Podcast on the LMHR study with the lead researcher...who recommends statins for some

(Bob M) #1

This is a Metabolic Mind podcast with the lead researcher of the LMHR study, where they looked at atherosclerosis in lean, metabolically healthy people with (very) high LDL on a keto diet:

If you don’t know, what happened was that neither LDL nor ApoB predicted plaque growth. In fact, some people with insanely high LDL/ApoB had plaque regression. Instead, what they found was that people who started with plaque had more plaque progression. Start with no plaque, don’t get progression; start with plaque, get progression.

The lead researcher says that he’d look into starting statins for people with plaque, stating that statins have been shown to stop plaque progression and even to reverse progression. (My note: I thought that stains caused advances in CAC score? And they didn’t stop progression or reverse progression? I’ll have to do more research.)

Anyway, yet one more thing to consider if you are keto, get high LDL. You should get a CAC scan done. If your score is zero or low, there’s likely low risk. If your score is high(er), then you should consider your options.

Personally, I’d like to see if there’s anything these people with plaque progression are doing or if there’s any similar genetics or something else indicating why the plaque is progressing. Because if it’s not LDL/ApoB, then what is it?

My notes: here’s a study where’s there’s an association between taking statins and higher CAC scores over time:

The problem: maybe the people who are taking statins are the ones causing the higher scores. In other words, it’s the people, not the statins. Not sure, because the study isn’t an RCT (have one group not on statins and one group put on statins - preferably before calcification - and follow them),

(Joey) #2

The study @ctviggen cites above is interesting, but I remain unconvinced it found a meaningful link between statin use and increased risk of arterial calcification. I agree with his thought that it’s the people, not the statin.

First, the increased association (in terms of “OR”) is fairly weak … not much above the 2x multiple laid out by Bradford Hill for whether there’s a hypothesis that’s even worth actual testing.

And then there’s the population: all bordering on obese (based on BMI), significant proportion of whom have T2D, roughly half of whom are smokers, three-quarters of whom have high blood pressure, and about half of whom already have “high” atherosclerosis risk in the first place.

It would seem the conclusion that statin use is an exacerbating factor in promoting arterial calcification, given these confounding factors and “lackluster” (my interpretation) correlations of elevated association risk, is a bit of a stretch.

Statistically meaningful? Perhaps, perhaps not.
Clinically meaningful? I remain skeptical.

I’m not a fan of statins, but am not ready to conclude they actually make calcification worse. Possible, but this study doesn’t seem to advance knowledge on this question.

(Edith) #3

Sigh … everything is always so complicated. Just conjecturing here, but inflammation is a contributing factor to plaque build up. It’s possible that the people with the plaque progression have something else going on with their lives: more stress, poor sleep, unknown food intolerances, environmental stressors…:woman_shrugging:

(Denise) #4

Just now saw this post @ctviggen I so appreciate it right now. My DO said that a CAC test may not be very accurate if I’m on a statin, but little does she know, I’m not taking her damn drug. But here I am seeing there may be a valid reason for people to take it, I just hope I won’t have to.

If I don’t hear from “imaging” by Friday, I will call to see if I’m scheduled in for CAC which my doc did order for me, supposedly. The “imaging” is pretty slow to get people in for tests here though, so I’m usually patient. It goes without saying really, that I am anxcious to see if I have any plaque. Some test showed (coratoid artery) I had little to none, but the CAC is something I have failed to ever set up for myself.

(Alec) #5

I contend that this is bollox, just his opinion. Did he provide study references?