A very well-informed patient asked me to compare my position to that of Dr. David Diamond on statins, as done on STEM Episode #41.

https://www.youtube.com/watch?v=DpZIX...

He calls Ancel Keys a bully and blames him for 50 years of wrong dietary advice. I think David D is right. No argument. I just did a series on this.

https://www.youtube.com/watch?v=Ua3ZL...

https://www.youtube.com/watch?v=KRxUC...

Dr. Diamond says LDL is NOT the biggest risk. This is another area where I agree 100%.

https://www.youtube.com/watch?v=D5-r2...

He says statins have risks. I agree with that. I have a lot of videos on that.

https://www.youtube.com/watch?v=qaoCY...

Diamond quotes Paul Ridker MD at Harvard in saying our standards overestimate the risk of LDL. I Agree. LDL is nothing in terms of risk compared to low HDL, or the big one- diabetes.

Dr. Diamond knows that the exception is a genetic condition call Familial Hypercholesterolemia. We agree here as well.

He says the genetic test for statin value is not very practical. We agree here as well.

We also agree that lifestyle is far more important than drugs.

Here's where we part company. Even the beginning part I agree. He says that ABSOLUTE RISK is totally different from RELATIVE RISK. He says he's offended that the JUPITER study reports RELATIVE RISK, rather than ABSOLUTE RISK. The PI of this study has been quoted many times by Dr. Diamond - it's Paul Ridker.

I quote others on this issue. Here's the problem; RELATIVE RISK only translates to absolute risk if the incidence of the disease is high. In JUPITER, it was 50 yo apparently healthy men (and healthy 60 yo women). Dr. Diamond and I also agree on this: I don't recommend a statin for 50 yo men with no apparent risk - no plaque, no calcium in their arteries, no cv inflammation. But for a 67 yo with IR, cv inflammation, hypertension, (many with a positive history of an event)

- we have a totally different story.