 12% bodyfat. In discussions with my specialist and finding out that I had family history (my granddad died at 72 of a heart attack which i suspect had something to do with this, and my dad has elevated LDL and has been on statins for more than 30 years) I was prescribed statins (rosuvastatin 10mg per day) to control my cholesterol.
I was initially full of hesitation and reluctance to get on the medication. All my lifestyle factors were under control (I dont drink or smoke, extremely healthy, low bodyfat, clean diet etc) and I have heard so many horrible anecdotes over the years of the high chance of being addicted to big pharma drugs and having all sorts of horrible side effects from being on lifetime medication like statins. So i set out to find the truth for myself and thankfully found your channel, which did so much to help me understand cholesterol, LDL, Apo B, and of course statins without all the unsubstantiated BS or fearmongering
I have been on statins for about 6 months now and my LDL has dropped to 2.4. Zero side effects. Both my specialist, my dad, and I are very happy with the result. Incidentally my dad is now older than my grandad was when he died and is fit as a fiddle, thanks probably in no small part to making the decision to get on medication all those decades ago. Hopefully the same will also apply to me. Thank you for helping the average guy understand, it is saving lives...mine at least! Please dont stop!
thanks for the kind words, Kevin, happy to hear you found something that worked for you and your family!
I had my mom not be on statins and she is now 80. Both her parents didnt make it pass 65 and both died of heart attacks. my mom's brain is quite sharp as well. She eats and exercise moderately. Has a slight elevated blood pressure but feels great in her day to day life. The important supplements I have her on is Vitamim D3 30,000 IU (based on The Optimal Dose of Dr Judson Sommerville) when there us not much available sun but during summer, natural sunlight is her friend. Magnesium 400 to 600 mg, Vitamin K2 300mcg and Vitamin C. she has a green smoothie with B superfood powder everyday and eats the fish, meat and eggs she can have. Not obssessed with lab numbers. Her life now revolves on helping others and praying. She has outlived her dad and mom by 2 decades. She is living in borrowed time. She survived breast cancer in 2001. People should stop obsessing with numbers and studies and try to manage chronic diseases without too many synthetic drugs. Emergency drugs are a different story and for that they are awesome in saving lives.
@@NutritionMadeSimple Love your work. Can you dive into the Framingham study that showed that HDL was more important than LDL. By default someone with high native HDL has low Triglycerides so this would be consistent with the low TG:HDL ratio being cardioprotective. (is this theory wrong?) I heard you dismiss HDL as being cardioprotective on another video, however I don't mean an artificially derived HDL creating a non native particle so as that of Niacin or some drugs , i mean a native HDL such as that derived from genetics or exercise. Thank you.
@@andrewj4426 All trials that attempted to raise HDL with pharmaceuticals failed to improve outcomes.
It's interesting that in my more than a decade of working in a hospital that's also a stroke center, virtually everyone Ive seen with a stroke or heart attack was already on statins before they developed the stroke or heart attack.
Your clarification is distilled into such relevant simplicity that anyone can appreciate....very well done
thank you for this info. Due to all your fantastic presented evidence, I have decided to take statins for my genetically high cholesterol. I was previously scared of taking them. and now i can see that benefits can out weigh risks. I really appreciate this channel.
How are you doing after taking statins? I’m trying to decide whether to take them or not.
I remember a time when scientific meant truth based upon scientific facts and research.....
Unfortunately nowadays even that statement is skewed from truth and facts because of politics.....
At least Dr's like this are trying to get the best clinical medical information out to people so their not bullied by their Dr's cuz of corporate influence....
But ultimately the choice will be yours so educate yourself hopefully you'll find your optimum path for good health ❤
Thank you for bringing science and knowledge, together with ludicidity and a gift for education to the internet.
Thank you for a clear and concise explanation. This information is very valuable to those who are interested in understanding subjects thoroughly.
What I learned: Cholesterol is used as a MARKER for the VEHICLES carrying it which are the real culprits. To me, this is a great insight because I 'intuitively' tended to believe that cholesterol can't be all that bad, given its key roles making cell membranes, hormones, and vitamin D.
I am hoping my blood numbers are better. Going back June 20th for blood work. I change my diet after watching several of your videos. Thanks for bringing facts.
If a clinical trial is stopped early for ethical reasons, how do they extrapolate numbers out to age 70 and beyond?
Serious question: Have you taken a statin - for how long - and what were the side effects?
Great question..my guess would be no.
