Cholesterol Levels Can't Be Too Low (report) 
Author Message
 Cholesterol Levels Can't Be Too Low (report)

Cholesterol Levels Can't Be Too Low

TUESDAY, Oct. 11 2005
Very low levels of LDL cholesterol, the so-called "bad" cholesterol,
seem to be safe for heart patients who are taking statins, researchers
report.

Patients taking high doses of statins can see their LDL cholesterol
drop from over 200 milligrams per deciliter past a target goal of 70 to
80 mg/dL to as low as 40 mg/dL. Whether such low cholesterol levels are
safe has been a matter of conjecture.

The findings appear in the Oct. 18 issue of the Journal of the American
College of Cardiology.

"We looked at patients who got to ultra-low cholesterol levels, and
wanted to make sure that was safe," said study co-author Dr.
Christopher P. Cannon, a cardiologist at Brigham and Women's Hospital
in Boston. "We found that it was not only safe, but it was better to
have your cholesterol down in the range of 40 or 50 mg/dL than 70 or 80
mg/dL."

In their study, Cannon and his team collected data on 1,825 patients
who were taking statins after having a heart attack or unstable angina.
Patients were taking 80 milligrams daily of Lipitor.

After four months of therapy, 91 percent of the patients saw their
cholesterol drop below 100 mg/dL. Of these, 11 percent saw their
cholesterol drop below 40 mg/dL, according to the report.

Compared with other groups, those with cholesterol levels of less than
40 mg/dL and those whose cholesterol was in the range of 40 to 60 mg/dL
had fewer heart attacks, strokes, cardiac death, chest pain or
additional heart procedures, the researchers found.

Moreover, there were no significant differences in adverse side effects
from statins, such as muscle, liver or retinal abnormalities, bleeding
in the brain, or death.

"We can feel comfortable using high-dose statins in all high-risk
patients, even if their cholesterol ends up at 40 mg/dL. That's
actually a good thing," Cannon said. "The message is that lower is
better and safe."

One expert believes these results will lower current cholesterol goals.

"I think this is an important direction of our therapy for the future
-- lowering the bar," said Dr. Eric J. Topol, chairman of the
department of cardiovascular medicine and chief academic officer at The
Cleveland Clinic. "And this study helps, validating its remarkable
safety."



Sun, 30 Mar 2008 10:46:14 GMT
 Cholesterol Levels Can't Be Too Low (report)

Quote:
>Cholesterol Levels Can't Be Too Low

>TUESDAY, Oct. 11 2005
>Very low levels of LDL cholesterol, the so-called "bad" cholesterol,
>seem to be safe for heart patients who are taking statins, researchers
>report.

>Patients taking high doses of statins can see their LDL cholesterol
>drop from over 200 milligrams per deciliter past a target goal of 70 to
>80 mg/dL to as low as 40 mg/dL. Whether such low cholesterol levels are
>safe has been a matter of conjecture.

>The findings appear in the Oct. 18 issue of the Journal of the American
>College of Cardiology.

>"We looked at patients who got to ultra-low cholesterol levels, and
>wanted to make sure that was safe," said study co-author Dr.
>Christopher P. Cannon, a cardiologist at Brigham and Women's Hospital
>in Boston. "We found that it was not only safe, but it was better to
>have your cholesterol down in the range of 40 or 50 mg/dL than 70 or 80
>mg/dL."

>In their study, Cannon and his team collected data on 1,825 patients
>who were taking statins after having a heart attack or unstable angina.
>Patients were taking 80 milligrams daily of Lipitor.

>After four months of therapy, 91 percent of the patients saw their
>cholesterol drop below 100 mg/dL. Of these, 11 percent saw their
>cholesterol drop below 40 mg/dL, according to the report.

>Compared with other groups, those with cholesterol levels of less than
>40 mg/dL and those whose cholesterol was in the range of 40 to 60 mg/dL
>had fewer heart attacks, strokes, cardiac death, chest pain or
>additional heart procedures, the researchers found.

>Moreover, there were no significant differences in adverse side effects
>from statins, such as muscle, liver or retinal abnormalities, bleeding
>in the brain, or death.

