(Flickr photo (cropped) by Francis Bourgouin).

High cholesterol is well known as a risk factor for heart disease. But far too many people are under the impression that taking a medication to lower cholesterol also reduces their risk of dying from an initial heart attack. While all our experts agree that statin-type drugs such as Crestor, Lipitor and Zocor (simvastatin) are appropriate for a person who has established heart disease, they disagree about the benefits for preventing heart disease in healthy people. Learn how the benefits and risks stack up for people like you.
Guests: Robert Califf, MD, is Vice Chancellor for Clinical Research at Duke University Medical Center and Director of the Duke Translational Medicine Institute.
Lisa Gill is prescription drug editor for ConsumerReportsHealth.org
Nortin Hadler, MD, MACP, FACR, FACOEM, is professor of medicine, microbiology and immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals. His books include: The Last Well Person; Worried Sick: A Prescription for Health in an Overtreated America; and Stabbed in the Back.
The podcast of this program will be available the Monday after the broadcast date. Podcasts can be downloaded for free for six weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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  1. MV
    Reply

    What is the connection between a high C reactive protein level and high cholesterol? A few years back my CRP level was 11 and the doctor’s office (nurse practitioner first then doctor when I didn’t follow the practitioner’s advice) insisted that unless I started on Lipitor immediately, I would die from a heart attack. I could not get them to redo the blood work (it’s too expensive) to see if it could possibly be a lab error. I did relent and take Lipitor for 3 months and was miserable the entire time so I stopped.
    10 mg of Simvastatin had the same effect – pain, muscle aches, total fatigue, loss of strength, my skin burned if in the sun (I don’t leave the house without 30 SPF).
    Same practice, new doctor now says CRP numbers are unimportant and inconclusive (my last CRP was around 1) but now I am taking Lovaza and Niaspan because I still refuse to take statins (my rheumatologist recommends I avoid these medications). My lipid numbers are UP, I still feel miserable, I am exhausted. I exercise as much as possible. My dietician’s only recommendation is to eat nuts (I have an allergy to all tree nuts).
    So where do I go from here? I refuse to allow their worry to dominate my life. I feel fine without the medications – medications that only make my lab work worse. Any suggestions are welcome.

  2. Sue C.
    Reply

    The discussion between Dr. Hadler and Dr. Califf was amazing! Anyway you can link the research articles? I would love to read the original research and share it with my colleagues at the VA.

  3. Ron G
    Reply

    Kudos to Dr. Hadler for his very insightful discussion, and poor Dr. Califf unable to put the Great Myth of Cholesterol to rest. It is rather telling how the big industry has a stranglehold on medical practice here. There is so much evidence out there now showing how cholesterol levels or ratios are the poorest predictors for heart disease, as poor as one can imagine to make them totally irrelevant, and still we spend billions on useless drugs to try to “control” our fate.
    It is galling. It is even more disturbing that people like Califf let themselves taken by the nose. We expect better judgement from our MDs and especially those in high level academic institutions who ought to take the cold hard scientific facts for what they show: cholesterol is NOT the culprit so stop wasting your time effort and resources on that. It is a dead end.
    Inflammation and a dynamic interaction between immune cell accumulation and other factors are a much more fruitful avenue to take to solve the problem of aortic infarcts.

  4. beau10
    Reply

    Several years ago I was prescribed a statin (zocor)and developed every nasty side-effect. I began investigating natural alternatives, one of which is one red grapefruit a day (among other things) I quickly lost the side-effects, and told my VA doctor after better readings than when taking the statin, was told I was nuts and not to speak to other vets about it.
    A friend’s wife told me her husband had begun taking a statin and had a personality change that frightened his family and employees. I suggested the problem was the statin and to try discontinuing it for a while to see if there were a difference. Bingo! No more statins for him.
    Three weeks ago another friend told me he felt terribly ill since taking a new med. A statin, surprise! I suggested he discontinue the statin for awhile. A few minutes ago he telephoned to say he felt fantastic and I was invited to tomorrow afternoon’s bar-b-que.
    I realize this is anecdotal, but three in a row??

  5. HJL
    Reply

    Just another guy in the Atkins school which includes, Karl, ajr, JP and Kp. Although I have read both Taubes books which are excellent, they are both difficult although the second is for the general public. I heartily recommend the Westman book, The New Atkins Diet, etc. which is in paperback and about $16 or get from your library. It is a how to book, but also has enough of the science to make most comfortable doing the diet. For what it is worth, my Cleveland Clinic doc., sees the results and tells me to just keep doing what I am doing.

