LDL en personas mayores
Hace un par de días mi padre me envió los resultados de su última analítica:
Sin grandes diferencias en los niveles de colesterol respecto de esta analítica del pasado diciembre y un poco mejor que la analítica del pasado marzo. Un colesterol total de 175 mg/dl no parece tan preocupante como los 153 mg/dl anteriores. La glucemia basal nuevamente bajo control (91 mg/dl ahora, 89 mg/dl hace tres meses) y la hemoglobina glicosilada (HbA1C en la gráfica anterior), ha bajado ligeramente hasta 6.1%, en lugar de los 6.3% de las analíticas anteriores. Como mínimo no es mala noticia. Las transaminasas están en rango de normalidad.
¿Algún dato preocupante? Bajo mi punto de vista, la única preocupación en este momento es que cuando mi padre visite al cardiólogo este señor le convenza de que tiene que tomarse una pastilla para bajar el colesterol.
Estudio publicado ayer, que revisa la relación entre colesterol LDL (el supuestamente «malo») y mortalidad en personas de 60 o más años. Conclusión de la revisión de 19 estudios de cohorte: en la mayoría de ellos se encontró que, de forma estadísticamente significativa, cuanto mayor es el LDL, menor es la mortalidad.
Dar por bueno, sin más, el resultado de un metaanálisis es una actitud muy poco rigurosa (ver,ver,ver,ver). Decir que el metaanálisis es otra forma de mentir, no es exagerar (ver). Habría que echar un vistazo a esos 19 estudios, para comprobar que no hay nada raro. La confianza no es buena compañera. No obstante, como ya habíamos visto en el blog este mismo resultado, y ya analicé un número relativamente grande de estudios que planteaban exactamente la misma cuestión y que llegaban a similares conclusiones (ver), no veo razón para dedicar mi tiempo a revisar los que forman parte de este metaanálisis.
Leer más:
No vuelvo a engordar 
Buenas tardes
Aún así, se podría bajar el ldl malo con BORRADO POR EL AUTOR DEL BLOG?
Malos no son y contribuyen a la función normal cardíaca
Que opinas? Gracias
El LDL es mortal y te tienes que tomar la pastilla para bajarlo, sí o sí, pero la relación entre niveles de colesterol LDL y mortalidad es difícil de detectar. Yo no me creo que sean imbéciles: son sinvergüenzas.
Decir que el colesterol LDL es malo, digan lo que digan los estudios científicos, no es una postura demasiado defendible. ¿Qué tal si, en lugar de demagogia, presentan las evidencias científicas en las que se basa el uso de estatinas en personas mayores?
Atentos a los que critican este estudio, pero no critican que se esté medicando a nuestros mayores sin que exista evidencia científica que lo justifique.
Vicente, esto es lo que me llegó ayer en el boletin de Uffe Ravnskov al que estoy suscrito.
Elderly people with high LDL-cholesterol, the ”bad» one, live the longest!
For many years it has been known that high cholesterol becomes a minor risk factor with increasing age. As I pointed out long ago [ http://www.ravnskov.nu/2015/12/27/myth-9/ ] many studies have even shown, that people with high cholesterol live the longest. Supporters of the cholesterol campaign have explained this fact away by claiming that serious diseases, for instance cancer and infections, lower cholesterol. But as I have shown as well, it is just the opposite; low cholesterol predisposes to cancer [ http://qjmed.oxfordjournals.org/content/qjmed/early/2011/12/08/qjmed.hcr243.full.pdf?keytype=ref&ijkey=kZGZxqVjYWEOtoc ] and it also predisposes to infectious diseases [ http://qjmed.oxfordjournals.org/content/96/12/927.full?ijkey=172mwKXqzgmtE&keytype=ref ].
Another misused explanation is, that those with high cholesterol have already died. But this is obviously wrong, because in Sweden for instance, more than 95% of those who die from a cardiovascular disease have passed the age of 60.
Yet another argument has been that as an analysis of cholesterol includes both the “good” HDL-cholesterol and the “bad” LDL-cholesterol, the explanation may be, they say, that elderly people with high cholesterol may have high HDL-cholesterol and low LDL-cholesterol.
Therefore I decided to investigate this question in more detail together with 16 experienced colleagues from various countries, who shared my skepticism against the cholesterol hypothesis. We searched the medical literature after all studies, where the authors had analysed LDL-cholesterol in elderly people representing the general population and followed them for several years. We identified 19 such studies including 30 cohorts (groups of people) with a total of 68 094 individuals age 60 or older.
