Statins - miracle or menace?

[hugh flung_dung]

Having had a medical hiccup it's been suggested that I should take statins (despite not having high cholesterol) on the basis that there is apparently some evidence that they are generally a "good thing". When I look around I see people saying they're dreadful, cause memory loss, and might be the cause of nearly half the world's ailments.

What's the opinion of the medical pilot community on statins? (references to back-up assertions would be good!)

[gingernut]

The evidence for their use is strong.

Medicine generally tends not to extend life. It's got it's place when one get's mangled up on the M6, put apart from that, there are only a few occasions when it actually makes much of a difference.

Immunisations work well, the "golden hour" saves a few lives, and fiddling about with peoples blood pressure/sugar levels may make a bit of a difference.


The other stuff we spend your money on could perhaps be spent on other areas.

Statin's however, seem to save lives. The odd recipient may suffer liver problems/ muscle problems, but in reality I haven't seen much evidence of this, and nowadays, the monitoring we use, seems to pick these problems up quickly.

They do seem to have a "magical" effect that we perhaps don't understand just yet.

Should we just tip them in the water?

[obgraham]

It's unfathomable to me why anyone would be offered statins in the absence of a lipid problem.

But I'm sure there is a segment of my profession that thinks it would be a good idea.

A dozen years ago it was conventional wisdom that hormone replacement therapy should be offered to every woman at that stage of life. How'd that work out?

Graham MD

[dirkdj]

I stopped taking statins a year ago; I feel considerably better now. Statin Drug Side Effects - Main Menu (http://www.spacedoc.com/statin_side_effects)

[gingernut]

I suspect the issue surrounds itself around the arbitrary number given to when lipids become a "problem."

In secondary prevention, (ie when you've already had your heart attack/stroke), reduction in lipid levels (irrespective of starting point) seems to reduce further events.

Primary prevention (ie preventing events in those who are otherwise healthy), does also seem to be supported by a robust body of evidence, although I'd be the first to admit that the tools designed to take into account other factors such as smoking, age, family history, blood pressure etc) are far from perfect.

But don't just take my word for it:) CG67 Lipid modification: full guideline (http://guidance.nice.org.uk/CG67/Guidance/pdf/English)

[obgraham]

It seems to me, gingernut, that it's another example of pulling together a committee, then coming up with a recommendation that keeps the majority happy. So it was decided that seeing as how the downside of drug therapy is low, the threshold for treatment could be lowered. And then if you lower it enough, then everyone over 50 will have a 10 year cardiac disease risk high enough to cross the threshold.

Unfortunately history shows that in most of medicine if you think you have the final answer, it'll turn out in the future to be completely wrong. (Think "mammograms" and "PSA")

And today we are often guilty of assuming that the most recent "study" is correct, even if it negates the previous 25 studies. That's usually because the recent study was not one at all, just a "meta-analysis" (i.e. a rejiggering of the data).

Rant off. I'm late for bed!

[homonculus]

There is good objective evidence for statins

First they reduce cholesterol in people with hi levels and this is shown to be beneficial

There ae also two large studies showing that if given to people with normal cholesterol and no increased risk factors, the death rate from strokes and heart attacks was reduced

A large multi centre study coordinated by Oxford was released two weeks ago. It not only confirmed this but also clearly showed that the only significant side effect was myalgia or muscle pains which is a condition that stops if you stop statins

Sadly people will say statins are pushed by drug companies or committees but the science speaks for itself. Of course everyone can make up their own mind and there is no compulsion to take them but it verges on the immoral to frighten people from taking them when the evidence does not support this stance

[gingernut]

It's refreshing to meet someone as cynical as myself obsgraham. I'd agree there is never "the final answer," provided by research, and of course, we can never "prove" or "disprove" our interventions absolutely, but I think where we have moved on, is that we are using more robust evidence, relying on realistic outcome measures, (such as the Grade 1 RCT's in statin intervention), and are less likely to rely on studies of poor design, using proxy outcome measures (which don't translate to clinical benefit), or even worse "expert opinion."

A meta analysis or systematic review shouldn't automatically refute the past 25 studies, it should add collective weight to the accuracy (or innacuracy) of the previous studies.

The RCGP stuff I cited does rely on high quality studies.

The decision to offer statins to those of CVD risk of 20% or above (in 10yrs), was made by a committee- I suspect this was made on the basis of cost, rather than clinical effectiveness, and I accept,the method we use to establish the risk calculation is far from perfect. (Although better than what we had before.)

[cavortingcheetah]

Once you've been on a statin such as Crestor for a while, the evil cholesterol levels within you will begin to decrease.
When you've been on Crestor for a long time, the furring of the arteries, caused by the previously mentioned nasty cholesterol, will slowly begin to reduce.
Something else will kill you when you least see it coming but anything which reduces the chances being a stroke victim and unable to get along to Dignitas is to be taken with relish if not tomato sauce and tabasco.

[aviate1138]

I was told my local surgery's computer had decided I should take Pravastatin. I pointed out my Cholesterol level was 3.9 so did I need it? Well I was persuaded I would benefit from its use. Since taking it my hair has fallen out at a much quicker rate than normal, I have massive muscular pains and at present have a particularly nasty intercostal muscle [right side] that has spasms that make me gasp [squeak loudly!] in pain. I am cutting down over a 4 week period and telling my doc when it is done. My arteries are apparently 'clean and clear of any clag' according to my cardio.

Onward and upward.

[gingernut]

Get your CK (Creatine Kinase) levels checked.

CK and statin treatment - General Practice Notebook (http://gpnotebook.com/simplepage.cfm?ID=x20030225045838821100&linkID=66711&cook=yes)

:)

[hugh flung_dung]

Thanks for the link to the guidance document; it isn't exactly a fun read but I got through the majority of the bits that seemed relevant. Having read the guidance I didn't feel convinced that the evidence was sufficiently strong for someone with "normal" cholesterol levels to risk the side effects (documented in spacedoc.com, gpnotebook and elsewhere), especially as the reported beneficial mechanism for this group seems not to be fully understood.

Maybe this is a case of a (very) little knowledge being a dangerous thing, but ... I was confused by a couple of statements in the GPnotebook guidance: "It is hypothesised that there are two types of atherosclerotic lesions: atherotic (soft, lipid rich, there is often inflammation which destabilises the plaque's fibrous cap, the risk of plaque rupture makes these dangerous) and sclerotic (hard, collagen-rich, these are safe). The statin family of drugs alters the characteristics of the lipid core and reduces inflammation. The fibrous cap is stabilised preventing rupture. The total volume of the plaque may remain unchanged." Yet it also says: "... however, no statistically significant differences were seen for cardiovascular mortality or stroke". Elsewhere I've read that a rupturing atherosclerotic lesion can lead to stroke so if the hypothesis about statins stabilising the lesion is correct why has no significant improvement in stroke rate been seen?

[gingernut]

hugh flung, it's a little difficult to give specific advice to someone via this forum.

I'm imagining that you've been prescribed pravastatin for a very good reason, (ie you've suffered some type of "event" already), as pravastatin isn't generlly used in primary prevention. It is important that you communicate your concerns to your docs.

My comment about pouring the stuff in the water does have to be taken with a pinch of salt, statins have been associated with serious side effects, muscle damage and liver damage being the ones that spring to mind.

I'm involved with statin prescribing/monitoring on a daily basis, and whilst I've seen the benefits of statin prescribing, (ie less people dropping dead or becoming disabled through stroke and heart disease), I don't think I've ever come across a case of statin induced muscle damage or liver problems.

Having said that, it is important to differentiate between a side effect, (eg aching legs) and disease (eg rhabdomyolysis), and your clinician should, hopefully have monitoring systems in place to detect these.

I haven't the expertise to answer your question about the nature of the atherosclerosis, but in a way, it's of secondary importance, as the outcome (ie reduction of risk of further "event") is more important than the process behind it. (We know it works, were not quite sure how.)

Statin use does prevent stroke. CVA and lipids - General Practice Notebook (http://gpnotebook.com/simplepage.cfm?ID=x20060219225148725580)

As ever, patient choice reigns, its our job to give the facts as accurately as we can given the knowledge we have at the time. (It may all change again next week!).

Good health,

ginge.:)

[hugh flung_dung]

Thanks gingernut. To be clear: I'm not looking for advice (just to understood what's on each side of the risk/benefit balance) and I haven't been prescribed anything (it's been suggested that a statin might be beneficial, despite not having high cholesterol levels).
That link is very positive about the benefits of statins but the NICE guidance - statins for the prevention of cardiovascular events (http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20060329134717258590) says "for patients without clinical evidence of CHD, statins significantly reduced all-cause mortality ... however, no statistically significant differences were seen for cardiovascular mortality or stroke". To a medical layman this seems to be at odds with the guidance in the "CVA and Lipids" guidance - what have I missed?
If there isn't a known mechanism, and the stats don't show any significant differences, then what's the compelling evidence that justifies the risk of even minor side effects?

HFD

[gingernut]

"primary prevention for patients without clinical evidence of CHD, statins significantly reduced all-cause mortality, fatal MI and non-fatal MI in the meta-analysis carried out for the NICE appraisal however, no statistically significant differences were seen for cardiovascular mortality or stroke" Yes, it seems a confusing stance. As far as I can gather, statistical significance concerns itself with academic "proof" (ie more than 95% sure of certainty-or more technically, less than 5% percent of innacuracy), whereas the bottom line revolves around "clinical significance," ie the ability to to do what it says on the tin. It works the other way round as well. I once looked at some statistics around smoking cessation-the intervention showed a statistically significant difference in the number of cig's smoked-when we looked at this in more detail, the amount of cig's smoked was reduced from 20 a day, to 18. Statistically significant-yes, clinically significant-no. (in other words, the cig's will still kill you.) I think I've got the correct end of the stick, there's a really good BMJ book that can probably explain things better than me, or perhaps an Academic would care to step into the breach :-) It's important to note that the statement concerns itself with chd/cva MORTALITY only. I'm wondering if it means "no proof of effect" or "proof of no effect" (Very different things.) Notably, statins reduce "all cause" mortality, and I'm assuming, chd/cva MORBIDITY, which I guess is the ultimate bottom line.

Thanks for the questionning, it's good to shake around the grey matter.

[obgraham]

As you correctly surmised, ginge, I am a true cynic. And somewhat of a therapeutic nihilist.

My concern on this issue is that, faced with potential cost savings by encouraging widening use of statins, the boffins will tend to cherry-pick the statistics to support their agenda. That's why I am skeptical of our current love of meta-analysis. Mr. Dung quite accurately picked up on the deficiency in the mortality question.

And, as we've often pointed out, mortality still remains at 100%.

[gingernut]

And somewhat of a therapeutic nihilist.

I had to google nihilist, and I'm not quite sure I understand it still, but I guess we are probably p*ssing in the same bucket. (A Manchester term.)

Definition of a pessimist?