  6. MSO
    Reply

    Thank you for this program.
    It was a pleasure listening to Dr. Hadler (who was one of my profs in med school at UNC-CH in the late ’70’s ). His lack of faith in the industries that put constant pressure on us every day at work is refreshing. There might not be a lot of us but we are out there— the primary care physicians who are fighting this pressure and who are sincerely trying to do our very best, drugless work, for the people under our care. By the way, many of you make it hard work too– the many who want the “easy” way out of illness and dis-ease by taking pills.

  7. paulbyr
    Reply

    I found all these varied comments interesting. The only sense I can make of the conglomerate of them is that people need to find a better Dr. (MD or DO) who will listen AND work with you.
    My belief, without any data to back it up, is that the farther down the training chain (i.e Family Practice vs Internist vs Cardiologist) MAY result in doctors who must rely on pharma sales pitches for information. I don’t know that this opinion of mine has any validity at all.
    Your congressman or congresswoman should be forcing the FDA to do a good job but won’t because pharma sends contributions for re-election.

  8. paulbyr
    Reply

    I think the only obvious answer is to GET A SECOND OPINION – even if you have to pay out of pocket because your insurance would pay. Something is wrong in your body chemistry or your lab work just got screwed up (lab mistakes do happen).

  9. TM
    Reply

    I’m interested in what you find out as my numbers are similar. Thanks.

  10. TM
    Reply

    I was on Niaspan at an $80 co-pay. I asked my pharmacist what the difference was between Niaspan and OTC slow released niacin. He told me “your body can’t tell the difference” between the two. So I don’t see any reason to be on Niaspan when you can purchase OTC niacin for less. Is there something I’m missing here? This has made me lose faith in the physician’s practice I’m attending and I’m looking for a different place to go.

  11. WFB
    Reply

    What are comments concerning my cholesterol numbers of HDL 33, LDL 64 Total 129. Is this good bad or just what?

  12. LC
    Reply

    I’d trust the opinion of a rheumatologist; they have to deal with all the side effects of statins.

  13. kp
    Reply

    I highly recommend the book “Good Calories, Bad Calories” by Gary Taubes.

  14. Jim
    Reply

    Congratulations on your significant reduction in your cholesterol numbers. I got a wake up call at 338 total and 267 LDL. I took a different route from you, eating more fat, and pretty much embracing the new Atkins approach and, by not being too fanatical, other than cutting out sweets and bread, have dropped my total to 221 (-35%) and my LDL to 131 (-51%). At the same time my HDL went from 45 to 75 (+67%). I also have been taking fish oil and flax oil. I have dropped 20 pounds from 190 to 170. I have been doing this for over a year, and it is just part of my lifestyle now. No stress.
    Anyway, I feel good, enjoy what I eat, and feel that knowing the numbers has helped me to make positive changes in my life.
    PS My doctor wanted me to start statins and I resisted. I am glad I did.

  15. littleellum
    Reply

    K H – you’re not alone in North Texas. I too live in the area and am ashamed at the greed and ignorance. We have been led down a path of consuming both food and medical treatment in this country that is driven by very wealthy companies, their executives and the special interest money that goes along with it. We must educate ourselves and keep the pressure on making progressive changes that will pay off in the future.

  16. DWD
    Reply

    Here you have one doctor taking statins and believes it improves his odds. The other doctor says he does not even want his cholesterol tested. They are both looking at the same numbers and reach different conclusions. The numbers I remembered was 50 must be treated to prevent one heart attack. Not extension of life, just eliminate one heart attack.
    The doctor taking statins must be one of those who suffers no side effects. I do suffer muscle aches and depression when taking them. So if it really gains me no time in this world then why should I be plagued with body aches and depression for my remaining time on earth.
    I quit two years ago and it has been great. At 65 I still get aches, but nothing like when I was on statins. I did continue taking 100 mg of CO-Q10 because I discovered it actually seems to reduce my normal aches I have after a day of yard work.
    I have been increasing my avocado intake and I started the tablespoon of Bragg’s Apple Cider Vinegar (in a juice glass of water and a teaspoon of sugar) and my latest cholesterol was 192 – it has been a bit better, but it has been worse too.
    My foot & leg aches/cramps kept getting worse though. About a month ago I started taking 250 mg magnesium and no more foot/leg aches/cramps. Now where did I read about that – oh yeah – The Peoples Pharmacy.
    Thanks for the show.