I’m a Dr from London, been on one for years (45 year old type 1 diabetic), currently on Rosuvastatin 10mg nocte as LDL stayed at 2.0mmol despite doubling the Atorvastatin to 40mg OD. Rosuvastatin is more potent but let’s see next week when I get bled 🤷🏻♂️
No side effects; thought I had some muscle pain in the quads on and off over the years (mild), but it also seems to settle after I went from 20mg to 40mg so make of that what you will 🤷🏻♂️
Great communication, doctor! Very, very helpful to understand the long term impact of statins as life savers. There are some side effects though, but manageable! I think you'll also tell us how to manage those in a video to follow. 😊🙏
This was amazing explanation of the pitfalls of reading science articles without prior education.
My goal was to get off my Statin and I worked with my doctor to monitor my bloodwork every quarter. I was only off the Statin a single quarter and I had seen a quite large jump in my APO B. So while Statins may not reduce risk for everyone, it certainly works for me. FYI, I had a triple bypass which is why I started Statins.
The problem is that even a statement about risk reduction is hard to comprehend for most. Tell patients the amount of expected years gained if they take the said drug from now on every day, and weigh that up against risks and or side effects of taking said drug.
Thank you, best explanation of this difference I’ve ever seen.
What is the life extension between those with high cholesterol being treated with statins compared to those not being treated with statins but with life style interventions?
It would depend on the relative success fo the lifestyle intervention vs effect of the drug.
Many of my patients are already vegetarian, d/t their genetics may need statins
That’s a great question
I'm definitely interested in more content going over funding and outcomes of the clinical trials
As well as number needed to treat
Excellent video. Thankfully this is going to be a extended series as there is much to learn about statins.
During one of this series I hope you will cover what statins can do for our existing 40% or greater "vulnerable" volatile plaque areas, Possibly transforming those fatty plaques into safer fibrous natures with greater cap thickness.,
Making them much less likely to rupture, thereby setting up a thrombosis (clot) leading to a full heart attack.
My understanding is that, aside from slowing progression of plaque, that changing the makeup of existing plaque may be the key factor in preventing deadly events.
I have been exposed to the argument that reporting relative risk is misleading, and always intuitively felt the argument was silly. If my risk is 1% and something lowers it to 0.33%, then it seems fair to say that my risk was lowered by 67%. What I didn't understand was why we were making a big deal about CVD if the risk was so low. This video made it very clear that the risk can be much higher in certain contexts, and that relative risk reduction is a value whose meaning is transferable between contexts, making it more meaningful than absolute risk reduction.
Still we don't know what causes plaque build up. Not saying statins don't work, but what is the real problem?
More content on statins 🙏 please!
As clear as it could be for the average Joe (or Linda) like me.
Thank you for your sharing this valuable information with us!
Both numbers are important. For example you could have an absolute risk reduction from 90% to 70% that is sizeable bigger than the relative risk reduction and more meaningful for that situation.
Was watching some of your older videos. Also great content but I am so glad you got rid of that annoying music!
Your Analogy should be the One Percent Difference 50 Crashes and 50.5 Crashes to be Accurate
Hi Gil - I was wondering if you were able to do a video on seed oils like canola, rice bran, and sunflower. It is something I see a lot of people talking about. On the cons sides there are a lot of conspiracy pushers who seem to claim these are to blame for the emergence of diabetes/heart disease and cancers (saying the uptick in these diseases is strongly correlated with an increase of seed oils in our diet) whilst proponents seem to say 'they can be bad, but aren't generally terrible for you'.
I love watching your videos because I'm a statistician and economist by education but am interested in learning more about health/nutrition and biology from as critical a lens as possible. Having someone walk through peer-reviewed papers and their findings really hits the spot for me, because I simply do not have the time to educate myself on the fundamentals of biology and nutrition at present.
yup it's in the works :)
What is the effect on overall mortality in statin trials?
Tremendous analysis. I’m in the ‘add it to the water ‘ camp - but that’s me. Compelling data.
Thank you for giving us the conversion between US & UK levels. 👍
Thank you so much for all of your research. This was very helpful.
Thank you for the video. Living up to the name of the channel once again! 🙂
Great video and amazing channel.
I was bizarrely offered statins in 2019 based on a Qrisk heart health calculator that cares more about postcode than lifestyle or even measurable metrics.
That’s because postal code has a huge effect on overall mortality rates. You lose about 10-12 years of life in the US if you live in an economically depressed neighborhood.
Can you make a video on dairy similar to the one you made on red meat? A whole series even would be great. Keep up the amazing work.
What about all-cause mortality?
