Friday, 13 March 2015

Cardiology CIA

When you have blood-fat numbers like mine, stumbling on to heterozygous familial hypercholesterolaemia (HeFH) papers, that actually bother to look at something other than the lipids, can be a fascinating experience. I could be wrong, but they seem to be fairly rare and I’m often starved of some good confirmation bias.

In 1985, Sugrue et al ran some numbers on a small group of people with, what they defined as, HeFH. Without today’s genetic screening tools, the eligibility criteria was slightly more ambiguous, but the fact remains that they all had fairly high levels of cholesterol – dodgy LDL receptors or not.

Of the 61 people they studied, 32 had evidence of coronary heart disease and the other 29 did not.  

Without even looking at the rest of the paper, those numbers should be worth noting. The oldest heart-healthy person was 59. Why she/he wasn’t whisked off to the bowels of Cardiology CIA (c’mon, surely there is such a thing) to be studied and dissected will remain a mystery, because Sugrue certainly ain't telling.

Long story short – after comparing those with CHD and those without, coagulation factor VIII and fibrinogen were significantly greater in the CHD group.



“There were no significant differences in any lipid variables between the two groups”
  
I’m not for a second suggesting that such a small sample size is indicative of anything in terms of coagulation-CVD cause and effect, because I also found this interesting chapter of a PHD thesis – in which they found (sort of) the reverse, i.e. certain coagulation factors were decreased in those with CVD. 

I think the author was funded by pharma and the whole thing was pretty ugly to read, but there was one glaring consistency in both studies - this group of 106 HeFH ‘sufferers’ also had a proportion that were, according to the doctors, heart disease free. Or at least a group with no prior cardiovascular event. 

Can you guess what the “no CVD” percentage was? A quarter? A half?

Eighty one (76%) of the 106 HeFH patients did not have a previous CV event. 

The two groups had very similar lipids (total chol of about 10.4 mmol/l), but the CVD group were older, fatter and probably male. I suppose the CCIA would claim that the CVD percentage would rise to 100% given enough time.

Whether the coagulation factors are THE deciding factors in who does or doesn’t develop CVD remains to be proven - they most likely play a role. But one thing that seems fairly clear, in these two examples at least, is that it’s certainly not the lipids.

Just a side note on the second paper, I found this comment interesting - “After 6 months of high dose simvastatin therapy, the present study showed an increase (12%, p<0.0001) of fibrinogen.”

Of course they were pretty quick to conclude that “the increase of fibrinogen by simvastatin is not related to clinical outcome, but rather a ‘side-effect’ of statin treatment".


Ha. Well played, sir.
Katherine Gorge is pretty quiet this time of year

13 comments:

  1. Interesting Chips.I have a friend with those sorts of numbers and she refuses to give up her statins despite the fact that she shows obvious signs of statin poisoning. Is your cholesterol up in that range?

    You will be amused by the nicely printed report my doctor gave me recently, main feature 'Dyslipidemia'. Incredulous I said WHAT? Bullshit!
    "Your LDL is 3.5" says he, "That's too high."
    Hah, it's taken me a year and a half to get my HDL back up to 5.5, says I.

    Which usually produces a stunned silence but it is true. This doctor annoyingly ignores the fact that I have taken my TAG/TC ratio from 2 down to 1.18, a change of -40%, in the last year --- by high sat-fat/low carb eating of course! There aren't any medications I know of that would accomplish changes like that so effortlessly.

    Another idiot doctor had me on statins for a while but it didn't take long to cotton on to the harm they were causing. Insomnia, confusion, aching muscles. That was more than five years ago and I still have weird muscle problems on occasion. Sadly I think it will be at least another 50 years before there are any successful class actions around these drugs.

