Guest guest Posted March 24, 2004 Report Share Posted March 24, 2004 Tue, 23 Mar 2004 09:04:58 -0500 HSI - Jenny Thompson Ball of Confusion Ball of Confusion Health Sciences Institute e-Alert March 23, 2004 ************************************************************** Dear Reader, Are you rethinking the importance of your HDL level? You might be if you listened to the news reports last week about the sudden " confusion " surrounding high-density lipoprotein (HDL), also known as the " good " cholesterol. But guess what? The confusion is completely manufactured. And why is it manufactured? Do you even have to ask? ----------------------------- Highs and lows ----------------------------- In a nutshell, here's how LDL and HDL work: LDL transports cholesterol from the liver to the rest of the body, and HDL returns cholesterol to the liver where it's disposed of. According to the National Institutes of Health (NIH), the optimal LDL level is anything less than 100 mg/dL (milligrams of cholesterol per deciliter of blood). The " near optimal to above optimal " range is 100- 129. " Borderline high " is 130-159. And anything over 160 is considered " high. " The NIH guidelines call for HDL cholesterol to be 60 mg/dL or more in order to help reduce heart disease risk. HDL lower than 40 is considered dangerous. All of that seems pretty clear. So where does the sudden confusion about HDL come from? Prepare to be not the least bit shocked: It comes from high-profile promoters of cholesterol-lowering statin drugs. ----------------------------- Freeform extrapolating ----------------------------- Last week a New York Times article reported that " some scientists " point to " new and continuing " studies suggesting that HDL may not effectively counteract the potentially harmful effects of elevated LDL. The Times article was picked up by a number of other newspapers and media outlets. The primary scientist singled out by the Times is Dr. Steven Nissen - a prominent cardiologist with the Cleveland Clinic, and an outspoken advocate of statin use. He's also a leading proponent of the statin-friendly concept that LDL should be lowered as much as possible - well below the NIH's " optimal " mark. Last November, the Associated press quoted Dr. Nissen as saying, " There is no such thing as too low an LDL. " Remarking on the HDL question this past week, he told the Times that, " There is so much confusion about this that it is unbelievable. " Dr. Nissen cites a recent study that he headed up - a study I told you about in the e-Alert " Broken Ground " (3/11/04). The trial enrolled more than 4,260 subjects, each of whom had been hospitalized with " an acute coronary syndrome. " In other words, these were not average Joes who merely had elevated LDL levels. Subjects were divided into two groups. For two years, one group took 40 mg daily of a statin drug, and another group took 80 mg per day of a statin. Results showed that the higher dosage lowered LDL better than the lower dosage. The rate of death was also slightly lower in the high dose group. Dr. Nissen notes that HDL played no role in plaque growth among subjects in the study. He told the Times that LDL was the only factor that mattered. But one of several problems with this study is that there was no control group. Without a control group (that is; a group not taking statins to compare against the other subjects who all were), there's no way of knowing if the HDL and LDL outcomes are really as significant as Dr. Nissen is convinced they are. ----------------------------- Believability ----------------------------- So when the Times article refers to " some scientists " pointing to " new and continuing " studies, it's apparently referring only to Dr. Nissen and this single study of his that wasn't even designed to examine the effects of LDL vs. HDL on plaque growth in the first place. The Times article does mention one other trial: the Framingham Heart Study, which is the ongoing, landmark study that has included many thousands of subjects since its inception in 1948. The Times notes that Framingham data clearly demonstrates how higher levels of HDL are actually associated with a decreased risk of heart disease. Dr. Nissen described the recent confusion about HDL as " unbelievable. " I agree completely. I don't believe it. But I believe it WILL help sell statin drugs. ----------------------------- NSPM! ----------------------------- When Dr. Nissen's study was released earlier this month, the media reported the results with fawning respect for the idea that " superdoses " of statins should now be considered the norm in order to drive LDL as low as possible. So with major news outlets getting out the message that statin superdoses should be used, and then two weeks later reporting that you can't depend on HDL to help lower heart disease risk (but you CAN depend on statins), I don't think it's too much of a stretch to go ahead and officially declare March as NSPM; " National Statin Promotion Month. " Just imagine how many people will respond to these reports by asking their physicians to raise their statin dosage. The doctor on TV said it was a good idea. And the guy on the morning show said HDL might not even matter anymore. Imagine! The " good cholesterol " has let us down! Here's the best way to observe NSPM: Ignore the manufactured " confusion " about HDL, and be deeply suspicious of the flawed study that encourages millions of people to start taking large, expensive doses of statins. Because they're both unbelievable. ************************************************************** To start receiving your own copy of the HSI e-Alert, visit: http://www.hsibaltimore.com/ealert/freecopy.html Or forward this e-mail to a friend so they can sign-up to receive their own copy of the HSI e-Alert. ************************************************************** ... and another thing Never say never... A friend sent me an interesting list of quotes this week. Here are just a few: " The abdomen, the chest, and the brain will forever be shut from the intrusion of the wise and humane surgeon " Sir John Eric Ericksen, British surgeon, appointed Surgeon- Extraordinary to Queen Victoria, 1873 " Everything that can be invented has been invented. " Charles H. Duell, Director of US Patent Office, 1899 " There is no reason anyone would want a computer in their home. " Ken Olson, president of Digital Equipment Corp., 1977 " There is no likelihood man can ever tap the power of the atom. " Robert Miliham, Nobel Prize in Physics, 1923 " Heavier than air flying machines are impossible. " Lord Kelvin, President, Royal Society, 1895 " Video won't be able to hold on to any market it captures after the first six months. People will soon get tired of staring at a plywood box every night. " Daryl F. Zanuck, 20th Century Fox, commenting on television in 1946 " This 'telephone' has too many shortcomings to be seriously considered as a means of communication. The device is inherently of no value to us. " Western Union internal memo, 1876. " Such startling announcements as these should be deprecated as being unworthy of science and mischievous to its true progress. " Sir William Siemens, electrical engineer, upon hearing Edison's announcement of a successful light bulb. " Louis Pasteur's theory of germs is ridiculous fiction. " Pierre Pachet, Professor of Physiology, 1872 This list makes me feel hopeful. Just imagine how many healthcare breakthroughs that seem impossible today will simply be part of everyday life in 2104. Who knows? The medical mainstream might even come to recognize the fact that many natural therapies are safer and more effective than prescription drugs. Do I REALLY believe the medical mainstream will come around? I admit, it's a stretch, but never say never. To Your Good Health, Jenny Thompson Health Sciences Institute ************************************************************** Sources: " Scientists Begin to Question Benefit of 'Good' Cholesterol " Gina Kolata, The New York Times, 3/15/04, nytimes.com " Bad Cholesterol Not The Full Story " Robert Bazell, NBC News, 3/16/04, msnbc.com " Comparison of Intensive and Moderate Lipid Lowering with Statins after Acute Coronary Syndromes " New England Journal of Medicine, 3/8/04, content.nejm.org Copyright ©1997-2004 by www.hsibaltimore.com, L.L.C. The e-Alert may not be posted on commercial sites without written permission. ************************************************************** Before you hit reply to send us a question or request, please visit here http://www.hsibaltimore.com/ealert/questions.html ************************************************************** If you'd like to participate in the HSI Forum, search past e-Alerts and products or you're an HSI member and would like to search past articles, visit http://www.hsibaltimore.com ************************************************************** Finance Tax Center - File online. File on time. Quote Link to comment Share on other sites More sharing options...
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