An experienced optimist:)


time for bo bo's.:p

[obgraham]

Well, Ginge, you know, I do come by my cynicism honestly.

I was, after all, born in Preston!

**: Therapeutic nihilist: one who thinks doing nothing is often as good or better than doing something. Especially involving pharmaceuticals. And some kinds of cancer.

[aviate1138]

Saw my doc who looked at my records [over the last ten years my cholesterol level has been in the lower half of acceptable levels and as I have atrial fibrillation and can no longer fly [bugger!] and am taking a series of drugs to help the AF he has stopped the statin intake. :)

[slowjet]

And that good mate of mine, diagnosed with Diabetes type 2, prescribed statins wound up in dreadful pain (lower lumbar region), pissing tar coloured urine ,investigated for all sorts of other things like kidneystones, took action himself & threw the damned medication down the toilet. He has never felt better, looked better & has little to recommend the medical profession. Oh, he once worked as a Medical Sales Rep & knows the inducements offered to GP's by the pharmaceutical giants. we have to suffer this lot every six months & they have the power to wrongfully diagnose, wrongfully prescribe dangerous drugs & potentially wreck the professional careers of pilots. For my other mate, having passed his Class One Medical (enhanced requirement as he was over the age of 60), wound up in ICU with double kidney failure just weeks later. Oh, he died.

[homonculus]

Slowjet

You obviously have been close to people who have had medical problems and may or may not be justified in blaming doctors. Doctors make mistakes just like pilots. However, you are not justified in claiming nonsense about the pharmaceutical industry inducing GPs. This stopped over 20 years ago. Drug companies can't give doctors anything now. I am not a GP but such abject rubbish does your argument no credit

[gingernut]

Ok, this is a challenge to any of homonculus's patients. I bet there is some drug company reference somewhere in his or her office. (Look at the clock, everyone's got a Lisinopril clock.)

All joking apart, the inducements to GP's are probably few and far between, the Medicines Management Gestapo regulate this sort of thing robustly. I suspect it's still more of a problem in secondary care, loss leaders still seem to filter down to us in primary care-(who usually take on the role of life long prescribing.)

Although bodies such as NICE and the other quango's that have gone bust get knocked, they were initially very effective at spending tax payers on interventions which improved health. (They got a bit wooly in the end though.)

Oh well, time to strengthen 'me teeth with having a glass of flouridated water. (Bloody mass medicators.)

[Light]

Hi

Your number one priority in life while being on any kind of chronic subscription medicine should be to get off from it. Do not take the statin drugs, it is bad sceince and any doctor prescribing you statins have already given up on you!

The medicine will eventually stuff up your biochemistry i.e. "side effects"...you can easily and 100% take care of your health the natural way with no side effects...period!

"I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect"...taken from the Hippocratic Oath.
I am amazed how doctor's do not apply this oath.
The word "money" and ignorance rings a bell.

Air Traffic Controller
Massive heart attack in 2007, 3 stents
Completely off "Western Medicine" since Dec 2011
I only do Nutritional supplementation and lifestyle change(easy)
I have never felt so healthy since stopping all pharmaceutical and prescribed medicine!
If you want the facts and science, then speak to a Biochemist.

Blessings

[obgraham]

Light:
First: calm down. This is a web-board, not a courtroom.

Second: If you truly believe that chicanery outweighs productivity in the regular medical fields, then you must be ignoring the vastly greater amount of deception, greed, and out-and-out quackery that goes on in the area of "alternative medicine". In the absence of any scientific methodology, you are essentially your own experimental trial.

Good luck with that.

[homonculus]

Hi Gingernut

No no clock or pen or anything else. In secondary medicine we no longer get to meet reps and get no free lunches. The companies themselves are so strictly controlled. I not infrequently go for a social meal with reps I know via my partner and who sell products I can never even access let alone prescribe in my specialty. I have to buy them dinner as they can't be seen to buy me a meal even from their own bank account

And so Light I find your comments offensive. I practice medicine to the best of my ability based on science. I have never accepted money to prescribe a particular treatment nor indeed has it ever been offered. The suggestion that I might is below the belt and unprofessional. you may want to ignore scientific evidence obtained by blinded research from Oxford University over many years, and you are Welcome to avoid modern medicine and return to a
World where life expectancy was only 49 just a century ago. But if you want to accuse the medical profession of corruption and effectively harming patients please provide the evidence or go back to the day job

[etrang]

...you can easily and 100% take care of your health the natural way with no side effects...period!

Don't forget the natural tin foil hat, light. Remember, shiny side out.

[ausdoc]

Hang on a minute there Light. I am detecting an element of hypocrisy here. First you say you can easily and 100% take care of your health the natural way , and then tell us you've had a massive heart attack requiring 3 stents! Doesn't sound that your health was 100% taken care of. I'm also guessing that the stents weren't carved from hemp and inserted by a "biochemist" on the kitchen table with no anaesthetic, other drugs, or modern medical equipment!

[Landflap]

Dear oh dear; see what we mean ? Massive fight back by the medics but showing re-action rather than careful thought. LIGHT said he had a massive heart attack in 2007. He ditched western medicine in 2011. Er, three years later (!) and has never felt better. He was also asked to calm down yet my reading indicates a very calm submission with advice & info he wishes to share.

SLOWJET referred to a colleague of his & I think I know who he is. I agree, since ditching the statins (back on thread please) he has never looked better, fitter & pisses normal urine with no blood tracings & looks set to lead a fabulous retired life in the Med.

Gingernuts, I want you for my GP . Don't need an AME as I too, just hung up my flying boots. You sound perfectly balanced and of great comfort to many, including me, on this forum. Pity that many of your colleagues head for the prescription book faster than the Lone Ranger reached for his gun.

[ausdoc]

No, not a "massive fight back" at all. The stated aim of this forum is ......debate about medical and health issues .......
To debate, one must take an alternate view. There have been a number of accusations bordering on the criminal bandied about here, suggesting all sorts of ludicrous conspiracies. My treatment decisions are based on evidence from properly conducted clinical trials, overlaid with the wishes of my patients.

OK, I take your point that Light ditched western medicine after it had saved his life. Lucky for hime that he didn't choose to take this path in 2006. What happens when the stents fail (as they often do)? Will he simply allow himself to die?

Of course everybody has the right to make decisions about their own health care, but they should make those decisions based on accurate and validated information.

[Bad medicine]

Unless you want this thread to go the way of so many others, please get back on track. :=

Cheers,

BM

[gingernut]

Kind words, Landflaps, for the record I am a nurse, albeit working at an advanced level.

I guess what's happening on here is a display of passion, not always a bad thing, but as Bad Medicine points out, it's about playing the ball, not the player.

My passion for this sort of thing arises from having to deal with the scourge of arteriosclerosis on a daily basis. When I started my training many moons ago, families were destroyed by diability and death, caused by strokes and heart disease, (often with the victim being about my age.)

Things seem to have changed, for the better, and there are various reasons for this-people are smoking less, eating more fruit and veg, exercising more etc, but I still reckon statin's play a large part in both primary, and secondary prevention. Systematic, organised health care has also helped.

Make no mistake, drugs companies are ruthless, and I'm one of their biggest critics, but (my) very objective observations, convince me that statin's work.

This view point may change as we discover more, but that's okay, that's the nature of the beast.

Good health.:ok:

[homonculus]

A great post 40&80

You are right - in todays regulated medicine as Gingernut alludes to, care is reasonably standardised and 'bad' docotrs and nurses are rare. Mistakes can happen, but the main determinator for whether a patient thinks a doctor is good or not (and vice versa) is communication. Unfortunately for us doctors patients vary in their preferences. I can send 2 patients to the same consultant - one will say the doctor was arrogant / uncaring / cold and the other will say he was authoratative and didnt waste their time talking about social matters.

Interestingly, when I read your consultant's comment about the GP I took the opposite view - he was saying he liked and knew the GP and she was kind; there you go.

But back on theme - statins. In fact there is evidence statins continue to be protective for months - much longer than they remain in the bloodstream. Aspirin will reduce platelet stickiness and prevent clots for at least 10 days. So whilst they are prescribed daily, missing the odd dose is not critical.

In fact very little in medicine is - clotbusters in heart attacks reduce the long term disability and death rate in the population, and paramedic services may reduce the death rate in a very small percentage of patients, but we rarely 'save lives' - we reduce pain, treat symptoms, hopefully put some cancers into remission and overall improve your statistics so you are on the planet with a reasonable quality of life for longer. Doctors who claim they save lives somehow rile me.

[gingernut]

Please let me indulge myself a little.

When I first came to primary care (GP land) a chap came into the corridor complaining of chest pain, and promptly collapsed. A colleague and I administered a jab of morphine, sent for the ambulance and got him seen at hospital.

Thankfully he survived. (This was before the time of using aspirin/clotbusters.) Apart from reducing the risk of cardiogenic shock, it's likely we didn't make much a difference to the outcome. He survived through luck. Ever since, he equated the jab, with the saving of his life, and every Christmas, he brought my colleague and I a bottle of whisky.

In those days, we worked as hard as we do now, but we weren't organised. The average patient would come along with his sore toe, we'd treat the sore toe, and off home he'd go, happy with his prescription of flucloxacillin. The other stuff which should have been performed, like ensuring his blood pressure was controlled, or making sure the patient had the correct blood tests, mostly fell out of the window.

We (!) decided if we could organise things better, ie positively invite the patient to come along for the tests, monitoring, treatment etc. This was aided by various mechanisms, including the way we paid GP's, (through the PMS/GMS and what eventually became QOF-paying GP's for jumping through hoops, which impacted on health outcomes), extending the scope of other professionals (eg allowing nurses to prescribe), and putting someone in charge of the whole thing, (Practice nurses were good at this.)

We (roughly) estimated, that as a result of putting these measures in place, there were 4 extra people walking around at the end of the year, that may have died of heart disease previously.

It wasn't rocket science- no new drugs, no fancy clotbusters, no millions spent on tertiary care centres, just getting things organised for our 12,000 patients.

The system was rolled across the PCT, and eventually the country. I reckon there are thousands of people walking around as a result of this systemised approach to care.

AND NOT ONE OF THE B*GGARS HAVE EVER BOUGHT ME A DRINK.:)




A simplistic view point, I'm not here to defend QOF, I've got my own reservations, just trying to make the point that in Primary Care/GP land, the work isn't always that sexy, but it does make a difference to both the quality (morbidity) and quantitiy (mortality) of our patients lives.

I'd agree with homon, communication is key to keeping the art of medicine and nursing alive.

[40&80]

A Question regarding Statins.......
Does life time daily Statin medication deplete Cq10 in the body to a dangerous level?...if so is it wise to supplement with CQ10 daily tablet intake?
I this is a fact... then the NHS would also I feel also have me on daily CQ10 tablets.
The truth is I have absolutely no real idea what this CQ10 is all about other than what is on the internet....the internet sales persons make it sound very important that I buy some.