>"We can feel comfortable using high-dose statins in all high-risk
>patients, even if their cholesterol ends up at 40 mg/dL. That's
>actually a good thing," Cannon said. "The message is that lower is
>better and safe."

>One expert believes these results will lower current cholesterol goals.

>"I think this is an important direction of our therapy for the future
>-- lowering the bar," said Dr. Eric J. Topol, chairman of the
>department of cardiovascular medicine and chief academic officer at The
>Cleveland Clinic. "And this study helps, validating its remarkable
>safety."

I think this is another screwup by a journalist.
--
Jim Chinnis   Warrenton, {*filter*}ia, USA


Sun, 30 Mar 2008 11:58:44 GMT
 Cholesterol Levels Can't Be Too Low (report)

Quote:


> >Cholesterol Levels Can't Be Too Low

> >TUESDAY, Oct. 11 2005
> >Very low levels of LDL cholesterol, the so-called "bad" cholesterol,
> >seem to be safe for heart patients who are taking statins, researchers
> >report.

> >Patients taking high doses of statins can see their LDL cholesterol
> >drop from over 200 milligrams per deciliter past a target goal of 70 to
> >80 mg/dL to as low as 40 mg/dL. Whether such low cholesterol levels are
> >safe has been a matter of conjecture.

> >The findings appear in the Oct. 18 issue of the Journal of the American
> >College of Cardiology.

> >"We looked at patients who got to ultra-low cholesterol levels, and
> >wanted to make sure that was safe," said study co-author Dr.
> >Christopher P. Cannon, a cardiologist at Brigham and Women's Hospital
> >in Boston. "We found that it was not only safe, but it was better to
> >have your cholesterol down in the range of 40 or 50 mg/dL than 70 or 80
> >mg/dL."

> >In their study, Cannon and his team collected data on 1,825 patients
> >who were taking statins after having a heart attack or unstable angina.
> >Patients were taking 80 milligrams daily of Lipitor.

> >After four months of therapy, 91 percent of the patients saw their
> >cholesterol drop below 100 mg/dL. Of these, 11 percent saw their
> >cholesterol drop below 40 mg/dL, according to the report.

> >Compared with other groups, those with cholesterol levels of less than
> >40 mg/dL and those whose cholesterol was in the range of 40 to 60 mg/dL
> >had fewer heart attacks, strokes, cardiac death, chest pain or
> >additional heart procedures, the researchers found.

> >Moreover, there were no significant differences in adverse side effects
> >from statins, such as muscle, liver or retinal abnormalities, bleeding
> >in the brain, or death.

> >"We can feel comfortable using high-dose statins in all high-risk
> >patients, even if their cholesterol ends up at 40 mg/dL. That's
> >actually a good thing," Cannon said. "The message is that lower is
> >better and safe."

> >One expert believes these results will lower current cholesterol goals.

> >"I think this is an important direction of our therapy for the future
> >-- lowering the bar," said Dr. Eric J. Topol, chairman of the
> >department of cardiovascular medicine and chief academic officer at The
> >Cleveland Clinic. "And this study helps, validating its remarkable
> >safety."

> I think this is another screwup by a journalist.
> --
> Jim Chinnis   Warrenton, {*filter*}ia, USA

Good ol' Eric. Anyone still listening to him?

Eric J. Topol, M.D., Chairman, Department of Cardiovascular Medicine,
Cleveland Clinic Foundation, Cleveland.

Member, board of directors of Conceptis Technologies Inc.

Has stock options in Conceptis Technologies.

Editor-in-chief, Theheart.org, an on-line resource owned and produced
by Conceptis Technologies, which provides advice to medical
professionals on heart disease.
( http://www.***.com/ #sponsors; accessed 5/4/05)

According to the New York Times, Topol in early 2005 sent letters
severing his ties to all drug companies in the wake of news accounts
revealing his ties to a hedge fund that was shorting Merck stock.
(Pollack, Andrew. Medical Researcher Moves to Sever Ties to Companies,
New York Times, 1/25/2005, p. C4)

Co-author on the CAMELOT trial, which was sponsored by Pfizer. (JAMA.
2004;292:2217-26.)