  17. ajr
    Reply

    I believe it was your program that prompted me to get the book Good Calories Bad Calories by Gary Taubes. Will there be a day when your apo B number will trump your cholesterol number? Will there be a day when we watch our sugar intake rather than our fat intake? Will there be a day when the biochemistry of how sugar promotes accumulation of plaques is confirmed? Statin drugs may end up being unnecessary if dietary changes go beyond just reducing saturated fat and cholesterol intake.

  18. Margie
    Reply

    In January 2011, my total cholesterol was 237, with HDL of 60 and LDL of 147. My doctor insisted I start Crestor. When I balked at that idea, he wrote a presciption for Zetia. I did not get that one filled either. My 10 yr risk factors put me in the very low range, so I decided to try a more natural approach and put myself on phytosterols and pantethine (B5). I also upped my intake of veggies and fruits and decreased my intake of meats, and added some oat bran and flaxseed to my morning cereal. I have had my lipids checked twice since I started my “diet” and my numbers this month showed my total cholesterol at 197, HDL 71, and LDL 107, so someting is working and I will stay off statins as long as possible.

  19. C.S.
    Reply

    Joe and Terry, I am a physician who follows your show faithfully. I love it but you do us a great disservice when you do not ask speakers, e.g., the cardiologist in the statin discussion, to divulge potential conflicts of interest. I would bet the cardiologist is funded by a statin drug co. Dogmatic statements in such a circumstance is more than unethical.

  20. K H
    Reply

    Just listened to your show on The Cholesterol Controversy. Thanks again for superior work reporting real science. It also enlightened me on why the right wing wants to defund NPR, now an article of faith for Republicans running in my new congressional district in North Texas. Fourteen billion dollars in profits apparently must be protected, even as America poisons itself. What a country.

  21. TSL
    Reply

    As a primary care internist, I have these “conversations ” with at risk patients everday, and I continue to be disappointed with the lack of consensus amoung the experts regarding use of statins for primary prevention. I heard nothing about the use of risk models , such as Framingham 10 Year Cardiac Risk Assessment or the Reynold’s Risk Score to help target true “at risk ” patients for use of statins.
    Nothing was mentioned about the fall out that the Jupiter Trial results is having on changing practice patterns of physicians’ use of statins on supposedly
    normal patients.
    Lastly, what is a rheumatologist doing on the program discussing primary prevention of anything – especially coronary disease.
    With time, I have become very conservative with my use of ANY prescription medication in my practice- but to summarily withhold the use of a medication as well studied as a statin I feel is not in the overall best interest of my patient.
    Your shows are always informative and helpful for me. Thanks.

  22. Karl L.
    Reply

    Let’s not forget all the damage that was done by 30 years of the medical industry pushing carbs and dissing fat.
    My cholesterol was 270. For 6 months I went on a low fat nearly vegan diet. My cholesterol went to 317.
    Carbs are a culprit. Factory ruined fats are a culprit, as are fats from animals that eat “chow” or “ration” other than their natural foods produce unhealthy fats.
    I now eat a what most would consider a high-fat diet. But my fats are largely organic from animals that eat grass and bugs.
    My cholesterol is now 105. As far as I’m concerned the medical industry should be tarred and feathered.

  23. paul43
    Reply

    I had 2 pharmacists tell me to take the REGULAR NIACIN— NOT —the SLO-RELEASE NIACIN instead.
    If you are going to use it instead of NIASPAN–they claim it works better.

  24. HJL
    Reply

    If you are on statins, take at least 300mg. of CoQ10 daily. No known side effects and it helps many with muscle and other statin problems.

  25. fbl
    Reply

    My hubby had really high cholesterol and the red yeast rice stuff upset his system. His number is perfect now (as far as I’m concerned) at 220. It was over 100 points more. He is taking no drugs.
    What have we done? Eliminate foods with additives, all veggie oils other than olive, use only natural fats such as organic coconut and palm oils. We are using a few nut oils to make mayo and also rice bran oil for high heat sauteing.
    He is now eating closer to his metabolic type, not perfect mind you, but it has also made a difference in his gut. No he is not overweight any more. He’s lost about 20 lbs without even trying.
    From the studies I’ve seen about the centenarians they all have cholesterol in the low to mid 200s. Unfortunately my number is too low 110). I am the one with the cardiovascular problems, albeit mine are from trauma to my heart from a seat belt. My vessels are squeaky clean.

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