[homonculus]

CQ 10 ia a substance the worried well buy on the Internet. It is claimed to cure blood pressure, heart attacks, strokes and many other diseases. If there were a scientific basis for this we would be using in in conventional medicine. We don't. There isn't.

That is not to say many believe in it. Just that the scientists don't. Anti oxidants don't work. If they did we would all live to 100

[dirkdj]

Take five minutes to review this:

Dr. Osborne - Statin Drugs and CoQ10 Deficiency.avi - YouTube (http://youtu.be/sxWP3Q2M-Pw)

[homonculus]

The good doctor is not a doctor as in the term medical practitioner. He is a chiropractor in Texas.

John Travolta advertises for Quantas

Caveat emptor

[Pace]

I think the concern for outsiders are the large drug companies.
Looking at medicine in the future we would want "cures"! Cures for Cancer! Heart disease! etc etc etc.
Cures would not suit the big drug companies! Prescribe a drug for life and the drug companies get an income for life which is very different to selling a product which you do not need after a couple of weeks! End of income.
Those drug companies are going to protect those life long earners maybe develop drugs which are better tolerated but still life long earners.
BP tablets and Statins fill that category!
In Fact I would go further the drug companies will produce research which paints a picture they want to paint and have a massive marketing effort placed to make sure the medical world are conditioned to believe it!
I wonder how much the drug companies actually stifle medical advancement in finding proper cures as that is the very last thing they want!

The latest trend no doubt backed up by shady research is for mass medication over a set age Wonderful for the drug companies so do not be surprised that some of us are sceptical? We all know that research like statistics can be made to read what you want them to read.

Pace

[dirkdj]

I started reading Dr Duane Graveline's book 'Statin Drugs Side Effects and the Misguided War on Cholesterol'. He is one of 'ours', being a Flight Surgeon (USAF ret) and Astronaut-scientist (NASA Ret) as well as a family doctor. Cholesterol is what makes your brain and memory function. You might loose your medical very quickly if you have some of the side-effects he describes and suffered himself. Red Yeast Rice will have the same cholesterol-lowering effect but with no side-effects, if you think that cholesterol must be lowered for any reason.
I stopped taking simvastatin a year ago, I couldn't remember all the digits of a frequency given by ATC anymore, it was like one of the digits 'dropped into a hole' (short term memory lapse). The fog has now cleared and being clear of statins I am ready for more ATC frequencies and waypoints.

If I would have mentioned this memory problem to a GP he would have said it is old age and never connected it to statins.

[homonculus]

Dirkdj - a few weeks ago I flew my aircraft and it rained. The next day I didnt fly and it was sunny. So I sold my aircraft because it makes it rain.

Sorry, but your ATC problems were not due to statins. How do we know? Because objective research on thousands of patients has shown it doesnt happen.

Pace - first we had dodgy doctors, now you are claiming there is shady research. The only shady elements are to do with quacks and alternative medicine. Research is highly regulated by ethics committees. You are talking rubbish.

Yes drug companies do exist to make profits and put themselves first. A few years perhaps the best anaesthetic drug in use was pulled because the drug company wanted the plant to make an antibiotic which was more profitable. I am no excusnik for the pharmaceutical industry. BUT without chemists, drug companies and engineers, medicine would still be chopping off legs on the unanaesthetised. There would be no diagnostics and no cancer treatment.

In fact patent law has changed so that the time a pharmaceutical company has to make a profit is so limited they want high profits per unit dose and mass uptake - having someone on a drug long term is little use as it will come off patent

[Aeronought]

I don't claim to have the answer. Just a bit of evidence.
When my GP suggested statins because of my family history of heart problems, I said I'd think about it. I too had a fear of the secondary effects, which are much publicised, and thought that as a slim-ish, fit and active non-smoker who looks after his diet, my risk was not that great, despite being over 70.
Now, having had two very minor TIAs I have accepted, and have taken 75 mg aspirin and 20 mg Simvastatin per day for a mere 5 weeks.
The result is that my cholesterol level has reduced from 5.1 to 3.7 and BP from 130/80 to 125/75 with, so far, NO adverse side effects thank goodness.

Readers may like to contrast this with my father's experience. At the age of 55 he had a TIA (though I don't think the term was in use at the time) and ignored it. Six months later he died in the street from a massive heart attack!

I consider myself to be lucky to have had the warning and in this case suspect that my GP was right, though it will take a little while to be sure!

[dirkdj]

After reading this book, I know exactly where the memory gaps come from. Several more stories are told, much worse than mine. The food/drug industry has been betting on the wrong horse (cholesterol) since about 25 years and it will be a big job to turn the wagon around. Anyway, I am the 'Patient' and it is my health.

There is one good side on statins: they reduce inflammation and this is what clogs our arteries. Cholesterol has nothing to do with it.

On the other hand, the side effects are such that you lose more than you gain and we haven't seen the end of it yet. Some cases got Transient Global Amnesia only after four years on statins, some of it irrepairable.

[gingernut]

We all know that research like statistics can be made to read what you want them to read.

I think that's accurate.

It's our job to work out the wheat (statins), from the chaff. (?CQ10).

[dochealth]

Any advice on dealing with the memory loss other than stopping the statins? Needed a stent 6 years ago for major block in " widowmaker" and not prepared to stop.
Thanks DH

[dirkdj]

Both magnesium and red yeast rice are natural statins without side effects. Have a look at spacedoc.com website as well, several other docs have articles. Stephen Sinatra is a retired cardiologist.

[obgraham]

He's also a guy who thinks we need to walk around barefoot or lay on a special pad in order to remain "grounded" at all times.

I suspect that's connected to his tinfoil hat, too.

It never ceases to amaze me that the world of "alternative medicine" is filled with these characters that somehow think they and they alone know the answer to every major issue in health care. And everyone else is wrong.

And people buy into this stuff. Well, Steve Jobs regretted it.

[mad_jock]

So whats the view on Mg then?

Seems to have a bit of science behind why it should work.

[dirkdj]

Magnesium is a mineral we should get from our vegetables, unfortunately due to modern agriculture techniques, we get less than we need.

There is a free e-book on Magnesium you can download. Moer on this website: Nutritional Magnesium Association Information on high blood pressure, heart disease, stroke, diabetes, magnesium deficiency (http://www.nutritionalmagnesium.org/)

[mad_jock]

As usual it comes down to what my granny used to prescribe having zero medical training.

A table spoon of cod liver oil a day, the more vile tasting the better, keeps the doctor away.

And eat your greens or you will get a thick ear.

[Dg800]

Both magnesium and red yeast rice are natural statins without side effects.There is no such thing as "no side effects". Well, except for water. And placebos. :E
I would steer clear of anything (or anybody, for that matter) for which such a claim is made.

Ciao,

Dg800

[Pace]

Homonculus

Of course there is shady meaning in the shade or not clear research!
The science itself is imperfect hence the unclear bit can be used to paint a picture!
I am sure most remember the governments research on global warming and the biased in accurate science that was used ?
I am sure the same occurs in medicine where a lot of gain is at stake ?
The perfect science would largely eliminate the drug companies as patients would be cured of things like cancer and HIV rather than being kept going!
If your saying your industry is not open to the pressures of others where science is used to make a case which itself leads to big money then I am surprised.

Pace

[dirkdj]

Dg800,

Please take this into consideration: millions of years ago, the earth was 'born' (use whatever term is suitable for you); first were plants then animals then mankind (some kind of animal too). Nature has had time to perfect many, many details in everything on earth. Why would man think he can do it better since about 100 years or so.

Diabetes and cancer and obesity have skyrocketed in the last 30 years. Cancer and diabetes were very rare 100 years ago, what has changed since? My grandmother didn't know what a supermarket, a fridge, a microwave oven was, did it matter? She lived till she was 92, her mother till 98. Industrialized food and modern allopathic medicine are probably partially to blame.

[dirkdj]

What is good about this thread is that some people are finally beginning to think about health and how to maintain it.
I do so since a full year now and you wouldn't believe the difference it makes.

[homonculus]

Pace

You need to dust off your dictionary.

Research is investigation and observation. Properly conducted research shows something is or is not significant. Leading aside probability coefficients, the result is yes or no. Nothing shady there.

Governments have never done research - they do studies but these are sociology babble. It is perhaps because politicians dont consider facts or science that we are in such a mess.

A perfect science is a meaningless phrase. Science is science. Gravity exists. It creates the universe we live in including cancer. Man tries to modify these bad bits but he doesnt perfect science.

Back on thread. Statins have been shown by MASSIVE studies over many years to save lives and to have but two side effects, both of which can be monitored. The drug companies have made a lot of money out of them but that doesnt mean there is any conspiracy. If you believe the earth is flat or cancer can be cured by not walking on the lines in the pavement, be my guest, as illness costs society money and any resultant early demise is economically benefitting society. All I ask is that you dont peddle witchcraft and rumours which frighten others, who may well be vulnerable because of illness, such that they reject medical advice and fail to benefit.

[obgraham]

I don't disagree with your premises, Homunculus, except that nowadays Science is not Just Science. It's Science-filtered-by-statisticians, and we all know that how the data is tweaked can easily be (a)biased by the hoped-for results, and (b)subject to re-evaluation in the future with a different conclusion.

That's what I have against the current fad to pounce on every new study as the ultimate result.

And yes, the pharm companies are interested in selling drugs. We just have to keep their agendas in perspective, and we are entitled to differing conclusions.

That said, I find it appalling that so many apparently bright folks are willing to discard scientifically obtained advice, whatever its flaws, in favor of junk science, quackery, and hucksterism.

[Bertie Thruster]

evidence obtained by blinded research from Oxford University over many years

Would be grateful for references.

[gingernut]

That's what I have against the current fad to pounce on every new study as the ultimate result.

And that's where the skills of critical appraisal and systematic review come into their own. I'd argue that these are as an important component of a doctor/nurse/clinicians toolkit as a stethoscope. The whole purpose of these skills is that we can sort out the wheat from the chaff.

In terms of grades of evidence, we have "expert opinion," (whether that's an eminent Professor or a man in a silver foil hat) at the bottom of the pile, and multi centre, double blind, large, randomised controlled trials, at the top.

The evidence for statin use lies nearer the latter rather than the former.

[dirkdj]

Reading further, there is some hope for statins after all. Spacedoc explains that low-dose statins have a beneficial effect on inflammation and thus reduce mortality on patients that already have heart disease. However, the way statins are 'sold' to us is different; they are supposed to lower cholesterol readings (which they do) but cholesterol is not the culprit after all. So what happens: docA sees patientB and finds cholesterol level too high (according to common wisdom) so B gets a prescription for statins, even if B has no pre-existing heart disease. In order to get the cholesterol reading to the published level, A prescribes heavier and heavier doses until B reaches the level required. In reality even a small dose will fight the inflammation and do good, an overdose will do good but brings side-effects as well, and these can be very nasty since cholesterol is fuel for the brain.

