Statins: His & Hers?

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The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

This is Dr. Barbara Roberts. She’s a cardiologist and the Director of the Women’s Cardiac Center at one of the Brown University Medical School teaching hospitals. She’s an Associate Clinical Professor of Medicine and takes care of patients, teaches medical students, and does clinical research. She specializes in gender-specific aspects of heart disease, and in heart disease prevention.

We previously reviewed Dr. Barbara Roberts’ excellent book “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs”. It prompted some requests to do a main feature about Statins, so we’re doing it today. It’s under the auspices of “Expert Insights” as we’ll be drawing almost entirely from Dr. Roberts’ work.

So, what are the risks of statins?

According to Dr. Roberts, one of the biggest risks is not just drug side-effects or anything like that, but rather, what they simply won’t treat. This is because statins will lower LDL (bad) cholesterol levels, without necessarily treating the underlying cause.

Imagine you got Covid, and it’s one of the earlier strains that’s more likely deadly than “merely” debilitating.

You’re coughing and your throat feels like you gargled glass.

Your doctor gives you a miracle cough medicine that stops your coughing and makes your throat feel much better.

(Then a few weeks later, you die, because this did absolutely nothing for the underlying problem)

You see the problem?

Are there problematic side-effects too, though?

There can be. But of course, all drugs can have side effects! So that’s not necessarily news, but what’s relevant here is the kind of track these side-effects can lead one down.

For example, Dr. Roberts cites a case in which a woman’s LDL levels were high and she was prescribed simvastatin (Zocor), 20mg/day. Here’s what happened, in sequence:

  1. She started getting panic attacks. So, her doctor prescribed her sertraline (Zoloft) (a very common SSRI antidepressant) and when that didn’t fix it, paroxetine (Paxil). This didn’t work either… because the problem was not actually her mental health. The panic attacks got worse…
  2. Then, while exercising, she started noticing progressive arm and leg weakness. Her doctor finally took her off the simvastatin, and temporarily switched to ezetimibe (Zetia), a less powerful nonstatin drug that blocks cholesterol absorption, which change eased her arm and leg problem.
  3. As the Zetia was a stopgap measure, the doctor put her on atorvastatin (Lipitor). Now she got episodes of severe chest pressure, and a skyrocketing heart rate. She also got tremors and lost her body temperature regulation.
  4. So the doctor stopped the atorvastatin and tried rosovastatin (Crestor), on which she now suffered exhaustion (we’re not surprised, by this point) and muscle pains in her arms and chest.
  5. So the doctor stopped the rosovastatin and tried lovastatin (Mevacor), and now she had the same symptoms as before, plus light-headedness.
  6. So the doctor stopped the lovastatin and tried fluvastatin (Lescol). Same thing happened.
  7. So he stopped the fluvastatin and tried pravastatin (Pravachol), without improvement.
  8. So finally he took her off all these statins because the high LDL was less deleterious to her life than all these things.
  9. She did her own research, and went back to the doctor to ask for cholestyramine (Questran), which is a bile acid sequestrent and nothing to do with statins. She also asked for a long-acting niacin. In high doses, niacin (one of the B-vitamins) raises HDL (good) cholesterol, lowers LDL, and lowers tryglycerides.
  10. Her own non-statin self-prescription (with her doctor’s signature) worked, and she went back to her life, her work, and took up running.

Quite a treatment journey! Want to know more about the option that actually worked?

Read: Bile Acid Resins or Sequestrants

What are the gender differences you/she mentioned?

Actually mostly sex differences, since this appears to be hormonal (which means that if your hormones change, so will your risk). A lot of this is still pending more research—basically it’s a similar problem in heart disease to one we’ve previously talked about with regard to diabetes. Diabetes disproportionately affects black people, while diabetes research disproportionately focuses on white people.

In this case, most heart disease research has focused on men, with women often not merely going unresearched, but also often undiagnosed and untreated until it’s too late. And the treatments, if prescribed? Assumed to be the same as for men.

Dr. Roberts tells of how medicine is taught:

❝When I was in medical school, my professors took the “bikini approach” to women’s health: women’s health meant breasts and reproductive organs. Otherwise the prototypical patient was presented as a man.❞

There has been some research done with statins and women, though! Just, still not a lot. But we do know for example that some statins can be especially useful for treating women’s atherosclerosis—with a 50% success rate, rather than 31% for men.

For lowering LDL itself, however, it can work but is generally not so hot in women.

Fun fact:

In men:

  • High total cholesterol
  • High non-HDL cholesterol
  • High LDL cholesterol
  • Low HDL cholesterol

…are all significantly associated with an increased risk of death from CVD.