Great video! Please keep uploading on this topic
40mg of Atorvastatin, a vegetarian diet, and regular strenuous exercise helps me keep my LDL and triglycerides in the 50s. I think I need these extra low because I have extremely high lipoprotein(a) which is very "sticky" and more or less unaffected by diet and lifestyle and there are currently no drugs to treat it.
I hope that changes soon and that there will be a therapy for you. It’s a good thing that you are taking good care of yourself to minimize your risk.
High sense drugs that lower Lp(a) should be available soon. PCSK9 inhibitors also lower Lp(a) but are extremely cost prohibitive.
I went vegan several years ago. No cholesterol in plants (?). When I go out for meat now, it feels greasy.
I think another area where people get conflicting info about statins is the risk of cardiovascular events vs all cause mortality. I have seen some studies that show statins do reduce the risk of heart disease but increase the risk of all cause mortality.
this may help :)
ruclips.net/video/CxX51n2Z0vc/видео.html
Now You know why We call this Nutrition Made Simple.
As a sufferer of severe GERD, I am extremely reluctant to take a statin!
I take a statin for bp and another for cholesterol. I have a decent diet and I exercise. Every so often I seem to think that I don’t need them anymore and quit taking them. Two months later I check my bp and it’s shy high. A lab test on my blood and confirmed…cholesterol is high! Statins work.
The way you present the difference between absolute and relative risk is somewhat inflated in favor of relative risk.
Realistically,... if the relative risk reduction is 23% when the absolute risk is 4%. It means your risk went down from 4% to 3.08%. On a group of 1000 people, it means the number of people with an event went from 40 to 30. Not exactly an impressive result. It's worse in larger groups. On 1 million people it would be a reduction from 40000 people with an event to 30000 people with an event.
You can say you saved 10000 lives, but you can also say you failed to save 30000 lives. These numbers aren't great.
But in the question of what causes CVD, none of this explains it. Or we assume that plaque build up is just part of life, to which LDL determines the rate of progression, or we have to look somewhere else for the cause of CVD.
The problem is that there are many people without any CVD. That means plaque build up is not just part of life. It's part only of some people's lives. I want to know what's different in those people.
You are right with everything you're saying in this video. But reducing LDL/Apob isn't a solution to the problem. It just reduced the problem a little bit. But CVD is still the main cause of death. From that point of view nothing got better. And that's impressive if you consider how many other chronic diseases got way worse during the same time that CVD event survival rates went up big time.
You make good points, but arterial plaque is quite common and a precursor of certain CVD symptoms. Having a modicum of plaque build-up isn't equal to having CVD.
Otherwise you are right that for a part of the studied group, the statins do not seem to do anything in the absolute sense. This is sadly a common occurence in medicin. ApoB is a strong predictor of CVD, but not the sole causative agent. Genetics and other lifestyle factors play a role as well, and those are not addressed by the statin.
Perhaps Gill should have briefly explained what the pharmaceutical target of a statin is, which is to inhibit the body's own ability to make molecular cholesterol, which in turn lowers LDL-c and ApoB. On the other hand, that'd be a side track, as for patients the clinical outcome is much more relevant.
I think that the difference is that cardiovascular disease should be considered like a 60 year disease. The absolute risk over five years might be 4%, but the absolute risk over 60 years might be 48%. Those numbers aren't accurate, just indicative.
so no to statins yeah?
@@brucetattrie7341 They are that high, considering that most people die of CVD.
I just wonder about what causes it. I don't think LDL or ApoB is causal. It is part of the disease of cource and when you lower it with medication, progression goes slower.
But there is a reason that it starts and there is a reason that it progresses. And I don't believe that the existence of LDL or ApoB is the reason.
Very informative thank you so much you’re awesome and many blessings to you and your family
All fine and good... but will people live longer?
Yes, please, a video on NNT!
Same issues. Look up Number Needed to Mislead from Stephen Senn.
I've been 20 mg simvastatin for about 15 years. Whole food plant based diet for last 5 years. My LDL is 45. No sore muscles.
Awesome vid! Can you make a video on food and immunity. Which foods to avoid for a weakened immune system and which foods to consume to promote a strong one
There is a good reason why the medical professionals often say: "in the statin era..."
Unfortunately most younger people aren't concerned about colesterol let alone taking a pill for the rest of their life
Doc, please explain in your next video if it is okay for young people to take Statins. Almost no long term statin clinical trials exist for teens. Also, Medical bodies don't have any recommendations for teens except familial hyperchoestomia ~ 300+, what about teens who have 200-250 points cholesterol? Should they wait till 40 years of age or should they initiate treatment at an early age?
You say almost none, yet you’re language says there aren’t any. Sounds like you already have an answer to the question you’re asking.