This is simplified a very plausible explanation as written by spacedoc in his book mentioned above.

[Pace]

Dementia risk from sleeping tablets: Pensioners on pills taken by 1.5m are 50% more likely to be hit, warns Harvard study | Mail Online (http://www.dailymail.co.uk/health/article-2209694/Dementia-risk-sleeping-tablets-Pensioners-pills-taken-1-5m-50-likely-hit-warns-Harvard-study.html)

Taken from front page of mail today is it wrong? or a reason to mistrust medication like Statins which get mixed opinions.

I believe recently beta blockers received bad press too?

Will statins be making the headlines too in the future? or is there nothing to worry about with statins?
As medically non qualified people are we right to question long term use of drugs when reports like this seem to occur more and more often?

Even fit people over a certain age are being advised into mass medication with an over 50s pill but for whos benefit?

Pace

[gingernut]

but cholesterol is not the culprit after all.

Probably something in that, it is, after all, it's only a proxy outcome measure. The important factor is, do statins prevent death and disease ? (And the evidence suggests they do.) The process is less important than the oucome.

So what happens: docA sees patientB and finds cholesterol level too high (according to common wisdom) so B gets a prescription for statins, even if B has no pre-existing heart disease. In order to get the cholesterol reading to the published level, A prescribes heavier and heavier doses until B reaches the level required.

Not actually strictly true,certainly for primary prevention, (without established disease). Once risk is established, the statin is prescribed, (usually Simvastatin 40mg), but interestingly once the patient is established on the routine, we don't tend to retest the cholesterol levels. (There's no point, it doesn't affect the management of the patient.) Hence the "putting it in the water" argument.

Secondary prevention, (ie the patient has established disease) requires more aggressive chasing.

[CharlieOneSix]

Seven years ago at age 60 my Doc said that due to reaching that age I had moved into a higher risk category and he prescribed daily 40mg statins and 75mg aspirin. Very soon I experienced increased night cramps in my legs and the statin dose was reduced to 20mg which I have remained on with no ill effects. My cholesterol has reduced from 5.9 to 3.3.

After five years on the aspirin I began to feel ill with no appetite, was very lethargic and I lost 30lbs in weight over three months without trying. An endoscopy showed gastritis and duodenitis. I stopped taking the aspirin and have fully recovered. I gather that if you are going to get problems with aspirin it usually happens earlier in the course than it did with me.

[homonculus]

Yes problems normally occur earlier - but not always. You may have been slowly bleeding such that you eventually became lethargic. The gastritis may also have occurred off aspirin so the drug was merely coincidental or additive.

All goes to show that these drugs should be taken with the knowledge of your GP. But the evidence is that aspirin does more good than harm

[gingernut]

It sounds like your GP has got his finger on your pulse.

Aspirin has been heralded as a "cure all," or rather "prevent all," -some studies recently suggested it can prevent cancer.

In those with established (arterial) disease, low dose aspirin is a life saver.

In those without established disease, the "risk/benefit" equation is less clear. For the time being, we should leave it out of the water :)

[aviate1138]

When I was in my early thirties i was advised by a friend [now Cardiology Prof at Stanford University] to take small [baby] doses of Aspirin on a regular basis. Three decades later my AF induced Angiogram showed clear arteries [thanks Hannah V].

I am sure they would have been clogged but for the Aspirin intake.

[Pace]

Aviate

There have been some interesting discussions and I do not think that anyone questions the use of drugs for serious illness.
Maybe you would have had clear arteries anyway? ;)
But these discussions have brought up a question in my mind! Like it or not the drug companies are Multi Billion dollar enterprises who are mainly there to sell drugs.
Drug companies would not want a cure for Cancer HIV etc if such cures dried up their own market of long term drug use.
How much that influences "cures" ?
How much is spent creating new drugs rather than finding cures for some of the life crippling disease in our society?

Pace

[homonculus]

Pace

Your argument falls a bit flat because aspirin was invented in 1846 and was never on patent so no drug company had a vested interest

Sadly drugs don't cure. They control and manipulate. Just as it fashionable to slag off bankers so this forum slags off drug companies. I have no reason to support the but they can only develop chemicals they can produce and sadly these chemicals don't cure

Interestingly some of the most profitable drugs are........antibiotics which........cure

[Cameronian]

CharlieOneSix (post 62) - possible undiagnosed helicobacter pylori causing sensitivity to aspìrin? There's a very great deal of it about coupled with rumours that there's a lot of money to be made from selling antacids and more sophisticated products for life.

I'm surprised how few have had the chance to hear of Professor Barry Marshall and his Nobel prize Barry Marshall - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Barry_Marshall) and the relevant foundation The Helicobacter Foundation (http://www.helico.com/) .

Worth a look, perhaps?

[gingernut]

I'm not sure that I've ever "cured" anyone, except when I syringed some'ones ears.

[ausdoc]

And even ear syringing has a significant risk profile. :)

[gingernut]

Yes indeed. Olive oil for 4 weeks, or take the risk, thank fck for patient choice:)

[ausdoc]

I am at somewhat of a loss as to what the medical profession is supposed to do these days. Many of the conditions that we are talking about are the result of a complex combination of factors including genetics, environment, long-standing lifestyle choices, ageing, various exposures, etc, etc. Many would have us "cure" these complex conditions instantly, without the use of drugs (because drug companies are just trying to keep people sick to maximise their profits), and with no side-effects.

I wonder how many contribute to research in a meaningful way, rather than simply quoting doubtful science (and I use the term loosely) from self-serving websites.

[gingernut]

Yes, let's look at how we spend our (your) £100billion/year.

Let's sort the lawyers out first of all (£10 billion)

Then let's deduct anything that doesn't directly improve health of patients (About £35billion)

Let's put that £45 billion into pre-school education.

Which will probably save on spending on Doctor's, Nurses and lot's of medications.

(oh, and we subsidise oily fish-ever seen a Fijjian with heart disease?)

[ausdoc]

(oh, and we subsidise oily fish-ever seen a Fijjian with heart disease?)

Yes...yes I have. Recent WHO data lists cardiovascular disease as the leading cause of death, at around 39% of all deaths in Fiji (as a subset of chronic disease in general which acounts for 74%).

[etrang]

Sadly drugs don't cure. They control and manipulate.

Some drugs do cure, antibiotics for example. But from the drug company's point of view a drug which treats a condition and must be taken every day is vastly superior to a drug which cures outright.

[gingernut]

oh well, fair enough comment. Another myth busted.

[slowjet]

Well, "cured" me of thinking very bad things about the Medical Profession ! A bit more balanced now thanks but STILL very wary of Statins which is what this thread is all about.

[Thomas coupling]

When the doc checked my Chol level it was 5.0. Because I lived in Wales he prescribed statins (simvostatin). If I had lived 20 miles further east in England, I would NOt have reached the level for statin prescription (5.2).
Anyway - i loved the idea that I would be getting FREE statins for life under Welsh rules. I had read up on them and truly believed in what I was told about the wonder drugs.
Simvostatin lasted 3 months, by which time I could barely walk due to chronic hip pain. Told the doc, he said it will wear off, I said no it won't. I stopped. The pain stopped. Doc then swapped me across to Lipitor. Mmm, lipitor didn't cause any joint pain, not that I could remember because .....I couldn't remember!
Actually, I started having this feeling that my thinking process was a little cloudy. I had to work hard at thinking logically and clearly - it was a haze at times. I lived with it for about 6 months and wondered what would happen if I stopped the Lipitor. I didn't bother telling the doc - just stopped. Within weeks, my thought processes resumed normal. I went back to the doc - a different doc. Told them what happened. She looked sideways at me and said, she wasn't sure if the symptoms related to the statin. So she put me on Pravastatin. Everything was fine for months, then i started getting golfers elbow, then tennis elbow at the same time and in both elbows??
Went to docs, she said, you've got tennis elbow and alittle bit of golfers elbow. It's not the statins - less than 2% get those side effects. So I lived with it for a further year, blaming press ups, RSI etc etc. Then one day, after a check up with blood tests wherte my Chol level was 4.4. I decided to stop the statins: 3 months later the elbow pains have gone.
I have since started eating porridge, drinking pomegranate juice and watching my sat fats like a hawk. Latest blood test: 3.9 (no statins).

I wish they had worked, because of their other beneficial side effects but it was not to be. Statins do and can cause side effects which one could easily put down to other things and for that period in your life, the quality of your life drops.

Listen to your body.

[Bertie Thruster]

Statins use and coronary artery plaque compo... [Atherosclerosis. 2012] - PubMed - NCBI (http://www.ncbi.nlm.nih.gov/pubmed/22981406).

Seems to suggest statins might not be so good?

[slowjet]

Thomas, thank you very much. Giving more credibility to the "balance" and "everything in moderation" . To those who subscribe statins as the obvious remedy.........................be careful, be VERY careful. H U G E evidence mounting against this drug. Aaaaaah, but then you might lose your annual subscription to your fave golf club ( oooooops, SOREEEEE, just can'y help myself !). Tommy, good on you.My mate, referred to in the earlier discussion, also drinks pomegranite juice ( was that introduced to the Ozies by us ? ..Oh, damn, there I go again ! ). As I said before, he looks terrific after ditching the drugs & just passed his annual check-out for medical insurance, the local doc saying, as usual, WOW !

Look, before Ausdoc hits the frenzie button & Hermoncles thinks he is back at the Oxford Union ; there is a remedy, a cure, a comfort drug but for Gawdsake Medics, look at a balanced field. Pleeeeeze ! Admit, statins are showing results for those who REALLY need them. They are showing very serious side effects in those, incorrectly subscribed, who don't.

[Bertie Thruster]

Cholesterol in the range 200(5.1)-240(6.2) = "Lowest all cause mortality."

WHO source.

[40&80]

Berti....I read this report is based on people with...No known CAD.
I was told Statins are part of the NHS golden treatment for people who...
Have Known CAD.
If you have had a heart attack I am again told you have CAD.... plus... also...you would then have had angiography...so the consultant knows what your blockage percentage is and probably he also has a good idea also of your E.F. factor.
A local consultant has described Statins as Drain cleaners...as he has noted their added long term added side effect of reducing arterial blockage.
As I read he is regarded by the USA as amongst the top five cardiologists in the UK...I take my 40 mg of statin daily as instructed.
However I do also experience all the symptoms described above and only since starting on statins eight years ago.
I find the hip pain that comes on having walked 200 yards can be walked through eventually.This pain instantly ceases if walking is stopped.
I have never had hip pain at all peddling 12000 miles on my bike since my heart attack.
So..it is still all a big mystery to me...and I just do as I am told.
For the record I also detest taking the Beta Blockers as I feel the cause me to be depressed just as much as watching the BBC news and Today in Parliament: ok:

[Thomas coupling]

Fascinating feedback. I take bisoprolol, a B Blocker, and have done for years - no side effects whatsoever. yet me and statins simply don't get on.
Who knows whats best for whom. time will tell. The jury is most definitely still out.

