BY JUPITER, HOW LOW SHOULD BLOOD CHOLESTEROL BE DRIVEN BY DRUGS?

  Q.   Some cardiologists including in JUPITER argue for drastic lowering of LDL cholesterol.

A. This narrow cardiology argument focusing  solely on  statin for vascular disease  is counterproductive and counter-intuitive. because it ignores basic metabolism, physiology. It is correct for patients with severe lipidemia,  or perhaps advanced vascular disease with refractory mild-to-moderate hypercholesterolemia MMHC .

and the new Canadian Universities’  Study metanalysis   of statins in preventing primary cardiological disease– finds reduction of only 7% in all-cause mortality, 23% reduction in heart attack, but only 11% reduction in major cardiovascular events .

One cannot ignore that if you lower the vascular risk by 11% with statin (as the Canadian analysis shows, and you lower all-cause mortality by only 7% or 20% (JUPITER) , so  you are not addressing the other major common chronic degenerative diseases which statins don’t address, or actually worsen – fatigue-myositis-hepatorenal impairment, lung impairment, cancer, osteoporosis,  obesity, diabetes, impotence (let alone depression) which occur frequently in real life (not trials) on statin.

Statin-for-all enthusiasts do not address the fact that , against a sensible background of improved diet and lifestyle factors, statins do nothing for the core pathogenesis of mild-to-moderate hypercholesterolemia MMHC (and  of most of the  non-vascular diseases above-listed) – ie insulin resistance and overweight.

A simple head-to-head trial would prove the obvious, that metformin plus a balanced appropriate supplement of all the vitamins, minerals, and biologicals- especially fish oil, magnesium & chromium, vits B,C,D,E,K, arginine, carnitine, coQ10, etc. Acute lab tests  do show some insulin-sensitizing benefit of statin, but no clinical trial of any duration in practice has apparently ever shown that statin (as opposed to metformin) reduces excess body fat, insulin resistance, existing or incident diabetes, or incident cancer as metformin does.

But Pubmed lists not a single comparative randomized controlled trial  of statin VERSUS metformin. No statin manufacturer would be crazy enough to mount such a trial! So no researchers can afford to do so. And the statin industry generates huge revenues for Regulators and IRS, so they wont argue for sanity.

and the new Israeli study shows poor compliance with Statin.

and a new 24yr population study of men by Universities Laval & Montreal confirms that, “compared with those who remained well, incident diabetes without cardiovascular disease had a relative mortality risk RR of 3, and those with cardiovascular disease an RR of 4)”.

JUPITER NON-DISCLOSURE:  in the huge  statin  JUPITER trial, over the mean of 1.9yrs in 17803 patients mean age 66yrs BMI 28.3kg/sqm, 48% with metabolic syndrome, starting with LDLC below 180mg 3.4mmol/L, on rosuvastatin Crestor 10mg dly vs placebo, mean LDLC  was reduced from about 2.8 to 1.4mmol/L; there was 50% reduction in cardiovascular endpoints, 40% reduction in cancer deaths, but only 20% reduction in all-cause mortality- and (in fine print), 25% increase in incident diabetes p0.01.  So if cancer deaths fell by 40%  and  major vascular events by 50%, why did all-cause-mortality fall by only 20%.?  It is puzzling that not even the original full paper nor the editorial reveals the number of deaths from cardiovascular causes, nor the non-CVD non-cancer causes– but the small reduction in total mortality suggests that (unless there was some other undisclosed non-CVD- non-cancer cause of mortality), the fall in CVD mortality must have been far lower than 20%. All previous major trial reports- of statins,  HRT,  metformin etc- have tabulated both total CVD deaths and  all the causes of death- why not in JUPITER? see follow-up commentary 7 January.

In primary trials with metformin prevention (which were  much longer  than JUPITER) , incident diabetes was decreased by 30 to 90% without even dose titration to optimally tolerated dose (~2.5gm/d). And the mean 50%  reduction  in new diabetes concurs with the Saskatchewan reduction in all mortality  of 50% over 5yrs in diabetics (Johnstone 2002-6), and the  36% reduction in all mortality in diabetics in the mean 13.6year UKPDS, as detailed in previous reviews below.. and the  >6year 40% reduction in all- cause  mortality with appropriate estrogen therapy  in the Womens’ Health Initiative.

So it is metformin, not statin, which should be available over-the-counter, and mandatory first line prevention and therapy for growing overweight,  for essential hypertension and MMHC (ie any facet of the metabolic syndrome)  and thus against all the common metabolic diseases of aging, as well as being bedrock treatment for all type 2 diabetics. .  It is criminally dangerous to argue otherwise.

For recent refs   see

CANCER WITH DELIBERATE HYPOCHOLESTEROLEMIA: TIME TO STOP DRASTIC CHOLESTEROL LOWERING. September 2, 2008

PUT INSULIN SENSITIZERS eg METFORMIN/ GALEGA (NOT STATIN OR ASPIRIN) IN THE DIET TO LOWER ALL COMMON DEGENERATIVE DISEASES INCLUDING CANCER. August 30, 2008

new from HealthSpan Life: Poll: OBLIGATORY METFORMIN (or equivalents) FOR OVERWEIGHT? December 31, 2008

and Cardiologists Drs Sinatra and Roberts’  books on Reversing Heart Disease, and Metabolic Cardiology.

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