tubby said:
Ironically, you bolded and most confidently stated the one claim in your post that has never been studied clinically. I agree that someone in the situation you're describing (who has already narrowed their treatment lane to statins, progressed to that point, and been on them for years) would likely do poorly to abandon statins at that point from a purely cardiovascular point of view.
Still, "no one" is a pretty broad qualifier. Statins are not the one true drug that all must believe in and proclaim their deference to from the rooftops. They're just another class of drugs with their own mix of pros and cons, like every other class of drug.
As a simple exception to "no one," it's easy to posit someone who is experiencing dementia, finds that symptoms reduce when statins are discontinued, and has decided they would prefer to be able to think more clearly in their final years over letting their cognitive faculties slip away from them just to get an extra year of life in a memory care unit. As arrogant as your typical cardiologist can be, I suspect that even in that case you'd find agreement from them if the family pushed for such a trade off.
It is great to see a lot of people making great progress in improving their health and wellbeing by weight loss, often after lifelong severe obesity. It concerns me that after doing this useful thing , many are making changes to treatment without medical advice that could put them at more risk than they were before they lost the weight, such as ceasing lipid lowering therapy. I realise that I am mostly saying the same thing in these responses, but if explaining it differently makes one more person understand what I am trying to say then it is worthwhile, and I get to vent in the process.
While technically no one has ever done a prospective study directly comparing the effectiveness of GLP medications vs statins for cardiovascular disease prevention, the information required to compare their effectiveness already exists. Without trying to make this into a scientifically correct response with accurate numbers and references as that would take 50 times as long to write, statins, and other lipid lowering therapies are much more effective, and the weight of that evidence is much stronger. No clinician or scientist would dispute that statement.
And it really misses the point of what I am trying to say. I do understand why so many people are disappointed or discouraged by conventional medicines' treatment of obesity, the bigotry shown by many doctors towards the obese, which I have seen first hand from both sides of the aisle, the near total lack of any actually useful treatments until GLP's arrived, given that advice to eat less and exercise more is not wrong but it just does not really work very well and is mostly not actually helpful. And in the US especially lack of access to good quality basic primary care doctors. And worldwide, there are finally , for many , after decades of waiting, there are treatments that actually help -- but you cannot have them as they are too expensive. This last bit probably applies to nearly everyone on this forum. And it certainly pissed me off.
So as a not surprising result people have turned in large numbers to a new black ( or grey ) market for GLP medications, and I am fine with that. But it risks throwing the baby out with the bathwater to reject or ignore the advantages that standard medical treatment offers, such as lipid lowering therapies and hypertension treatment that are some of the most proven treatments to have ever existed, in exchange for a peptide for everything type of treatment that sadly is mostly not backed by scientific evidence.
The purpose of lipid lowering therapy is to prevent cardiovascular disease or to prevent it from getting worse. Preventing heart attacks , strokes, vascular dementia, peripheral vascular disease, heart failure and more.
There are reasons for the existence of prescription drugs, the vast majority of the population do not have the scientific background to read , analyse and critique the science behind most medical treatments. Doctors may not be great at this, but learn a lot of the science and a lot of rules over a long time from other doctors in training to make safe decisions ( nearly all the time ) and specialists definitely need to know the science. Over the past couple of years I have read a lot more medical papers than ever before, hundreds at least in full and many more abstracts, and I found that my previous understanding was really quite limited, despite having a degree in that area and having mostly kept up with developments, to the point that I realise many of my understandings of research from the past were wrong and based on an inadequate understanding of the science. And this is a good thing , realising how little you know of complex fields is how you start to learn more. Now I think I am starting to get to a point where I can have a reasonable understanding of some of the research. But hardly anyone is going to spend anywhere near that much time reading and learning to get to a point where decisions about safety or effectiveness about self treatment can be made. Most people using peptides are making their decisions based on anecdotes from other people online, which is very different to reading the underlying scientific studies, and usually they say different things.
I see a lot of people on this forum rejecting medical therapies, or deciding they are no longer needed due to weight loss, and in many cases this may be correct, but not always, and it would almost always be better to have a medical opinion on whether stopping antihypertensive medication or lipid lowering therapy is a good idea.
For blood pressure, it is easy to measure and if it is consistently less than 120/80, there is no evidence that getting it lower than that helps, so ,,, so long as you do not have known cardiovascular disease or kidney disease then stopping it is probably safe, but getting a medical opinion is still a good idea as they can be used for other reasons like preventing heart failure or kidney failure progression.
Lipids are not as simple, lowering LDL more lowers risk more, and targets are different depending on degree of cardiovascular risk. Generally the lower the better for LDL if absolute risk is high. Target level might be as low as 0.5 to 1 mmol/l or 19 - 38 mg/dl ( US units ) in very high risk persons.
If you have known cardiovascular disease ( by symptoms , history of heart attack, angina, stroke, tia, heart failure, peripheral vascular disease or by testing - calcium score, stress test, ECG, angiography or echocardiography ) then ceasing lipid lowering therapy like statins, because GLP medications can also lower lipids, is a really bad idea, unless an expert has assessed the numbers and agrees, which is unlikely, doing this exposes you to a percentage point or more of extra risk for every year going forwards, and is literally risking your life. Adding GLP medications to usual treatment reduces cardiovascular disease progession more than just usual treatment. So both statins and GLP's are a good idea.
Many people who have, or have had, severe long term obesity that has been improved by GLP medications, are in a very high cardiovascular risk category, with risks as bad as those with known cardiovascular disease. And there are a lot of people on this forum in this position. Obesity even if reversed will most likely have caused damage over time, this cannot usually be fixed but you can stop it from getting worse or from causing illness. Ceasing lipid lowering therapy in this group is just as dangerous as in the group with known cardiovascular disease.
Most people are not going to have any idea what risk group they are in, if you do not know for sure then stopping prescribed statins does not sound like a good idea. Doctors make these assessments all the time and use that to decide if lipid lowering therapy is needed, not just based on lipid numbers, as all the other risk factors like family history, smoking, high blood pressure , diabetes, metabolic syndrome, impaired glucose tolerance, proteinuria, NAFLD/NASH, renal function and age all factor into determining risk. There are online calculators that can give you a pretty good idea.
Self treatment without adequate scientific knowledge is dangerous ( and even with good knowledge ) and in the end people will be harmed by it, there will also be some benefits , but mostly from the GLP medications as they are proven to work. Getting a medical opinion on potentially life risking medical decisions like stopping statin or other lipid lowering therapy, is a good idea. It seems ridiculous to be saying this, but unless you know what your 10 year cardiovascular risk is you should be getting expert advice before making those decisions, otherwise you could be risking your life and health to stop a treatment that for most people has no side effects.