For ordinary teens (with no Familial Hypercholestrolemia), they mainly advice lifestyle and dietary changes.
For some reason, they don't prescribe statins for them.
statins are not a great idea in pregnancy so you have to be careful in young women
I don't know what to think. MDs are on both sides of this. Why can't MDs be in agreement?
Great Video as always, but lacks quite a bit of information. How come you haven't mentioned all cause mortality? Cholesterol is everywhere in our body and it's level affects different organs and systems. And while cardiovascular risk may come down when cholesterol is lowered, other risks may come up. For example some brain degenerative diseases are linked to lower cholesterol levels and even some types of cancers. So the real benefits of lowering cholesterol should be measured in terms of all cause mortality imho.
we touched on ACM here: ruclips.net/video/CxX51n2Z0vc/видео.html
So from this I understand that taking statins to reduce high LDL is generally the right choice.
But how about people who exercise regularly, have normal blood pressure, ideal BMI, eat healthy etc? Is it necessary to take statins to lower high LDL for people who fall into such "healthy lifestyle category" ?
high ApoB will still mediate risk in the absence of other risk factors, so it would be advisable to try to bring it to the healthy range. for some people that might mean meds while for others a healthy lifestyle may suffice to have healthy lipids
This was answered in his previous interview with Dr. Ovadia. There is plenty of data showing that independent of other risk factors, lowering LDL-c with statins does show a reduction of risk for CV events. Obviously your risk is higher when you have multiple risk factors compounding each other, but ApoB specifically seems to how evidence that it's a singular causal risk factor for CVD (we infer ApoB from measuring LDL-c).
absolutely a great channel.....thanks for your insights
My cholesterol was 350, triglycerides 375 and LDL is 100, these numbers after 5mg Riboflavin 140/150/160. My father had similar bad numbers and had numerous TIA strokes in his retirement making him a cripple! I will stick with it but if I had slightly higher than average numbers I wouldn’t take the meds.
Excellent video. Is there evidence to show that triglyceride to cholesterol ratio is just as important if not more so than LDL alone?
This was so helpful - thank you!
You're killing it with these videos. Such a good demonstration about AR vs RR. Statistics is something humans are naturally very poor at from an intuitive standpoint. It's funny to me that that there would be doctors that are hesitant or even resistant to using statins when a patient is clearly headed toward a future crisis yet at the same time, would probably agree that the risks of giving a child chemo therapy would be very obviously worth it if the child is shown to have a malignant cancer. Even though chemo has its own significant risks, side effects and possibility of not working, there's enough data from science to show that it's one of the best interventions we have and few parents and doctors would decide against it in such a scenario. I don't know why we can't take a similar approach to prevention when data is just as clear. I worry much less about industry funding of scientific studies than I do about profits to be made in spreading misinformation by some "guru" in the next diet fad.
How many of these studies were done on women? I’d love to hear a discussion of the efficacy of statins for women.
Brilliant explanation thank you.
Many studies have found inverse relation of cholesterol vs Mortality rate. In the study it is found that highest mortality is when total cholesterol is less than 120. Mortality is the lowest when the total cholesterol level is between 240-260 which is far from the guideline. As per the finding the total cholesterol of 280 is actually better than 160 in terms of mortality rate.
One such study - Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults
Another study is - Towards a Paradigm Shift in Cholesterol Treatment
@Nutrition Made Simple! Could you please shine some light on this.
sure ruclips.net/video/CxX51n2Z0vc/видео.html
I don't think this one works so well Gil. All the benefits you list are the benefits of lowering LDL-cholesterol (or having a low level) not the benefits of taking statins. Sure statins may be a good way of lowering LDL-cholesterol or may even the best way but combining the two questions is what confuses people.
1) Does lower LDL-cholesterol (apoB whatever) indicate/cause lower risk of heart disease? Yes. No debate.
2) Are statins the best way for you dear viewer to lower your LDL-cholesterol? Maybe, depending on your age, current LDL-cholesterol level, lifestyle and desire/ability to change.
I think it is combining these two questions that gets everyone confused and polarised. If you walk people down the path of lower LDL-cholestrol being good and THEN ask what the best way to get there is people might decide it is statins. Maybe you were trying to do that and I misunderstood.
- I take SloNiacin for LDL/Cholesterol. Works well `👌
Maybe Gil will do a video about it...
Are you suggesting starting taking statins from birth?! Anyway, body produces cholesterol for a reason (for brain, for cell regeneration etc.), reducing cholesterol may lower risk of cardiovascular events, but make your life miserable because of side effects. Especially long term.