In women:

…levels of LDL cholesterol even more than 190 were associated with only a small, statistically insignificant increased risk of dying from CVD.

So…

The fact that women derive less benefit from a medicine that mainly lowers LDL cholesterol, may be because elevated LDL cholesterol is less harmful to women than it is to men.

And also: Treatment and Response to Statins: Gender-related Differences

And for that matter: Women Versus Men: Is There Equal Benefit and Safety from Statins?*

Definitely a case where Betteridge’s Law of Headlines applies!

What should women do to avoid dying of CVD, then?

First, quick reminder of our general disclaimer: we can’t give medical advice and nothing here comprises such. However… One particularly relevant thing we found illuminating in Dr. Roberts’ work was this observation:

The metabolic syndrome is diagnosed if you have three (or more) out of five of the following:

  1. Abdominal obesity (waist >35″ if a woman or >40″ if a man)
  2. Fasting blood sugars of 100mg/dl or more
  3. Fasting triglycerides of 150mg/dl or more
  4. Blood pressure of 130/85 or higher
  5. HDL <50 if a woman or <40 if a man

And yet… because these things can be addressed with exercise and a healthy diet, which neither pharmaceutical companies nor insurance companies have a particular stake in, there’s a lot of focus instead on LDL levels (since there are a flock of statins that can be sold be lower them)… Which, Dr. Roberts says, is not nearly as critical for women.

So women end up getting prescribed statins that cause panic attacks and all those things we mentioned earlier… To lower our LDL, which isn’t nearly as big a factor as the other things.

In summary:

Statins do have their place, especially for men. They can, however, mask underlying problems that need treatment—which becomes counterproductive.

When it comes to women, statins are—in broad terms—statistically not as good. They are a little more likely to be helpful specifically in cases of atherosclerosis, whereby they have a 50/50 chance of helping.

For women in particular, it may be worthwhile looking into alternative non-statin drugs, and, for everyone: diet and exercise.

Further reading: How Can I Safely Come Off Statins?

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  • Stop Tinnitus, & Improve Your Hearing By 130%

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Caveat: this will depend on the cause of your tinnitus, but there’s a quick diagnostic test first, and it’s for the most common kind 🙂

    Step by step

    To address noise in the ears (tinnitus) and improve hearing, start by identifying whether the issue is treatable. The diagnostic tests are:

    1. First, turn your head to the side, tilt it forward and backward, and observe changes in the noise. If the intensity changes, then the noise can be managed.
    2. Additionally, open and close your mouth, clenching and unclenching your teeth, and note any variations; this is about muscular tension affecting hearing.
    3. Finally, tilt your head downward—if the noise increases, it may mean it is a venous outflow disorder—there’s a fix for this, too.

    Effective exercises focus on releasing tension and improving blood flow:

    1. Begin with the neck’s scalene muscles, located behind the sternocleidomastoid muscle.
    2. Massage these areas by moving your hands up and down and varying head positions slightly forward and backward.
    3. Repeat on both sides to enhance blood circulation and reduce auditory interference. Next, target the chewing muscles.
    4. Massage painful areas of the jaw and temporalis muscle in circular motions, working along and across the muscle fibers.
    5. Divide the temporalis muscle into sections and address each thoroughly to relieve tension and improve hearing.
    6. Mobilize the outer auditory passage by gently pulling the ear in all directions—starting with the earlobe, middle part, and upper ear.
    7. Focus on the cartilage above the lobe, moving it up and down to restore mobility and improve blood flow.

    These exercises should fix the most common kind of tinnitus, and improve hearing—you’ll know quickly whether it works for you or not. Regular practice is required for sustained results, though.

    For more on all this, plus visual demonstrations (e.g. how to find that temporalis muscle, etc), enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Tinnitus: Quieting The Unwanted Orchestra In Your Ears ← our main feature on this topic, with more things to try if this didn’t help!

    Take care!

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  • Big Think’s #1 Antidote To Aging

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    Why This Video Is Important

    A lot of what we talk about here at 10almonds is focused on healthy aging. We want you – our lovely readers – to not only live for a long time, but also be healthy enough to enjoy that “long time”.

    We’ve talked about anything from Dr. Greger’s eight anti-aging interventions, to the specific benefits of resveratrol or metformin in combatting aging, to even reducing stress-induced aging.

    So, why is this video important? It goes beyond just talking about what we know about living longer, but also focuses on how we should live longer; there’s a big difference between living a long life but never leaving your house vs. living a long life beyond your front door.

    The Takeaways

    The core message that Big Think wants to convey is that our lifestyle is our best bet in slowing the aging process. Our bodies are adaptive systems, responding positively to healthy lifestyle choices. They focus on exercise: regular physical activity increases healthspan, consequently extending lifespan.