[CharlieOneSix]

CharlieOneSix (post 62) - possible undiagnosed helicobacter pylori causing sensitivity to aspìrin? There's a very great deal of it about coupled with rumours that there's a lot of money to be made from selling antacids and more sophisticated products for life.

Sorry - somehow missed your post. The first thing my GP did was to take blood to test for helicobacter pylori and I was completely clear. If I remember correctly, had it been present he would have hit me hard with three different antibiotics to sort it out.

[Cameronian]

Hi CharlieOneSix! That's bad luck for you because it seems now much more widely accepted that in way over 90% of cases with strong ulcer-style symptoms the cause is probably Helicobacter Pylori and the recommended and effective treatment regime has been getting easier and easier over recent years. You were probably put through more hassle etc. than the current HB treatment would have caused, had it been indicated!

Typically it takes a week of a couple of antibiotics with omeprazole and in many cases the treatment is started without any pre-testing because it's so easy and likely to be successful.

In the unlikely event that the problem isn't fixed then they start to look for other causes, some of them much nastier, unfortunately. Usually the poor sufferer has had the problem for many years and the risk of cancer comes more from waiting longer before treating the HB than from its having been the cause of the symptoms because the poor chap would have been long gone by then.

I've had quite a few family and friends who have been through this and, unfortunately, most have found that their doctor has either failed to suggest HB as a possible cause and/or resisted the idea when they brought it up. In every instance so far the quick HB treatment regime completely put an end to the years and years of pain they had suffered. What is more, not one has yet had a recurrence.

[soggyboxers]

Sorry, just to continue the thread drift, but as a warning to others who may suffer long-term dyspepsia or acid reflux, I suffered from dyspepsia for nearly 15 years. Initially I just started taking Rennies in increasing doses until after several months I went to see my doctor in UK who suggested that I may have had helicobacter pylori, particularly as I had already been working in Nigeria for many years. I was treated for it just in case whilst waiting for the results of the tests (which were negative) and prescribed with cimetidine for 4 months to reduce stomach acid. This gave temporary relief, but after some months the acid worsened so the dosage of cimetidine was increased, but I still had to take Rennies and was put on Ranitidine (Zantac). A short time after starting on the Zantac I started suffering heart palpitations and went to visit a cardiologist who picked up on the change to Zantac, told me to stop taking it (and the palpitations stopped within 24 hours) and an ECG, stress ECG and 24 continuous monitoring ECG confirmed that I had a healthy heart). I was then changed to a low dose proton pump inhibitor (lansoprazole - Zoton), but after a year or so, this failed to reduce the dyspepsia and I started developing severe acid reflux, so the dosage was increased. After 2 years of this the symptoms worsened again, the reflux was getting worse and I was put on to the maximum dosage of omeprazole (Nexium). At no stage did any doctor suggest a visit to a specialist or that I have an endoscopy. Luckily, last year whilst I was having a routine bowel screening test because of my age, I talked to the doctor doing the screening about my symptoms and he suggested I should have an endoscopy, which he arranged for later that day. As a result of that he thought I had Barrett's Oesophagus and a hiatus hernia and referred me to a gastroenterological specialist who carried out another endoscopy and I was finally confirmed as having Barrett's Oesophagus ( a pre-malignant condition which if left untreated can lead to oesophageal cancer) and a hiatus hernia which by then was in excess of 4.5 cm long. Last September I had keyhole surgery to repair my hernia and a Nissen Fundoplication to reinforce my oesophageal sphincter. Wow, what an amazing change it has made to my life :O. No more drugs, no more acid reflux for the first time in years. All I now have to do is have a further endoscopy and biopsy next year to make sure that the Barrett's oesophagus has not changed in nature.
The only thing which makes me somewhat angry is that 3 different GPs with whom I was registered during this period never suggested anything except increasing doses of proton-pump inhibitors :\

[homonculus]

Which all goes to prove specialists know more than GPs who know more than rumour networks !!!!

As a general rule indigestion should not be left for long periods without endoscopy or specialist review. Barratts is a good example why. I am glad you caught it in time

[gingernut]

Hmm...doesn't everyone get a bit "bilious" now and again?

Undiagnosed dyspepsia - a great phrase.

Is there a balancing act between between chucking a few omeprazole tablets (they're cheap and work well) and missing progressive cancers?

'scope everyone, and we'll kill more than we'd cure. (Some perforate, some of those die.)

Those in primary care, (where 40% of our patients present with tummy problems) tread the line finely.

Isn't this thread about statin's?

[homonculus]

Absolutely and statins should be in the realm of GPs as should the management of uncomplicated hypertension and ...........

Dyspepsia

But if the high blood pressure isn't controlled, or if the dyspepsia continues for months then it is time to refer on

This isn't anything new - it was what I was taught 40 years ago and stands as well today as it did then. After all Barretts is avoidable

[Bertie Thruster]

After all Barretts is avoidable

Why isn't proper nutrition considered to be medicine? Presumably most of our modern day ills are caused by ingesting novel ingredients?

[Pace]

Why isn't proper nutrition considered to be medicine? Presumably most of our modern day ills are caused by ingesting novel ingredients?

But is that not the point! Are not drugs novel ingredients and should not patients question the long term use of drugs?
Obviously a seriously sick patient has to take the better of two evils and pop the drugs but???
We are reminded of the recent very bad press on sleeping tablets which have been prescribed with reassurances from the medical world for decades.
Now even taking them 15 years ago increases your chances of dementia by 50%
Will we all be here with the same discussions and bad press on Statins in the future??

Pace

[40&80]

Today in my GPs waiting room I read a copy of the British Heart Foundation August/September 2012... Heart Matters Magazine.
This magazine explained why beta blockers are prescribed..their purpose and connection with adrenalin control...and suitability for preventing further attacks in previous heart attack victims.
There was also a note regarding the trial results of... CQ10 and a yeast tablet a day.
Assuming the British Heart foundation are a reliable source of information and this magazine is approved NHS patient reading material... it should be worth a read for all of us trying to make sense of various bits of heart information our GPs and consultants are far too busy to get involved with educating us.

[misterblue]

I have just been told by my GP to take statins. I have a TC/HDL ratio of 7.2

I am very sceptical over statins so I searched and found a risk assessment site
Qintervention.org.

You type in all your risk factors and it comes out with an overall risk of a cardiovascular event over the next ten years. Mine is 10%.

You can then put in some 'what ifs' such as taking statins. My risk drops to 7%.

However, is also shows the risks of statin side effects, kidney, liver, cataract, myolysis. The risk of these serious effects over 5 years is 2.1%.

So in summary, over 10 years 3% down on cardiovascular event. Over 5 years 2.1% up on a cocktail of nasties. (This presumably is greater over 10 years).

Now I am confused. To take or not?

Secondly, neither the Qrisk score, nor my GP ask about exercise levels.
We are always being told that exercise reduces the risk of heart disease, but it does not seem to be worth considering in an individual.

Baffling.

[gingernut]

The QRisk is quite crude, as are other risk scores we use, but it's better than clinical judgement alone.

It doesn't tell us which ten of the hundred will have an incident, only that ten will.

Why are you on a statin if you're risk score is only 10% ?

[misterblue]

Thanks, ginger.

My GP did not quantify the risk, he simply told me that I would have a heart attack.

I am a bit sceptical about the risk/benefits of statins in those who have not had a heart attack yet, so I looked up and found the Qrisk thing myself. I am an ex-vet, so I understand a good chunk of medical stuff and to me, if the Qrisk is reasonable then the argument in favour seems very thin.

Are you saying, Gingernut, that with an overall risk of 10% as taken from the Qrisk, it would be unusual to prescribe statins?

Thanks,

Mister not quite blue yet.

[gingernut]

There are several risk tools available, QRISK, ASSIGN Framingham etc. All should give a reasonably close estimate of risk over 10yrs. (!) and they beat what we had before. (Which was guess work). They certainly aren't perfect and ther'e variations in there use.

As you can imagine, there's been a lot written about these lately, on a population basis, it probably not that important which on we use.

Usually statins are used on those with a 20% or greater risk. This is a purely arbitary figure, which has more to do with cost than anything else. (NICE).

Some people reckon that statins can help down to a limit of 7%-so to be to fair to your GP, he's taking your side against the nasty people at the medicines management deprtment !

Remember, all this is true for primary prevention (ie in those without established disease).

Once the patient has been deemed to be at 20% or more risk, then they are placed on a statin, thier liver blood profile should be checked 3 times in the first year, then any monitoring (including retesting the lipid level) should be forgot about, although in reality, there is a massive variation in practice.

I've heard some horror stories on here regarding statins. I look after an awful lot of patients who take statins, and I haven't come across many problems.

It's not for me to second guess your GP, and please don't take the general advice I've given here to guide the care for you. Chat to your GP, he'll be glad you've taken an interest.:)

[Pace]

Gingernut

I have no problem where taking a tablet is the better of two evils as you describe.
As with the latest finding on sleeping pills which can now increase dramatically the incidence of dementia many of us are concerned that other medications will themselves prove to have very negative implications in the future?

Statins are one.

While with patients who have serious disease as stated the pills are the better of two evils there have been calls for mass medication of people over the age of 50 with statins.
I presume research designed to prove a case by the drug companies hence increasing their sales dramatically?

[misterblue]

Thanks again, gingernut. That's very helpful. I appreciated the unbiased advice, as a I believe that GP's get extra funding for putting folk on preventative programmes, and am concerned this may not be in my best interests.

Unfortunately, my GP told me, in his own words, "You are going to have a heart attack". After an exercise ECG last year, my cardiologist said "You are not going to have a heart attack".

Looking at the 'Qrisk Misterblue dropping dead Stakes' starting prices, I calculate

Not having heart attack, 1-9 fav. 9-1 Bar.

It seems if we take 100 folk, 10 will have an event in 10 years. If we take statins, this drops to 7 having an event, ie we've saved only 3. In addition 2 will have unpleasant side-effects including renal failure. On balance, that leaves 1 in 100 better off, for a total consumption of 365,020 tablets (including leap years).

Because of the methodology, I can see that QRisk does not take into account individual's fitness levels (nor did my GP) and I am pretty active. Any idea how that would influence things?

I think I intend to recheck my cholesterol in about 6 months, and decide then. I am not comfortable with basing a lifetime on medication on a single blood sample.

Thanks again for taking the time, gingernut.

[Evanelpus]

Usually statins are used on those with a 20% or greater risk. This is a purely arbitary figure, which has more to do with cost than anything else. (NICE).

Been on Statins now for about 3 weeks, Doc said my risk rate was currently 24%. I had a TC/HDL ratio of 5.9.