IYou’re wonderful. Thank you Doc.
This is one of the best explanations I've ever heard. Awesome video!!
It seems to me that elderly people trying to decide whether or not they should start a statin would have little use for relative risk reduction measures, since many studies are long enough to match pretty well their remaining life expectancies. That is, they (we) can apply absolute risk reduction directly to their situation, without undue worry about what may happen many decades in the future.
Also, how the example from tobacco explains the difference between absolute and relative risk isn't clear. I think it's because you consistently confounded age and/or years of treatment with longitudinal trial duration. The tobacco function would look different for people who started smoking in different decades of life, for example, or if the followup began at different points in people's smoking careers.
So why do we measure cardiac events and outcomes? They could be caused by all sorts of other inputs.
I'm also interested in plant sterols. This is often advised as a way to conteract cholesterol, but I've also heard that depending on your body, these can just be replacing one problem with another. I find it rather confusing!
Thanks so much for this video. This is super on-point for me.
It would be great if you could address some of the below arguments that are made by the statin naysayers.
Naysayers say that statins reduce cardiovascular events per studies, but they DO NOT reduce mortality, which is what really matters. They argue that the reason for this is that while you do ward of cardiovascular events to some extent, you expose yourself to a bunch of other health problems at the same time. (I am not sure which studies are used, but the argument has been stated in multiple places, I believe.)
In addition, naysayers say that LDL particles are NOT BAD, and in fact are critical to proper body function. They say that doctors have become overly focused on LDL particles as a cause for CVD. However, in fact, the LDL particles carry critical cholesterol needed to repair tissues, including tissues needing repair inside our arteries. Essentially, LDL particles are the “police” that show up at a crime, but that doesn’t mean they caused the crime or contributed to it. Thus, if you artificially change your LDL with a statin, you are making changes in this critical function of the body, which can have all kind of negative side effects that we don’t understand well. A statin-induced malfunctioning lipid and cholesterol-carrying system causes problems like diabetes, dementia and muscle-aches. LDL also carries lipids which are an energy source, so if you artificially muck with the LDL you are changing the way the body is metabolizing energy sources…which is probably not good.
Summarizing, Naysayers will often admit that taking a statin can have a small positive impact on the degree atherosclerotic activity in the arteries, but say that reduction is not worth it because of all the other things that you will have destabilized in the body (this dovetails to the “no-reduction-in-mortality” argument). They also may admit that statins can make sense for secondary prevention (i.e., after a first cardiovascular event), as those people need an intervention urgently…. but they are not appropriate for the vast majority of people that never had a cardiovascular event, especially if they have a calcification score of zero.
A couple more separate questions follow.
How should my LP(a) levels impact my decision to take a statin? If my LP(a) is high, does that mean I should “work” harder to reduce LDL (possibly with a statin), even though statins don’t impact LP(a)?
Which statins are best? Are hydrophilic statins better/safer because they carry less risk of dementia? There was an article in Nature that said “Subgroup analysis showed the use of hydrophilic statins were associated reduced risk of all-caused dementia.”
Finally, I have this question, which is probably subject for an entire video. What impact should my DNA testing have on my decision to take a statin? In my case, I am in the 100th percentile for risk of stroke. Both my grandfathers died of stroke. This makes me worry more that I need to get my cholesterol down to safe levels. Should it? (My DNA analysis is from Nebula.org.).
THANKS!!
I am also very curious to hear comments on the Lp(a) questions! Would you consider @Lpa_Doc as a guest? Would be a wonderful video!
Mortality cannot be reduced, death cannot be prevented, only delayed. The only sure things in life - death and taxes.
The question isn't simply do they work, it's should we use them in the 1st place? They are so dangerous that they cause far more harm than good.
It is a great money maker for the pharmaceutical industry, but in reality, people with higher cholesterol live longer.
the mortality Q is covered extensively here: ruclips.net/video/CxX51n2Z0vc/видео.html
Is there data comparing statins and a change in diet and lifestyle?
Best explanation i have seen. Puts it all into perspective, nicely.
In just 3.5 .months, my LDL went from a very high 177 to a very low 74. Statins work, and I've not had one side effect. 20mg.
Can you explain the Triglycerides/LDLc ratio, please?
hi, we covered it very recently ruclips.net/video/0dLzKwOrr8Q/видео.html
What about using herbal supplements for mild to moderate hypercholestremia?
Like Amla, Triphala, Arjuna and Guggulu.
I thought this might be another jive youtube medical quack-show, Instead it presents an accessible presentation of methods, statistics and results 👍👍