[m_a_g]

> and for good reasons

That prior discussion gives no good reasons. The linked medium posts are, to be frank, trash.

Statins are well-tolerated drugs with little to no noticeable side effects. You might have to try a few. You may need to combine ezetimibe to maintain a moderate statin dosage level, and that's it. (Like the author of this article)

Source: Leading cardiologists worldwide, and doctors of the rich and famous.

[guerby]

What the BMJ has to say on this very topic of statins:

https://www.bmj.com/campaign/statins-open-data

So no settled science here.

Unless you consider the BMJ a trash journal of course.

[davikr]

note: > individuals at low risk of cardiovascular disease

[guerby]

Yes, you're right.

I pointed to this BMJ reference because in the article there is the following: "To help drive down our ApoB, we have statins which do miracles for lipid management. Some people believe that everyone should be on a statin so long as they don’t have adverse side effects."

Most statins prescribed today are not for secondary prevention.

A lot of doctors prescribe a statin immediately on seeing just one measure of "high" LDL without looking at any other parameter or context.

[davikr]

Yeah, for each level of cardiovascular risk (in America, probably calculated with PREVENT) there is a target LDL which should guide whether you should start or not a statin.

[zamadatix]

I recently went on a statin (atorvastatin) and found I have the WILDEST dreams of my life if I don't take them in the morning, and my doctor said my liver readings were elevated after use but not enough he wants to switch it yet. Which alternative statins should I be looking at, or do they have even harder side effects to deal with?

[matthewdgreen]

I have intense anxiety attacks on atorvastatin. Rosuvastatin at the low dose (5mg) doesn’t do much, but at 10mg and 20mg it caused the same effects. It took years and multiple cycles of going on and off the drugs to become confident this was the problem. I switched to Repatha which doesn’t have this problem (it does make me a bit hungry though) but it’s expensive and it took a while for my insurance to approve it.

[lateforwork]

> Statins are well-tolerated drugs with little to no noticeable side effects.

Sorry, that's nonsense. It is a dangerous drug with plenty of side effects. If it had no side effects it would be sold over the counter. The brain needs cholesterol to function. If you artificially remove cholesterol this is what happens: https://www.health.harvard.edu/cholesterol/new-findings-on-s...

[cthalupa]

No, your post is nonsense. You link a random article that doesn't even make the argument that you're making - that it's low cholesterol causing the memory loss - or that statins are causing the memory loss at all.

And considering serum cholesterol cannot pass the blood brain barrier and that it is all synthesized de novo in the brain makes it an even sillier claim. Your serum cholesterol level does not have impact on your brain's cholesterol levels.

Quite a few organs have the ability to synthesize cholesterol as needed and can do so just fine. Another area where we make use of cholesterol is for synthesizing hormones... but those organs can all synthesize it de novo just fine too.

The new pkcs9 inhibitors have gotten people down to extremely low levels of LDL (<30 and <10!) and found no impact to cognition, hormone production, etc. We have mendelian randomization studies looking at people that genetically do not produce pkcs9 and have basically nonexistent serum levels of LDL, no impact to cognition, hormone production, etc.

https://pubmed.ncbi.nlm.nih.gov/36779348/

https://www.ahajournals.org/doi/10.1161/ATV.0000000000000164

https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/201...

https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/201...

[lateforwork]

Memory loss and confusion have been reported with statin use. The FDA makes note of this here:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-d...

FDA requires statins to have warnings about potential memory issues.

There are risks associated with extremely low cholesterol: https://www.webmd.com/cholesterol-management/cholesterol-too...

The human body creates cholesterol because it is essential for several vital biological functions. Cholesterol is a key structural component of cell membranes, providing rigidity and fluidity necessary for cellular function.

[cthalupa]

> Memory loss and confusion have been reported with statin use.

People reporting things doesn't mean much, because as your own original link mentions, people tend to overreport stuff when they are going to the doctor already for other things. What do actual studies that have controls show? We have human RCTs here that have looked at this very thing - and found no evidence of it.

A random article on webmd also says very little when it contradicts the data we have from human RCTs and provides no sources. The trials I linked specifically looked at the common concerns that people have raised as being possibly related to low cholesterol - and didn't find them.

No one is saying that cholesterol isn't essential - your brain literally won't work without it, among many other things. But there is a difference between serum cholesterol levels and its use in in your body. You do not need high serum LDL-C levels for your body to create cholesterol where it needs it.

Those studies I linked quite specifically check for these concerns on people with way lower LDL-C from PKCS9 inhibitors than even combo therapy of statins and ezetimibe will get most people.

[lateforwork]

You can do a "study" to prove anything you want. And study outcomes often do vary depending on who is paying for it. The FDA is a neutral party. I recommend prioritizing the FDA warnings over "studies".

[cthalupa]

The FDA errs on the side of placing more warnings rather than fewer. They'd rather have false positives than false negatives. The warning is also clear that there is not a definitive causal link.

If you want to trust individual anecdotes over RCTs while scare quoting the primary way we advance science in these fields, be my guest.