I'm on the lower doseage rate for 28 days and then I've got to do 28 days on the higher doseage ones. I do feel more tired on these tabs, i also seem to be suffering more than normal back ache but if I was to worry about all the possible side effects of the tabs from the info sheet in the box, I might as well not bother taking them at all.

This slight health scare has galvanised me and Mrs Elpus to eat more healthily and lose a bit of weight, so if for no other reason, I'll stick with the meds.

What a :mad: time of year to get this thing diagnosed!

[Taras B]

I always wondered why Fenofibrate is not prescribed more often:

Fenofibrate - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Fenofibrate)

"Like other fibrates, it reduces both low-density lipoprotein (LDL) and very low density lipoprotein (VLDL) levels, as well as increasing high-density lipoprotein (HDL) levels and reducing triglycerides level.

Fenofibrate has a uricosuric effect, making it of use in the management of gout.

It also acts as a blood thinner by lowering the amount of fibrinogen in the blood.

It also appears to have a beneficial effect on the insulin resistance featured by the metabolic syndrome.

Fenofibrate exhibits anticonvulsant properties."

Not a bad resume!

I've taken these drugs separately and at the same time - no side effects from fenofibrate, muscle aches from statin, even more aches when taken together.

Eventually I stopped the drugs and got my risk factors managed through diet and exercise, but this took years. I still take an 81mg coated aspirin every night except Sunday, but that's it. I may double that dose in the future.

[gingernut]

While with patients who have serious disease as stated the pills are the better of two evils there have been calls for mass medication of people over the age of 50 with statins.


I take your point about the stuff generated by the drug companies, I'm one of their biggest critic's, beware "grey" data. But if we try and "grade" the evidence, then the stuff around primary prevention is fairly/very robust.

Misterblue, you're very welcome, please chat with your doc, he's better informed about you, than I am.

Fenofibrate may reduce levels in your blood, it's doubtful that it'll make you live longer, or better.:)

[Pace]

Interesting report today on the common Grapefruit which apparently can have massive effects on those taking not only Statins but other drugs too!
Either they do not work or you overdose combined with Grapefruit!

Grapefruit drug interactions - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Grapefruit_drug_interactions)


Warning over grapefruit juice and cholesterol pills | Mail Online (http://www.dailymail.co.uk/health/article-324641/Warning-grapefruit-juice-cholesterol-pills.html)

Grapefruits can trigger overdoses in dozens of medicines researchers warn - Yahoo! Lifestyle UK (http://uk.lifestyle.yahoo.com/grapefruits-can-trigger-overdoses-in-dozens-of-medicines-researchers-warn-083154632.html)

Pace

[homonculus]

As old as the hills I am afraid

The Daily M@@@ is as authoritative as this thread.

Anyhow I thought everyone on statins died of renal failure before they could get down to the kitchen to get a grapefruit

[Pace]

Anyhow I thought everyone on statins died of renal failure before they could get down to the kitchen to get a grapefruit

Presuming they can remember where the kitchen is and their muscles actually get them there ;)
The Daily Ma*l must be the scourge of the GPs Surgery? :E

Pace

[homonculus]

Not at all. It makes the worried well chase elusive treatments from weird sources leaving us more time to manage those needing our care

[Burr Styers]

I'm my case, retrospectively - Nay.

In 2001 as an active ATPL/H I had an inferior MI - which was a bit of a Buggah, .....as I eventually got medically retired and lost my ticket....at age 45. But... I am still here.

I was prescribed statins post event (Pravastatin) and in the following years started to develop symptoms as decribed well in other forums - but at the time I didn't understand or associate the two.

In 2007, I had another heart attack, which resulted in a CABG (double).

The first line of my medical notes which I asked to see some months post op said, "Reaction to Statins".........Oh Buggah.....again.

I am very grateful to the skills of the surgeons and staff who treated me on the NHS, they were superb.

I do feel some bitterness towards the pharmacutical companies who are making hundreds of millions a year alone, just on this one product, and GPs ("incentivised" by said companies) are tossing these things out like sweeties at a panto.

Think a little more deeply about the message behind all these campaigns to give statins to the population at large- on a massive scale, its not quite as ultruistic as they would have you believe.

I now take a non statin replacement, (my cholesterol was never particulalry high in the first place (circa +/- 5.0), and 5+ years on from my CABG I'm fine thanks (Still working in aviation) :ok: .........but i'd rather had been the other side of an Inferior MI.....without the subsequent statin induced event. :uhoh:

Hopefully, my statin experience won't be that of others.

BS

[homonculus]

Sorry to disappoint you but your GP gets precisely nothing for giving a patient statins. In fact it costs him time and his own money but that is a separate issue.

The push to give statins come from those nice specialists you are so pleased with

It is a sad fact that many patients can't understand that everything we do as doctors has a risk. We only do something if the benefit is greater than the risk, so we give statins because they save many lives but a few patients have side effects - yes I know this thread will be full of responses that everyone gets side effects but it isn't true

Let me put it another way. If you had taken statins with no side effects and then been the unfortunate 1 % to die from your surgery, your family might well be having a go at the surgeon asking why he didn't let your superb GP carry on with the statins

Sadly what a patient thinks of a doctor is far more determined by outcome and the title on their name badge than their actual skills or hard work. But that is for another thread.

[misterblue]

Through the QOF, general practices are rewarded financially for aspects of the quality of care they provide. QMAS ensures consistency in the calculation of quality achievement and disease prevalence, and is linked to payment systems.

This means that payment rules underpinning the new GMS contract are implemented consistently across all systems and all practices in England.

For 2011/12 practices were paid, on average, £130.51 for each point they achieved.

Are we sure that GP's don't get points and therefore cash for prescribing statins?

[Burr Styers]

Homonculus,

thankyou for sharing your thoughts. I do have genuine and great regard for all those in the medical profession, irrespective of their job title. This was not a swipe at GPs, but one persons view of how the pharmacutical industry appears to the layman. As a medical professional you will have met and treated many thousands of people, most of whom gave you no thanks, or you will not see again, and those indivudals in their lives may only ever see a few medical professionals. So it is with being a pilot, I have flown many many thousands of people, our journeys all had a safe outcome, and yet I never got to meet or know any of them really, and they in their lives will maybe only ever meet a few pilots. Their perception of me at the time, or pilots in general, will be widely different from how I perceived myself and my profession - which is vocational, just like yours. Your points are well made and I respect your views.

BS

[Pace]

I tend to agree with Burr! We are laymen or patients so you are getting our views which will be things we read in the Daily Ma+l!

There is no mistrust of Doctors intentions but when you get a Multi Billion $ Industry who make those $Billions selling drugs there has to naturally be suspicion.
Those same Drug companies have massive marketing budgets to bring the medical world into their line of thinking and I am sure it works.

A cure would never suit those drug companies while a life long customer would and sometimes I wonder how much the drug companies prevent the Goal of cure rather than encouraging prolonged treatment as Cures would not be of benefit to them.

Where huge amounts of money come into the argument it is only natural to question the motives?

In the same way drugs have side effects, some small some not so small?
When we as laypeople see Scientists wanting to mass medicate people over the age of 50 healthy or otherwise with drugs like statins you have to question the motives or the fact that those scientists are seeing what they want to see because their mandate is to expand markets for the drug companies.

We had the horrendous revelation of the effects of sleeping pills churned out like smarties by Doctors 15 -20 years ago.
Those same Doctors would have been on forums like this claiming the evidence and safety of those drugs.

Now look at the results? Increases by 50% in dementia cases in those who took the drugs 15 years ago.

Somehow I have a sneaking suspicion that we will get the same with Statins at some point in the future.

Pace

[Burr Styers]

Homonculus,

Just looking back at your posts in this thread.......

Anyhow I thought everyone on statins died of renal failure before they could get down to the kitchen to get a grapefruit

Are these the comments of a medical professional in a public forum ? ......Bit harsh old man...........bit harsh

BS

[tomahawk_pa38]

Gingernut:I was prescribed statins by my 'former' GP. Had a blood test first and everything fine (except cholesterol of 6.1). Took them for 3 months - another blood test - all my liver enzymes off the scale - said GP was 'surprised' I wasn't bright yellow. I refused to take anymore but she insisted it was nothing to do with the statins but agreed I could stay off them for another 3 months. 3 months later, another blood test and guess what ? everything back to normal. QED. GP still refused to believe that statins were to blame so I changed GP - simples - couldn't cope with that sort of illogical thinking! Had a liver scan and now al Ok again and now on something different for cholesterol (Ezetimibe) and things are fine with cholesterol levels now about 4.

[misterblue]

Crucially, tomahawk, did you insist that this was reported as an adverse reaction?

[homonculus]

Burr Styers and Pace

Thanks. I appreciate your very sensible posts. I am not getting at patients in any way, and I agree pharmaceuticals like a lot of other big companies may have dubious practices from the individuals perspective.

This forum has great potential if it allow us as doctors to provide some non specific information. I really like to be challenged. However the renal failure issue was raised many weeks ago by a poster claiming statins damaged kidneys.

The bottom line is if you are fit and well you gain more benefit taking statins an not but of course you need a good GP who will check for liver problems and muscle problems

[gingernut]

all my liver enzymes off the scale

Yes, the lattitude is wide. By "deranged," this means 3x the usual level of "normal."

The bottom line, is that statins save lives. Stopping smoking and picking better parents is probably slightly more effective.

It's great to hear the other person's point of view, and it's always refreshing to realise that so many people take an interest in medical politics. And yes, we have to be very, very careful about the influence of drugs companies, (and we are generally.) The whole statin argument could be turned on it's head in a few years, and that's okay too.We have to work with what we've got, and that's why we are now (better) trained in critical appraisal now, it helps us sort out the wheat from the chaff.

I'm a little surprised about the vitriol pointed towards the medics (and nurses:)) involved in the prescribing of statins. But that's okay, we've got broad shoulders, and we're not all perfect ourselves. (I don't take a statin yet, but as I'm approaching 50, I'm sure there will be some health facist somewhere trying to force me to take Simvastatin 40mg with my cornflakes.)

We are in the business of improving health, we could deconstruct the arguments around QOF etc, but hand on heart, I don't think we're that naive.

We are on the patients side, we're paid to give advice, it's up to the patient whether they take it or not. Certainly for me, patient choice is paramount. I'd like to think we give a balanced argument.

[Burr Styers]

Homonculus,

As one is also now CKD 2 (due to guess what), then I re-iterate, that the comments from a medical professional in a public forum regarding renal failure due to statins, appears to me, a little bit flippant, even if it endorsed by someone else on the thread - bit of a weak answer really. It also implies that you dispense statins, but don't share with your patients the bit about potential renal failure (conflict of interest ?).

I really do believe you have the patients best interest at heart, but do be mindful of your audience when you dispense your wisdom on these forums.:ok:

BS

[Bad medicine]

OK Burr Styers, you've made your point...twice. How about the thread gets back on topic, and leave the personalities out of it.

[gingernut]

CKD2 isn't renal failure.