Received an annual fee for serving on the scientific advisory board of
Biomedical Value Fund, which is run by Great Point Parters and shorted
Merck stock. (McLean, Bethany. A Bitter Pill For One Merck Critic,
Fortune, 12/13/2004, p. 58)

According to a CME disclosure, consultant for Sanofi and Bristol-Myers
Squibb; grant support from Sanofi, Bristol-Myers Squibb, Pfizer,
Centour, Lilly, the Medicine Company, and Millenium. ("Therapeutic
Challenges in the Treatment of Cardiovascular Diseases" 11/9/2003 CME
disclosure; on file at CSPI)



Sun, 30 Mar 2008 12:06:15 GMT
 Cholesterol Levels Can't Be Too Low (report)
The reporter in the above press story may have quoted Topol M.D., but
his name is not part of the study group (abstract below).

Anything "wrong" with the study M.D.'s?

Seem to me that the point is that:
1. Lower LDL is better and,
2. Higher doses of statins did not produce markedly more side effect
than lower doses.
3. Since there is little no disparity between the dosage costs, where
is the Pfizer {*filter*}?

mp

mp

J Am Coll Cardiol, 2005; 46:1411-1416, doi:10.1016/j.jacc.2005.04.064
? 2005 by the American College of Cardiology Foundation
This Article

FOCUS ISSUE: PROVE IT-TIMI 22

Can Low-Density Lipoprotein Be Too Low? The Safety and Efficacy of
Achieving Very Low Low-Density Lipoprotein With Intensive Statin
Therapy
A PROVE IT-TIMI 22 Substudy

Stephen D. Wiviott, MD*, Christopher P. Cannon, MD, FACC* David A.
Morrow, MD, MPH, FACC* Kausik K. Ray, MD, Marc A. Pfeffer, MD, PhD,
FACC*, Eugene Braunwald, MD, MACC* for the PROVE IT-TIMI 22
Investigators

* Cardiovascular Division, Brigham and Women's Hospital, Boston,
Massachusetts
 The TIMI Study Group, Cardiovascular Division, Brigham and Women's
Hospital, Boston, Massachusetts

OBJECTIVES: This study sought to evaluate the safety and efficacy of
achieving very low calculated low-density lipoprotein (LDL) levels with
intensive statin therapy.

BACKGROUND: Intensive statin therapy reduces clinical events occurring
after acute coronary syndrome (ACS) and may result in LDL levels
markedly lower than guideline levels. Prior epidemiologic and
preclinical studies raise concerns about the safety of very low
cholesterol levels.

METHODS: The Pravastatin or Atorvastatin Evaluation and Infection
Therapy-Thrombolysis In Myocardial Infarction 22 (PROVE IT-TIMI 22)
study compared intensive therapy (atorvastatin, 80 mg) and moderate
therapy (pravastatin, 40 mg) in patients after ACS. Patients treated
with atorvastatin were divided by four-month LDL values into groups:

Quote:
>100, >80 to 100 (reference-range-meeting guidelines), >60 to 80, >40 to 60, and <40 mg/dl. Baseline, clinical, and safety data were compared among groups achieving guideline recommendation levels or lower.

RESULTS: Among 1,825 patients with four-month LDL, 91% were at goal
(<100 mg/dl). The distribution was >80 to 100 mg/dl (14%), >60 to 80
mg/dl (31%), >40 to 60 mg/dl (34%), and <40 mg/dl (11%). Those with
lower LDL levels were more often male, older, and diabetic, and had
lower baseline LDL levels. They had prior statin therapy and fewer
prior myocardial infarctions (MI). There were no significant
differences in safety parameters, including muscle, liver, or retinal
abnormalities, intracranial hemorrhage, or death, in the very low LDL
groups. The <40 mg/dl and 40 to 60 mg/dl groups had fewer major cardiac
events (death, MI, stroke, recurrent ischemia, revascularization).

CONCLUSIONS: Compared with patients treated with an accepted LDL goal
(80 to 100 mg/dl), there was no adverse effect on safety with lower
achieved LDL levels, and apparent improved clinical efficacy. These
data identify no intrinsic safety concern of achieving low LDL and,
therefore, a strategy of intensive treatment need not be altered in
patients achieving very low LDL levels.