    I had a few terse email exchanges with Norman Swan (abc) around the time that he seemed to be hysterically denouncing the Catalyst program about fat and statins etc. Another dyed-in-the-wool cholesterol hater it seems and I think he allows his medical prejudices to interfere with his journalistic, investigative, ethic. It was interesting to hear hm spluttering recently when some of his guests were denouncing a wide range of prescription drugs and the secrecy of the experimental data which is supposed to validate their usage. ( now there is another branch of the CIA: "Department of Experimental Secrecy'")

    :)

    http://www.abc.net.au/radionational/programs/healthreport/some-prescription-drugs-may-be-of-no-benefit-or-even-harmful/6290944

    http://www.abc.net.au/radionational/programs/healthreport/pharmacy-audit/6290472

    http://www.abc.net.au/radionational/programs/healthreport/responsible-data-sharing-for-clinical-trials/6291004



    C.

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    1. G'day PTC. 3.5 is too high...that's actually pretty funny. Your HDL to 5.5 or your TC?

      Yeah, my numbers are in double digits, but my ratios have greatly 'improved' like yours. Trigs down, HDL up etc. And, like your doc, the ones I've gone to have shown no interest in anything but the LDL number.

      I'm keen to throw up some more stuff on here about FH. Most seem to think it is clear proof that cholesterol kills, whereas I'm pretty sure the 'survivors' prove exactly the opposite.

      Gotta run, thanks for stopping by.

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    2. HDL back up to 5.5 Possibly an arbitrary value but that's what it used to be. It was as low as 4 at the height of the medically inspired madness. My doctor at the time was actually happy about that number. Sadly he's dead now but happily I'm not. Maybe there's a message there?

      I get a stronger dose of the low fat /low cholesterol madness from doctors since I'm T2D. I can't imagine what your conversations with doctors might be like!

      Galina: I've never had steady hands but now, if I plug my ears with my fingers, they rumble!


      C.

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    3. @Passthecream, I hope you don't have to perform surgeries. As far as I know, my former periodontist is enjoying his early retirement at the moment without being troubled with any additional statin-induced health issues. I have no information about any settlements he could have with the statines-producing company.

      Delete
    4. Arrrgh, I meant total chol. as you noticed. hdl is 1.1 up from 0.9

      C.

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    5. Galina, I could probably whip an appendix out if I had to but the book would never be the same afterwards.

      :)

      C.

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  2. My periodontist went to an early retirement due to a disability in his 50-s because he took statines for about a year and a half. At first he developed some strange weakness in legs, promptly dropped the medication, but within a year after he developed a slight hands tremor which prevented him from doing surgeries. He went to several doctors to investigate his problem, and the biopsy detected the permanent statine damage of his hands muscle fibers.

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    1. Damn, that's pretty shitty, Galina.I s'pose pharma would have enough high price lawyers to argue it was all just a sad coincidence.

      Cheers.

      Delete
  3. In US LC approach to health is getting a little more ligimate - a registered dietitian Franziska Spritzler just published her first book http://www.amazon.com/Carb-Dietitians-Guide-Health-Beauty/dp/0986342904/ref=sr_1_2?s=books&ie=UTF8&qid=1422323271&sr=1-2

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  4. Hi Chips,


    George H's latest contribution has some interesting points about LDL, HDL, TAG etc.
    Also L.C.D.'s links to lack of evidence about fats are very good. Golly life is getting interesting with all this new information! I must print some of it out and give it to my Doctor so he can ignore it.

    Did I mention that the same Dr. I refer to above informed me of two important things on my first visit. 1) don't eat lamb because it has too much fat in it. 2) that he had massively blocked arteries. It's true, you couldn't make this stuff up.

    Methinks he must have been following his own advice. I did give him a copy of Malcolm's 'Great Cholesterol Con' but I think it must have been too difficult for him

    Chips, do you know if is your specific version of FH is a result of fewer LDL receptors?


    C.

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    1. Perhaps you are too kind to your doc, PTC.

      Sorry if I have the impression I have FH, I think that's unlikely given my bloods on a low fat diet. While my current numbers may suggest my LDLR are buggered, i have to assume they are fine.

      Yeah, it's nice that George, Ivor and so many more are generous with their offerings. Makes study so much easier.

      Cheers.

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    2. George pointed out that LDL receptors upregulate on a low fat diet so the converse must also be true. Obviously the low fat regime creates a systemic hunger for whatever it is that LDL transports.

      C.

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