And people with CKD2 are very unlikely to progress to having renal failure.

They are far more likely to die from.........yes you guessed it......heart disease.

Which is why we are keen on intervening, which includes using statins.

[misterblue]

I would like to canvass opinion from both medics and patients on this forum.

For the medics, is it SOP to test everyone for Thyroid Stimulating Hormone (TSH) before prescribing statins?

For those on statins, was the TSH measured before you started?

Thanks,

MB

[dirkdj]

Blue,

TSH was tested by my 'new' doctor who put me off statins, not by the 'old' doctor who prescribed statins and who said my side-effects were just 'old age' (at 55?).

If you want more to read: http://www.thincs.org/:D (http://www.thincs.org/)

[Burr Styers]

Glad to hear about the CKD2 bit, and the other bit...... I kinda guessed that :\

No doubt statins is a topic that will run and run, and it certainly seems to polarise opinions with all stakeholders.

Still.....why fret about these things.....gotta life to live, things to do, places to go, people to see http://images.ibsrv.net/ibsrv/res/src:www.pprune.org/get/images/smilies/smile.gif

I wish Homonculus and all those medical professionals and contributors in this thread well, you have to make life affecting decisions that I don't - not everyone can do that, Respect.

And remember, growing old is mandatory, but growing up......is optional.:ok:

Take care all

BS

[hugh flung_dung]

I started this thread a couple of months ago and am slightly surprised by some of its twists and turns, but I guess that's one of the joys of PPRUNE ;-)

Following another blood test my figures are: total cholesterol 4.4, HDL 1.1 and LDL 2.9. My GP has now said that although there is some evidence that they protect arterial walls, with these cholesterol results he can understand why I might be reluctant to take statins.
I was going to use the Friedewald formula (LDL=Total chol-HDL-Total trig/k) to calculate my Total Triglyceride level but references for k seem to give 0.45, 2.19, or 5 (ostensibly all with measurements in mmo/l) ... what have I misunderstood?

[misterblue]

HFD, I would be sprinting away from statins full pelt, with those results!

Did he measure TSH, out of interest?

[hugh flung_dung]

Re TSH - no idea. We certainly didn't discuss it when I asked for the tests (although I did ask for a PSA, which came back as 1.7) ... looks like I'll live forever :eek:

[gingernut]

I can't think of a reason why TFT's should get tested prior to statin therapy.

Practice varies, sometimes the boxes on the blood form are ticked out of habit.

Yes, that's how the NHS works. :ugh:

Probably more important is the LFT test, but again practice varies.

Not heard of statin's affecting renal function, (other agents used to control risk factors such as ACE inhibitors could though.)

Perhap's we should not test as much, and use the money saved on subsidising oily fish and pre-school education, (which we know improves health).

And pour simvastatin in the water:)

[misterblue]

TSH is suggested in CG67,the clinical guidance, before GP's prescribe statins.

Presumably because hypothyroidism can result in high cholesterol.

QRisk2 puts the risk of acute renal failure at about 0.3%, caused by statins.

[gingernut]

I'm not sure that CG67 actually say's that.

Shouldn't we only test for TSH if there's dislipidaemia?

U&E's would be routinely checked for most people on statin's. Not 'cos of the statin, more to do with the reason why they're on the statin.

[misterblue]

From the CG67 pathway, para 1.7.1

Secondary causes of dyslipidaemia should be considered and excluded before starting lipid therapy. This should include measurement of TSH.

If there is no dyslipidaemia, why would you prescribe statins?

[gingernut]

Technically you could, all be it rarely.

[slowjet]

Ginge, not heard of the effect on renal system ? Not a Doc & I thought Renal meant something to do with me Aunty Rena.BORT...........long thread..........I did mention a mate of mine, on statins, pissing black tar. forced to take statins. He did so, only prior to a medical, so that the reading would please his Company Doc. Blood traces were found in his urine & blinkers went back on as they then subjected him to all sorts of further tests which started to affect his psychology ! Look, he tossed the lot down the toilet after retiring & looks fantastic. Mediterranean diet, reasonable exercise & enjoying his stress free retirement seems to have worked for this guy.

[gingernut]

there is a study describing unintended cosequences of statins (renal falure) but it hasn't the power to change practice.

[slowjet]

Coo, just love that; "Unintended consequences" ! Must be a Lawyer. Wish all pilots could take out "Unintended Consequence" Insurance!

[homonculus]

Dyslipidaemia is not the same as hyperlipidaemia

We don't test TFTS, but do correct known hypothyroidism before starting statins

Renal failure is not recognised as a risk.

Black tar urine is something I don't see in the UK

As a hospital doctor I use a bible called the BNF which covers the side effects and interactions. I also preview the tomb of paper provided by the manufacturer at the behest of the committee for safety in medicine. It does not mention this.

So someone may have written something for GPs - there is so much written in the NHS that I wonder how any trees remain standing - but it just shows how patients can be bemused and worried by too much information.

[misterblue]

Renal failure is recognised as a risk according to QRisk2

[gingernut]

"risk" of statins, or "risk" of IHD.
I think we're talking about separate things here.

[misterblue]

I'm trying to work out the cost/benefit of statins for me.

According to Qrisk2, for me (and I know it's just a bit of fun, but I'm looking at their assessment of my risk), I am at a 10% risk of a cardiovascular event in the next 10 years. ie out of 100 'me's' 10 will have something nasty.

If I take statins, the risk only drops to 7%, ie we only save 3 'me's'.

During the first 5 years though, the risk of really unpleasant side effects, including acute renal failure (0.3%) is 2.1%, ie we have only saved 0.9 'me's' overall for every 100 dosed (and this is assuming that the risk of side effects drops to zero for the next five years. If it doesn't then the case against is even greater).

Note that the side effect figure excludes the really nasty memory loss one, which now has to be included on the statin data sheet.

To summarise, 3 people don't have a cardiovascular event, but at least 2 do have a really crap time of it, from 100 people, taking 365,200 tablets overall.

Not the most convincing odds.

[homonculus]

No afraid not.

First a cardiovascular event has up to 40% risk of death, so we save 1.2 deaths. The other 60% end up with open heart surgery or angioplasty and the risk of chronic heart failure - being housebound in some cases. And pilots cant fly for say 2 years

Against that everyone keeps telling me about renal failure but I just cant find it. Anyhow it doesnt kill. The risk is of muscle pain - if this happens you stop and it goes away. You also have your liver function tests measured for 2 years by a simple blood test. If they go up you stop and they recover.

So we have to compare death and loss of license and major surgery with ........ muscle pain and a blood test. I know which I prefer. Which is why I and many many doctors decide to take statins even with normal lipid profiles and low cholesterol levels. I cant think why doctors, who hopefully (!!??!!) have the best understanding of the risk benefit ratio, would deliberately poison themselves and damage their kidneys for no reason.

[misterblue]

But then, as someone pointed out earlier, similar things were said about HRT.

There's also the anti-arrythmic drugs, which had to be withdrawn from the market due to them killing too many people, despite a very good rationale for their use.

Ah well, we agree to disagree.

Should you find yourself on a flight and during the welcome on board PA the captain can't remember where he's going, it could be me on statins, and I wish you the best of luck!

[gingernut]

It's a matter of balance misterblue. Have you asked your doc about the "10%" figure.

The evidence is for statins. We may be proved wrong in time, but we have to go on what we've got now, and, if, for example, you could "grade" the evidence for their use, it would be grade 1, out of a scale of 1 to 5.

You've got every right to take decisions for yourself, even if we (the prescriber) think those decisions maybe unwise.:)

[misterblue]

Homonculus, you have patiently waited for the renal evidence and I have made an error. This is where it comes from.

I went to Qintervention.org and entered my details. I came out with a 10% risk of CV event.

I then entered 'What if I were to go on statins?'

The side effects come out, on the website as

A few people may get unintended effects when starting statin treatment. The other interventions may also have a bearing on these risks.

With the interventions selected, you would have the following risks in the next 5 years:

0.1% risk of acute renal failure (ARF)
0.5% risk of cataract
1.2% risk of having abnormal liver function tests (LFT) severe enough for you to need to stop taking statins
0.3% risk of getting serious myopathy


I realise that I have got the ARF mixed up with the myopathy, but my figure of 2.1% side effects, over 5 years still stands. As I said earlier, it also does not mention the memory loss bit, which now has to be on the data sheet.

Ginger, regarding the 10% risk. I intend to be retested for cholesterol in a few months. I don't think lifetime medication based on a single blood sample is a good idea, and I'll raise the 10% with my GP then.

Finally, I quote from the Cochrane Foundation systematic review on statins. I trust this organisation to be impartial, and quote the author's conclusions, which are as baffling to me as I hope to you.

Authors' conclusions:
Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of cancers or muscle pain among people without evidence of cardiovascular disease treated with statins. Other potential adverse events were not reported and some trials included people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.

[homonculus]

No problem with that misterblue - sums it up well

A few years ago I would have been sitting up front. But then I forgot not only where I was going but where I was so I gave up the day job and look up medicine.

Much better now I am on statins and hope springs eternal

[gingernut]

I was a great fan of Cochrane, they were one of the first to make an attempt to differentiate between the wheat and chaff.

However,

Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of cancers or muscle pain among people without evidence of cardiovascular disease treated with statins. Other potential adverse events were not reported and some trials included people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk

does seem a bit "woolly." It sounds like they're saying, "You may not live better (no change in morbidity) , but you may live longer (decrease in mortality). Cost effectiveness should be the worry of public health politicians (:)) not the patient.

They are saying that at 10% risk, we'll corrupt the drugs budget.

Piccini et al (2009) says something slightly different, and may be worth a look.


The points about renal failure/liver problems/myalgia may be a little bit of a red herring, possibly inflamed by the media, although of course it's interesting to hear real life stories here.

Your strategy of getting re-tested in 6 months sounds reasonable. I only wish more of my patients were as enthusiastic. I'd be able to cure or control many ails, (eg hypertension, diabetes, dyspepsia....the list goes on), without resorting to the prescription pad.

Please let us know how you get on, and what worked.

[Pace]

Gingernut

Sadly we the laymen are just as guilty waddling into your surgeries 5 stone too heavy, smoking, drinking, and abusing ourselves and demanding a pill to make us feel better?
The drug Barons only too happy to supply such pills.
oh for CURES for some of the terrible life destroying ailments we suffer but cures have to come from both the medical world and the Laymen.
Sadly Cures do not suit the Multi $billion drug Barons.
If a fraction of what is spent on discovering Cures than is spent on discovering and re packaging drugs where would we be now???

[gingernut]

It's a very good point PACE. A good example is heartburn.

Back "in the day," if you had heartburn, you had 3 choices:

take a shed load of "rennies," that lasted 10 minutes or so,

have an operation, that had very high risk of killing you, (and generally didn't work), or

stop drinking 8 pints of "Stella" prior to a Chicken Ticka Jalfreizi.