Abbreviations and Acronyms
  ACS = acute coronary syndrome
  LDL = low-density lipoprotein
  MI = myocardial infarction
  PROVE IT-TIMI 22 = Pravastatin or Atorvastatin Evaluation and
Infection Therapy-Thrombolysis In Myocardial Infarction 22
  ULN = upper limit of normal



Sun, 30 Mar 2008 14:50:37 GMT
 Cholesterol Levels Can't Be Too Low (report)

Quote:
>The reporter in the above press story may have quoted Topol M.D., but
>his name is not part of the study group (abstract below).

>Anything "wrong" with the study M.D.'s?

>Seem to me that the point is that:
>1. Lower LDL is better and,
>2. Higher doses of statins did not produce markedly more side effect
>than lower doses.
>3. Since there is little no disparity between the dosage costs, where
>is the Pfizer {*filter*}?

My point in the OP was that the science reporting (the journal) was accurate
and talked about super low LDL. But the journalist writing up the science to
make it available to the masses creates the impression that *total
cholesterol* of 40 or so has been found safe and even beneficial.
--
Jim Chinnis   Warrenton, {*filter*}ia, USA


Sun, 30 Mar 2008 22:31:37 GMT
 Cholesterol Levels Can't Be Too Low (report)

Quote:


> >The reporter in the above press story may have quoted Topol M.D., but
> >his name is not part of the study group (abstract below).

> >Anything "wrong" with the study M.D.'s?

> >Seem to me that the point is that:
> >1. Lower LDL is better and,
> >2. Higher doses of statins did not produce markedly more side effect
> >than lower doses.
> >3. Since there is little no disparity between the dosage costs, where
> >is the Pfizer {*filter*}?

> My point in the OP was that the science reporting (the journal) was accurate
> and talked about super low LDL. But the journalist writing up the science to
> make it available to the masses creates the impression that *total
> cholesterol* of 40 or so has been found safe and even beneficial.
> --
> Jim Chinnis   Warrenton, {*filter*}ia, USA

Jim,
I've read several books related to heart disease. In one of those books,
the doctor wrote that about half of the people that die as a result of
heart disease have normal levels of cholesterol. He claims that many of
the people that die as a result of heart disease do so (die) due to
inflammation. Do you agree with the doctor that made this statement. Upon
request, I'll tell you the title of the book and the name of the doctor
that wrote the book related to Inflammation.
I should note that I rarely see "inflammation" mentioned in this and other
medical related newsgroups.
Jason

--
NEWSGROUP SUBSCRIBERS MOTTO
We respect those subscribers that ask for advice or provide advice.
We do NOT respect the subscribers that enjoy criticizing people.



Sun, 30 Mar 2008 23:50:17 GMT
 Cholesterol Levels Can't Be Too Low (report)

Quote:


> >The reporter in the above press story may have quoted Topol M.D., but
> >his name is not part of the study group (abstract below).

> >Anything "wrong" with the study M.D.'s?

> >Seem to me that the point is that:
> >1. Lower LDL is better and,
> >2. Higher doses of statins did not produce markedly more side effect
> >than lower doses.
> >3. Since there is little no disparity between the dosage costs, where
> >is the Pfizer {*filter*}?

> My point in the OP was that the science reporting (the journal) was accurate
> and talked about super low LDL. But the journalist writing up the science to
> make it available to the masses creates the impression that *total
> cholesterol* of 40 or so has been found safe and even beneficial.
> --
> Jim Chinnis   Warrenton, {*filter*}ia, USA

I don't think I'd survive such a drastic lowering. And again, I can't
be the only one. What am I saying we know I'm not the only one. Many
thousands have suffered the ill effects of lowering their cholesterol
so drastically: peripheral neuropathy, memory loss, transient global
amnesia, pancreatitis just to name a few. My first amnesia/memory
symptoms occurred when I first began Lipitor. 10 mg, lowering me from
13 point something to 6.5 in three days. If my LDL was lowered to 40
I'd be dead.


Mon, 31 Mar 2008 01:06:37 GMT
 Cholesterol Levels Can't Be Too Low (report)
maybe someone should revisit the "plieotropic" functions of
cholesterol..the study was 4 Months? given these are {*filter*} prescribed
for one's lifetime, seems a VERY short term study.


