Posted by ed_uk2010 on December 2, 2013, at 11:27:34
In reply to Re: How ridiculous » Phillipa, posted by sigismund on December 1, 2013, at 22:28:37
> One way I have seen it done is to divide the HDL level by the LDL level (or vice versa).
It can all get a bit theoretical. As far as I know, the correlation between drug-induced HDL increases and the risk of heart disease is not at all clear. Interestingly, HDL seems to (presumably usefully?) rise in people who live a healthy active lifestyle.
Most LDL cholesterol is made in the liver, which is where statins come in... many people have high LDL even on balanced low saturated fat diets. Reducing LDL with statins is more effective than other lipid-modulating drugs, and there's far more evidence that statins actually reduce cardiovascular events and deaths. Take fibrates and ezetimibe, they sure modulate your lipids but whether they save lives is not at all clear.
I generally rate atorvastatin (generic Lipitor) highly because it has so many useful characteristics:
1. Very effective at reducing LDL.
2. Lots of outcome data showings reduced cardiovascular events and deaths.
3. Normally well tolerated.
4. Wide range of doses available if adjustment is needed.
5. Possible to safely initiate at high doses post-MI or ACS.
6. Not expensive.
7. Not as many drugs interactions as older statins.
8. Overall, excellent first choice statin. If it's not effective or tolerable, by all means try another eg. rosuvastatin, or one of the older statins.
9. For pts who have excellent lipid control on atorvastatin, I do not 'buy' the idea than rosuvastatin is magically better. It smells of BS to me. Almost like suggesting that everyone needs the maximum dose of their antidepressant because the overall response rate is marginally better.
10. :)
poster:ed_uk2010
thread:1053481
URL: http://www.dr-bob.org/babble/20131115/msgs/1055209.html