Nowadays, it's easy to take Omeprazole. )

And I'm not preaching, we all do it. And it works.

[misterblue]

Well, Gingernut, you asked a while ago how it turned out. Here is is.

History was- Cholesterol of 5.9.
Tried cutting out all saturated fat, severely.
Cholesterol hardly blinked - 5.8.

Conclusion? In my case, saturated fat consumption is not connected with Cholesterol.

Carried on as normal, Cholesterol of 7.2. Was told to go on statins. Refused.

Tried small weight loss, (circa 2kg), plus cutting out a lot of sugar, plus Flora Pro-active Buttery (which tastes less like diesel than the rest).

Cholesterol of 4.7. You can keep your statins.

Conclusions?

Saturated fat consumption is irrelevant in my case.
Don't decide on a lifetime of medication on one or two blood samples.
Maybe the Flora stuff works.

Now where are all the pies?

[Airclues]

gingernut

.....but not without side-effects;

Side effects of omeprazole - Indigestion and excess acid - NHS Choices (http://www.nhs.uk/medicine-guides/pages/medicinesideeffects.aspx?condition=Indigestion%20and%20exces s%20acid&medicine=omeprazole)

[Pace]

Statins And Exercise Combined 'Decompose' Your Muscles

Dear Reader,

If your doctor is someone you can trust then he or she will strongly advise you not to do any exercise once you start taking a cholesterol-lowering statin drug... Then again, if your doctor really is someone you can trust, you wouldn't have been given a statin drug in the first place.

Oh the irony...

I know it makes no sense. Especially if you are worried about your heart health and you know you need to stay fit and active. But if you are taking statins the best thing you can do to prevent permanent damage to your muscles is to NOT exercise.

That's no going to the gym, no sit-ups, push-ups, no cardiovascular exercise or swimming... not even a brisk walk.

In short – don't exercise.

That's because if you take the world's most popular drug AND exercise, you could end up side-lined with debilitating weakness for the rest of your life.

For years now, we've known that statin drugs can cause muscle pain and fatigue. These are actually symptoms of your muscle tissue decomposing.

Now, that's horrific enough to make anyone avoid this drug. But it gets worse. Because there's one factor that dramatically increases the risk of muscle damage… Exercise.

In a new trial, researchers confirm this exercise danger.

Patients who were overweight began regular exercise and significantly improved their aerobic fitness in three months. Another group followed the same regimen. But they took a statin drug. Their aerobic fitness barely improved at all.

Amazingly — after weeks of supervised exercise — aerobic capacity actually DROPPED in some of the statin users.

Results on the cellular level were even worse. Health of muscle cells improved significantly in the exercise/no-statins group. But muscle cell health took a dangerous nosedive in the statins group.

The irony is appalling! Exercise alone reduces cholesterol and improves heart health. And statins don't effectively lower cholesterol unless you also exercise.

But combine the two and you'll be in grave danger.

[slowjet]

Well said. But the Pharmaceutical Industry making billions out of this miserable drug and somehow pursuading the Medical Profession to prescribe (I wonder how ?) ! On this open public forum, I sense the balance moving away from favour. Delighted. Mate of mine, referred to in previous posts ditched the poorly prescribed drug down the toilet. Mediterranean diet, walks rather drives up to the shops, stairs rather than lifts, fortunate to swim in his own pool throughout the summer, moderation in drinking habits, and, good grief, he looks better than I have ever seen him.

Medics, only a slight slap on the wrist. Drugs are an important part of your armoury & many of us would not be here today without your care & attention. Thank you. But, ditch this horrible medicine. Look at your providers, resist the cruise, free golf-club memebership,office wall clock etc and, as we say in France...........'Just say non !' !

[cavortingcheetah]

Ditching drugs down the toilet, literally, is not really sporting for those further downstream in the sewage processing passage, let alone the lobsters and crabs which lurk at sewage outlets and those who gorge upon their carcasses at great expense and sometime risk.
The statin argument rages and those on 40mg a day may sense a conflict of healthy interest. Those on a statin dose of 5mg or even 10mg a day perhaps more readily fall into the preventative category rather then the curative one.
A stroke may ensure free wheelchair transport for the remainder of one's life but the short sombre journey in a hearse is probably more to the liking of most of us?

[Landflap]

Amusing post cavortingcheetah and succint. In reply to your closing question..........YES ! In fact, can't wait. Have Near Death Experiences most nights but as I venture towards the light, always turned back my Aunty Stella ! Mind you, these modern wheelchairs with alloys, Capt Kirk chair, high speed option do look a lot of fun . Back on thread, I know Slowjet & his mate. The latter was prescribed 80mg per day. Could that be the reason for his near death experience in a crew hotel ? Just spoken to him & he apologises for ditchimg the drugs down the toilet.

[dubbleyew eight]

what is it in eyes, veins or arteries? I'll call them thingies.

anyway many years ago I was getting glasses sorted out and having a talk to the optometrist who was also a pilot.
while he was measuring things he went quiet. "gees mate you've got silver wire thingies you'd better get that sorted out."
so off I went and got a checkup and was prescribed a statin. it reacted badly with my bod, felt like knitting needles being poked into my liver. doc changed the prescription to ruovustatin which I have been on now for quite a few years.
last glasses redo I asked my (different) optometrist about my silver wire thingies. after a few minutes of peering around he sat back and said "if you ever had it you certainly dont have it now."

ymmv but I weigh in on the side of statins. the little buggers have worked for me.

[OFSO]

Last annual medical, my doctor found my HDL+LDL cholesterol was high.

No he said, I never prescribe statins. Ever.

What you do is take one Red Rice Yeast Tablet and one Danecol/Benecol anti-cholesterol yoghurt every day.

Result following six months of doing this:

Before was 273mg/100ml.

After is 190mg/100ml.

Normal range is between 130 and 220 mg/100ml.

[Pace]

Is your statin affecting your memory? Study finds some common brands can affect brain function | Mail Online (http://www.dailymail.co.uk/health/article-2432264/Is-statin-affecting-memory-Study-finds-common-brands-affect-brain-function.html)

[Radgirl]

Pace

Statins seem to bugging you given your previous posts. Like anything in medicine you will find hundreds if not thousands of research articles of differing quality and need to look at the overall picture.

The reality is that there is some evidence statins reduce the deposition of amyloid which correlates with the commoner forms of Alzheimer's. there are many papers relating to this although the level of evidence is such that we would not prescribe statins for this reason.

Statins also clearly reduce the incidence of cerebral vascular incidents - strokes to you and me - which are your real brain risk.

This is a single study reported in that reliable medical journal the Daily Mail involving, er, rats. Even the Mail's own article admits other professionals have imputed the findings.

I for one won't lose any sleep over this revelation

[dirkdj]

I certainly stopped Statins three years ago and feel the difference. It used to be that I could not remember all the digits of a frequency given, one or two digits seemed to 'disappear' from short term memory. I would sometimes go to the fridge and when there no longer know what I wanted. There are several links in this thread worth reading or watching.

[Pace]

Redgirl

I Am against mass medication especially when there is a huge profit to be made by drug companies and other interested parties.

How many times have Doctors prescribed pills with re assurances that they are harmless or the better of two evils only to find a few years later that they cause terrible damage?

Sleeping pills are one example.

Ok if you have serious problems then yes the better of two evils comes into play but it worries me when some new money making drug is being pushed towards the over 50s many of whom are healthy individuals but the potential market is massive!

Statins are one drug which have a lot of adverse publicity and no smoke without fire?

[Radgirl]

Statins are not new drugs and as such their patents have long expired. The generic drugs given out in the UK cost but pennies and make nobody fat profits. Yes you can still buy branded statins but GPs won't prescribe them as they get wrapped over the knuckles

This isn't about illness but about preventing early death in the well. Some statins are prescribed for the ill but what is so exciting is the ability to prevent early death in the healthy and allow these people to continue with a good quality of life

If we stopped using any drug or procedure due to an adverse paper as opposed to properly assessing the totality of research and its quality we would be back in the dark ages

Anyhow it is the individuals choice. If you don't want to take a statin nobody is going to force you. But it is interesting that so many doctors have decided otherwise and themselves take statins

[Pace]

This isn't about illness but about preventing early death in the well.

Is It???? that is a very dangerous statement!!! medicating people on mass who are healthy with Statins which have such awful side effects might suit the pockets of the drug companies but no one else.

i am sure you heard the announcement in the media about the large American study involving 340,000 people it was all over uk television and radio today!

People with heart disease who took medication had the same life expectancy as those with heart disease on a controlled exercise regime.
When it came to strokes those on medication did not do so well as those on a controlled exercise regime.
those with strokes who purely exercised survived longer than the medicated patients.
Popping a pill while great for the drug companies $billions is not the answer to all ills.
the mass medication of healthy people with drugs we really do not know are safe is a very risky route to take.

(with an opinion but not medically qualified)

[Radgirl]

No Pace we are not mass medicating. We are offering the drugs and letting patients have a choice. You choose no, many doctors choose yes. The reason for medicating the healthy is that it keeps them healthy, and we dont accept the awful side effect argument except in a minute number of patients.

The study is interesting but off thread. It is looking at people who already have illness eg have had a stroke. We know exercise is important to these patients and I am not sure I am that surprised that exercise gives the same benefits as many drugs.However this wasnt a statin review but a review of lots of different drugs given for lots of reasons

The prediabetes is the exception and very interesting as there is independent research showing exercise reduces the lipids in the blood which are known to trigger type 2 diabetes., This is the first clear research showing taking up exercise may prevent diabetes developing.

So the answer is statins and exercise!

[BWBI]

I suffered a TIA ( stroke ) four years ago and whilst in hospital I was prescribed Statins ( Simvastatin 40 mg tablet once daily ) My cholesterol had always been low and I asked my Consultant why I should take them and he said that they helped prevent Strokes even in the case's like mine with people with low Cholesterol, although the exact medical reason for their preventive nature was unknown.

Based on his advice I have continued to take them with no apparent side effects apart from slight muscle pain, although I was suffering from that before my illness in which case it was caused by the blood pressure tablets I had been taking for many years. Once my Doctor changed the tablets it went away ( It was very severe ) I don't feel inclined to start changing my tablets as it seems to me that over time that all blood pressure and Cholesterol tablets have some side effects and it is a case of putting up with what is now for me a minor discomfort as against their undoubted preventive benefits.

[slowjet]

People, have a look at the "Type 2 Diabetes" thread.
Radgirl ; Bit of a wild assertion that the answer is "Statins AND exercise". Nope. Exercise, yes. Drop weight, particularly if it has formed round the gut,drop the sugar levels, moderate the drinking (high sugar levels), control diet ; go for the "mediterranean style diet" and pleeeeeze, ditch the dreadful statins altogether. Oh, and, research showing that a starvation programme, really, absolutely nothing for one day in seven is showing signs of reversing type 2 diabetes altogether .