    A key takeaway is the difference between physical activity and exercise. While any movement counts as physical activity, exercise is a deliberate, health-focused activity. It benefits the brain by releasing growth factors that strengthen critical areas like the hippocampus and prefrontal cortex.

    The video encourages embracing physical activity in any form available to you, from gardening to walking. The goal isn’t to hit a specific number of steps but to stay active in a way that suits your lifestyle.

    Science may not solve death. Yet. But focusing on maintaining a healthy, functioning state for as long as possible is the real victory in the battle against aging. And, at the moment, exercise seems to be our best bet:

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  • Stop The World…

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Some news highlights from this week:

    “US vs Them”?

    With the US now set to lose its WHO membership, what does that mean for Americans? For most, the consequences will be indirect:

    • the nation’s scientists and institutions will be somewhat “left out in the cold” when it comes to international scientific collaboration in the field of health
    • the US will no longer enjoy a position of influence and power within the WHO, which organization’s reports and position statements have a lot of sway over the world’s health practices

    Are there any benefits (of leaving the WHO) for Americans? Yes, there is one: the US will no longer be paying into the WHO’s budget, which means:

    • the US will save the 0.006% of the Federal budget that it was paying into the WHO annually
    • for the average American’s monthly budget, that means (if the saving is passed on) you’ll have an extra dime

    However, since US scientific institutions will still need access to international data, likely that access will need to be paid separately, at a higher rate than US membership in WHO cost.

    In short: it seems likely to go the way that Brexit did: “saving” on membership fees and then paying more for access to less.

    Why is the US leaving again? The stated reasons were mainly twofold:

    1. the cost of US membership (the US’s contribution constituted 15% of the the overall WHO budget)
    2. holding the US’s disproportionately high COVID death rate (especially compared to countries such as China) to be a case of WHO mismanagement

    Read in full: What losing WHO membership means for the U.S.

    Related: What Would a Second Trump Presidency Look Like for Health Care? ← this was a speculative post by KFF Health News, last year

    Halt, You’re Under A Breast

    More seriously, this is about halting the metastasis of cancerous tumors in the breast. It is reasonable to expect the same principle and thus treatment may apply to other cancers too, but this is where the research is at for now (breast cancer research gets a lot of funding).

    And, what principle and treatment is this, you ask? It’s about the foxglove-derived drug digoxin, and how it stops cancerous cells from forming clusters, and even actively dissolves clusters that have already formed. No clusters means no new tumors, which means no metastasis. No metastasis, in turn, means the cancer becomes much more treatable because it’s no longer a game of whack-a-mole; instead of spreading to other places, it’s a much more manageable case of “here’s the tumor, now let’s kill it with something”.

    Note: yes, that does mean the tumor still needs killing by some other means—digoxin won’t do that, it “just” stops it from spreading while treatment is undertaken.

    Read in full: Proof-of-concept study dissolves clusters of breast cancer cells to prevent metastases

    Related: The Hormone Therapy That Reduces Breast Cancer Risk & More

    Force Of Habit

    “It takes 21 days to make a habit”, says popular lore. Popular is not, however, evidence-based:

    ❝This systematic review of 20 studies involving 2601 participants challenges the prevailing notion of rapid habit formation, revealing that health-related habits typically require 2–5 months to develop, with substantial individual variability ranging from 4 to 335 days. The meta-analysis demonstrated significant improvements in habit scores across various health behaviours, with key determinants including morning practices, personal choice, and behavioural characteristics

    So, this is not a lottery, “maybe it will take until Tuesday, maybe it will take nearly a year”, so much as “there are important factors that seriously change how long a habit takes to become engrained, and here is what those factors are”.

    Read in full: Study reveals healthy habits take longer than 21 days to set in

    Related: How To Really Pick Up (And Keep!) Those Habits

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  • Tuna vs Catfish – Which is Healthier?

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    Our Verdict

    When comparing tuna to catfish, we picked the tuna.

    Why?

    Today in “that which is more expensive and/or harder to get is not necessarily healthier”…

    Looking at their macros, tuna has more protein and less fat (and overall, less saturated fat, and also less cholesterol).

    In the category of vitamins, both are good but tuna distinguishes itself: tuna has more of vitamins A, B1, B2, B3, B6, and D, while catfish has more of vitamins B5, B9, B12, E, and K. They are both approximately equal in choline, and as an extra note in tuna’s favor (already winning 6:5), tuna is a very good source of vitamin D, while catfish barely contains any. All in all: a moderate, but convincing, win for tuna.

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    In short: tuna wins the day in every category!

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