We have now published our result in the medical journal BMJ Open [ http://bmjopen.bmj.com/content/6/6/e010401.full.pdf+html ] What we found was that in 16 of the cohorts including 92 per cent of the total number of individuals, those with high LDL-C lived the longest; in the rest, no difference as regards longevity was found. Thus, we didn´t find any study having shown that high LDL-cholesterol is a risk factor for elderly people.
We are well aware that it is not easy to question Nobel Prize winners. As you probably know Joseph Goldstein and Michael Brown received the Prize in 1985, but not because they discovered that high cholesterol is the cause of atherosclerosis (which most people think), but because their discovery of the LDL-receptor, the cell door through which LDL-cholesterol enters the cell. But in spite of that, they still maintain, that LDL is “the essential causative agent”. Read for instance their paper published last year [ http://ac.els-cdn.com/S0092867415000793/1-s2.0-S0092867415000793-main.pdf?_tid=edbd911e-2d3f-11e6-b6ba-00000aab0f6b&acdnat=1465366507_1539c4d503b47c0a4ad9f77f4472d7b5 ].
According to The Daily Mail [ http://www.dailymail.co.uk/wires/pa/article-3638103/Link-cholesterol-heart-disease-older-people-called-question.html ], The Telegraph [ http://www.telegraph.co.uk/science/2016/06/12/high-cholesterol-does-not-cause-heart-disease-new-research-finds/ ], The Guardian [ https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0ahUKEwjh5eKSk6TNAhXMC5oKHanZBBoQFgg2MAQ&url=http://www.guardian-series.co.uk/news/national/14552520.Link_between_cholesterol_and_heart_disease_in_older_people_called_into_question/&usg=AFQjCNGBTZpbbHdk6jbg03kEoOwLNVroFQ ], The Times [ https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=33&ved=0ahUKEwjB6uecmKTNAhUIM5oKHfmuAWs4HhAWCCowAg&url=http://www.times-series.co.uk/news/national/14552520.Link_between_cholesterol_and_heart_disease_in_older_people_called_into_question/&usg=AFQjCNEvPNPdvk6KkLpOD54LT5WwQEvCeQ&bvm=bv.124272578,d.bGs ] and more than one hundred other British and Irish newspapers our paper prompted (not unexpectedly) medical opponents to describe the results as «surprising», that we have drawn «completely the wrong conclusion”, that our paper has «serious weaknesses» and is «disappointingly unbalanced”. One of the experts claimed that ”there is nothing in the current paper to support the authors’ suggestions” and ”evidence from large clinical trials demonstrates very clearly that lowering LDL cholesterol reduces our risk of death overall and from heart attacks and strokes, regardless of age.”
It is correct that statin treatment is able to prolong your life with a few days on average, as documented recently in BMJ Open [ http://bmjopen.bmj.com/content/5/9/e007118.full.pdf+html ]by Danish researchers, but it is most likely due to their other effects, not by cholesterol lowering. If elderly people with high LDL-cholesterol live longer than people with low, how could its lowering be beneficial?
You can hear more about the benefits of cholesterol in two interviews with our coauthors Aseem Malhotra and Malcolm Kendrick. The first one is on Sky News [ https://www.youtube.com/watch?v=Vf5MwNXq0SI&feature=youtu.be ]; the other one is on BBC Breakfast [ https://www.youtube.com/watch?v=N2EWZN8NhxQ&feature=youtu.be ]
We are eagerly waiting to hear what we and BMJ Open´s reviewers have ignored.
Uffe Ravnskov
http://www.ravnskov.nu
My previous newsletters [ http://www.ravnskov.nu/newsletters/ ]
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«We are eagerly waiting to hear what we and BMJ Open´s reviewers have ignored»
Los que se ponen la palabra «ciencia» en la solapa no han tardado en criticar el estudio. Siendo que la gente desinformada está siendo ENVENENADA actualmente con estatinas, a cualquier persona mínimamente objetiva debería de preocuparle dónde está la evidencia científica en la que se basa esa práctica médica. Hablar de la abrumadora evidencia o de que son mayoría es faltar al respeto a los pacientes, que no necesitan saber cómo de convencidos están, sino en qué basan sus recomendaciones.
Cuando alguien dice «yo soy la ciencia», cuidadín.
Excelente análisis sobre el HOPE3.