Mon, 31 Mar 2008 01:38:55 GMT
 Cholesterol Levels Can't Be Too Low (report)


Quote:
> maybe someone should revisit the "plieotropic" functions of
> cholesterol..the study was 4 Months? given these are {*filter*} prescribed
> for one's lifetime, seems a VERY short term study.

It take about 12 years to get a drug on the market place. That is not a
lifetime unless you are in your 70's.


Mon, 31 Mar 2008 03:04:36 GMT
 Cholesterol Levels Can't Be Too Low (report)
neither is 4 months... and during that 12 yrs. there are no phase IV
studies to determine LONGER TERM effects of {*filter*}--just new studies
attempting to determine "new indications" for the {*filter*} to extend the
patent expiration dates.  m


Mon, 31 Mar 2008 05:25:08 GMT
 Cholesterol Levels Can't Be Too Low (report)
Jason,

It depends on what number you use as "Normal" The current standard of
total at 200 in normal in western societies using a statistical mean of
50 percent. So having below normal still leads to heart disease. If you
take a more isolated non-western lifestyle population such as
Tarahumara Indians whose normal cholesterol is generally under 130,
there is no heart disease. The inflammation theory then becomes
irrelevant. As does HDL levels. This is also why current
recommendations are for total levels under 160 and LDL under 70 or
less.

mp



Mon, 31 Mar 2008 06:58:56 GMT
 Cholesterol Levels Can't Be Too Low (report)
Jason,

It depends on what number you use as "Normal" The current standard of
total at 200 in normal in western societies using a statistical mean of
50 percent. So having below normal still leads to heart disease. If you
take a more isolated non-western lifestyle population such as
Tarahumara Indians whose normal cholesterol is generally under 130,
there is no heart disease. The inflammation theory then becomes
irrelevant. As does HDL levels. This is also why current
recommendations are for total levels under 160 and LDL under 70 or
less.

mp



Mon, 31 Mar 2008 07:00:31 GMT
 Cholesterol Levels Can't Be Too Low (report)


Quote:
> neither is 4 months... and during that 12 yrs. there are no phase IV
> studies to determine LONGER TERM effects of {*filter*}--just new studies
> attempting to determine "new indications" for the {*filter*} to extend the
> patent expiration dates.  m

A newer drug that raises HDL more will take hold of the market in the
future.
I drug would have to been used for years and not so with Vioxx.
When is the UCSD study coming out that would mandate FDA withdrawal of the
statins?
Not going to happen so your 20 year study might in fact come about.


Mon, 31 Mar 2008 07:59:31 GMT
 Cholesterol Levels Can't Be Too Low (report)
First sorry about the double post, hit the post button twice. It's
that statin twitch in my finger.......

"So, it is possible for the average American to eat a healthy diet
and reach those cholesterol levels without taking a cholesterol
lowering drug priced at roughly $100/month?"

Yes, for most people it "possible" not probable though.

"Does the average healthy American have an LDL of less than 70?"

Not even close. I would guess the mean is 110-120.

"Lets define healthy diet as one that adheres to the latest and
greatest cooking.net">food pyramid. "

Pritikin, Ornish way of eating and a few others work. Their  totals
(w/o drug) of under 160 are common.

mp



Mon, 31 Mar 2008 11:55:48 GMT
 Cholesterol Levels Can't Be Too Low (report)

Quote:
> maybe someone should revisit the "plieotropic" functions of
> cholesterol..the study was 4 Months? given these are {*filter*} prescribed
> for one's lifetime, seems a VERY short term study.

Still chuckling.

I love it.  Let's see, plieotropic functions of cholesterol,

- most common molecule in the brain by a factor of 2
- essential to skeletal nerve sheathing
- essential to cell mitochondria
- seems to form a natural pressure bandage when an artery wall is damaged by
inflammation (but sometimes goes too far)
- helps ensure normal neonatal neurological and limb growth

Jump right in folks, I'm sure you can think of more plieotropic functions of
cholesterol...

Then there is a friend's response to the question of what's your favorite
flavor?



Mon, 31 Mar 2008 12:20:06 GMT
 
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