Wednesday, 1 October 2008

Crabsallover News on Statins

Conclusion: Retake Cholesterol and blood pressure tests. The case for taking statins seems very positive.

Between November 2006 and February 2007 I reviewed use of statins (Crabsallover blog).

Main findings were:

  • 15% risk of Coronary Heart Disease over next 10 years (Nov 16 2006).
  • risk of depression from statins is about 1.4 per cent (Nov 30 2006)
  • supplements of coenzyme Q10 can prevent or minimise adverse effects of statins such as induced muscle pain and fatigue (Nov 30 2006)
  • reduce the chance of a heart attack or stroke by a third, yet causes no serious side effects. (Nov 30, 2006)
  • statins have been prescribed only to people with high cholesterol levels. But the study showed that even people with low levels benefited. That means doctors should dish them out to far more people. (Nov 30, 2006)
  • existing guidelines on prescribing statins to be ripped up. "The default has changed, so doctors should now ask if there's a good reason not to give the drug," he says. It may not even be necessary to measure cholesterol levels beforehand. (Nov 30, 2006)
  • the BMA is recommending caution despite the spectacular results. "It's still possible there might be long-term effects that might not yet have come to light," (Nov 30, 2006)
  • researchers didn't see any sign of the muscle wastage that in August led to the withdrawal of Baycol, a statin made by Bayer of Germany. (Nov 30, 2006)
  • a growing number of people who say they have suffered from amnesia and other nervous-system side effects after taking statins ... "No one should be discouraged from taking a statin because of such anecdotal reports. The benefits of statins far outweigh any possible risks." (Nov 30, 2006)
  • seven per cent of statin takers end up having more heart attacks and cardiovascular disease due to their weak response to the drug.... DNA for single polynucleotide polymorphisms (SNPs), DNA sequences which are used to track genetic differences between people. In patients with two particular SNPs, both located in the gene for HMG-CoA reductase, statins were 20 per cent less effective at lowering total cholesterol and low-density lipoprotein. (Nov 30, 2006)
  • reduction in Alzheimer’s Disease (Dec 29, 2006)
  • in your 40s, feel right as rain, normal blood pressure, normal cholesterol, pretty good diet, occasional exercise. How would you react if your doctor suggested you take a powerful drug every day for the rest of your life? The drug, known as a statin, will lower your cholesterol even further and reduce your risk of a heart attack or stroke. According to one recent estimate, most men and many women over 40 could benefit from the drugs. If you are worried about side effects, your doctor will reassure you that a meta-analysis that pooled data from 14 trials involving more than 90,000 people shows the treatment is very safe.... If you are worried about side effects, your doctor will reassure you that a meta-analysis that pooled data from 14 trials involving more than 90,000 people shows the treatment is very safe. ... "Lowering cholesterol is beneficial in pretty much everyone who has been studied,"..... we don't know enough about the possible adverse effects of taking them over a lifetime. .... "Some doctors, however, are alarmed by the trend towards dishing out statins to millions more people and giving higher dosages to lower cholesterol even further. They say the benefits for those who do not already have heart disease are small, while the potential risks are largely unknown. "What price should you pay for a modest effect?" Sutter asks. "The price shouldn't be very high because the effect is weak at best." A 20 per cent reduction in cardiovascular risk may sound impressive, but it doesn't look quite as good when you realise what it means for each individual: if your risk of having a heart attack over the next five years is 5 per cent, say, then taking statins will reduce it only to 4 per cent.".... "Sutter and others say that statin researchers have failed to report adverse effects in enough detail to allow doctors and patients to weigh the potential costs against the benefits. "There's no good reporting of adverse effects at high doses and very modest reporting even at moderate doses,"... "Alleged side effects include memory loss, extreme irritability, aggression, suicidal impulses and impotence. Evidence for these remains sketchy, however, coming from small trials and case studies. Statins do cause liver damage in around 1 per cent of patients, but this should be picked up by routine liver function tests and can be reversed by coming off the drugs. It is also clear that statins can damage muscles. As many as a fifth of people taking the drugs in trials say they experience some muscle weakness or pain, and exercise seems to make things worse. These symptoms are commonplace anyway in middle-aged and elderly people, however, and a similar number of patients taking a placebo also report them. So it is difficult to determine the exact extent of the problem. ".... "In very rare cases statins cause rhabdomyolysis, a severe form of muscle damage in which the breakdown products cause kidney failure. .... "Confusingly, some small studies have hinted that statins increase the risk of cancer while others suggest they may guard against it. .... "Yet even the more conservative guidelines will lead to millions more people taking statins for the rest of their lives, often starting younger or being given higher doses. You could be one of them. If the advocates of statins are right, this policy will come to be seen as a triumph for preventative medicine, saving tens of thousands of lives. If the critics are right, for those with a low risk of heart disease statins could do more harm than good. Which will you bet your life on when your doctor mentions the s-word? " (December 31, 2006)
  • individuals with a 1% risk of heart attack or stroke, 35 or older, could benefit from taking statins to lower cholesterol. ... (Jan 4, 2007)

  • number of lives saved through cholesterol-busting drugs called statins had tripled since 2000 to 9,700 in 2005. (Jan 5, 2007)
  • It is expected that 50% of Scottish men and 20% of women over the age of 40 could be prescribed cholesterol-lowering statins. (Feb 6, 2007)
  • current risk of CVD is 8%, 30% reduction in LDL cholesterol (from 3 to 1.9 mmol/l), 24% reduction in total cholesterol (from 5.1 to 3.88 mmol/l), reduce risk of CVD by 25% - from 1 in 12 (8%) to 1 in 17 (6%) over 10 years, Fibrates or Nicotinic acid treatment targets (after initial statin treatment), Reduce CVD risk to 5% (1 in 20) by increasing HDL cholesterol to medium levels (1.34 mmol/l), Reduce CVD risk to 4% (1 in 25) by increasing HDL cholesterol to high levels (1.73 mmol/l), Reduce CVD risk to 3% (1 in 33) by reducing systolic blood pressure from 130 to 108 mmHg by improving diet and increasing exercise (Feb 9, 2007)
  • statins makes people less likely to develop late-onset Alzheimer's (Feb 17, 2007)

No comments: