The point of this test is to decide whether to take statins. But statins are a problematic drug, see here: https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...

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asdfj999 6 days ago | parent | next [-]

Statins are a lot like climate change. Two sides, the establishment versus outsiders, each claiming their side is correct, arguing over mountains of data that you can never personally verify.

However, there is zero financial incentive for a physician to prescribe a statin. They are all generic medications. A month prescription is approximately $10.

We do not yet have final word on this topic, we will have a better understanding as time progresses, but until then I continue to recommend statins to my patients with appropriate risk factors, for the same reasons I find climate change credible. The data showing benefit is not just limited to the United States, it is international, and to essentially falsify something involving millions of individuals and thousands of researchers around the world just isn't feasible.

	▲	breadwinner 6 days ago \| parent [-]
		> There is zero financial incentive for a physician to prescribe a statin. Well, doctors make money when they prescribe drugs: Patients will make more doctor visits when they are on prescription medications than if they are not. > The data showing benefit... The reason for the benefit is not fully understood. The argument is that the benefit comes not from lowering cholesterol but from reducing inflammation and stabilizing plaque. The medical community has no incentive to research this because they are raking in money, and any further research could only slow down the gravy train at best.

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derektank 7 days ago | parent | prev | next [-]

Setting aside the fact that the majority of people prescribed them tolerate statins with minimal side effects, there are other therapies besides statins available for treating dyslipidemia such as PCSK9 and ANGPTL3 inhibitors, to say nothing of non-pharmaceutical lifestyle interventions one can make.

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breadwinner 6 days ago | parent [-]

Therapy for what, exactly? Cholesterol? A substance the human body naturally produces because it needs it (cholesterol is a key structural component of every cell membrane in the body)? A substance that has not been conclusively proved to be harmful?

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derektank 6 days ago | parent [-]

Excess LDL and VLDL cholesterol have absolutely been shown to be harmful. We know from studies of familial hypercholesterolemia, a disorder caused by single mutation in the LDL receptor gene, that too much LDL cholesterol directly leads to artherosclerosis and early death from heart disease.

There's a pretty direct analogy to type 2 diabetes and metabolic disease generally. The human body naturally produces blood glucose and we would quite quickly die if our blood glucose levels went to zero. That doesn't mean that hyperglycemia is healthy and in fact, we know it directly causes all kinds of bad health outcomes. We absolutely need some LDL cholesterol, and in our evolutionary history when we faced famine there was probably some selection for people whose livers didn't aggressively metabolize LDL particles from the blood (an energetically costly process), but that doesn't mean that high LDL cholesterol today is safe if you're hoping to live a long life.

	▲	breadwinner 6 days ago \| parent [-]
		If LDL cholesterol is the villain it is made out to be then lowering it — by whatever means — should produce a proportionate reduction in heart disease. It does not (see ENHANCE trial [1]). And yet lowering cholesterol using statins has proved beneficial for people who have already suffered heart attacks. How do you explain this? One explanation is that statins work for these people not because they lower cholesterol but because they reduce inflammation and stabilize plaque. The science behind this is not fully understood. Big Pharma has no incentive to research this because they are raking in money, and any further research could only slow down the gravy train at best. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa0800742

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rsanek 7 days ago | parent | prev | next [-]

not sure I'm gonna trust a medium article that lists NYT and Bloomberg as references over what basically every single cardiologist recommends

	▲	breadwinner 6 days ago \| parent [-]
		Cardiologists don't do their own research. Drug companies do the research, and cardiologists are limited to just trusting the drug companies. So then the question is how trustworthy are the drug companies? Pfizer’s Lipitor raked in $125 billion between 1996 to 2012, becoming the world’s best-selling drug of all time. You don't think drug companies are even a little bit motivated by profits? You are right about one point: You should absolutely not trust a random medium article, anyone can write medium article. Instead you should follow the links, then decide whether the experts quoted in the NYT and Bloomberg articles have a point.

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m_a_g 6 days ago | parent | prev [-]

That’s a horrible article to share as a source. Literally almost everything written there is wrong. What you’re doing is dangerous.

	▲	breadwinner 6 days ago \| parent [-]
		And you're offering nothing to back up your claim. Literally everything written in the article is backed up by sources such as New York Times, which in turn quotes experts in the field. - Is it not true that the existence of a link between high cholesterol and heart disease is only a hypotheses that originated in the 1950s, not a scientifically proven fact? - Is it not true that the FDA generally has not required drug companies to prove that cholesterol medicines (such as statins) actually reduce heart attacks before approval? - Is it not true that lowering cholesterol by different means (i.e., other than statins) is not beneficial, and does that not mean cholesterol is not the villain it is made out to be? - Is it not true that the only large clinical trial funded by the government (rather than drug companies) found no statistically significant benefit at all? What exactly are you saying is wrong?