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Statins - miracle or menace?

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Statins - miracle or menace?

Old 18th Oct 2012, 22:12
  #81 (permalink)  
 
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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:

Last edited by 40&80; 18th Oct 2012 at 22:18.
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Old 18th Oct 2012, 22:48
  #82 (permalink)  
 
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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.
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Old 18th Oct 2012, 23:04
  #83 (permalink)  
 
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Originally Posted by Cameronian View Post
CharlieOneSix (post 62) - possible undiagnosed helicobacter pylori causing sensitivity to aspěrin? 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.
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Old 19th Oct 2012, 12:08
  #84 (permalink)  
 
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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.
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Old 20th Oct 2012, 11:41
  #85 (permalink)  
 
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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 . 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

Last edited by soggyboxers; 20th Oct 2012 at 11:42.
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Old 20th Oct 2012, 22:38
  #86 (permalink)  
 
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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
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Old 21st Oct 2012, 21:32
  #87 (permalink)  
 
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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?
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Old 22nd Oct 2012, 03:10
  #88 (permalink)  
 
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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
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Old 22nd Oct 2012, 09:04
  #89 (permalink)  
 
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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?
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Old 22nd Oct 2012, 13:36
  #90 (permalink)  
 
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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
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Old 6th Nov 2012, 15:20
  #91 (permalink)  
 
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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.

Last edited by 40&80; 6th Nov 2012 at 15:22.
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Old 22nd Nov 2012, 12:31
  #92 (permalink)  
 
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Qrisk

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.

Last edited by misterblue; 22nd Nov 2012 at 13:30.
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Old 22nd Nov 2012, 14:21
  #93 (permalink)  
 
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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% ?
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Old 22nd Nov 2012, 17:56
  #94 (permalink)  
 
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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.
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Old 22nd Nov 2012, 21:42
  #95 (permalink)  
 
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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.

Last edited by gingernut; 22nd Nov 2012 at 21:44.
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Old 23rd Nov 2012, 10:05
  #96 (permalink)  
 
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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?
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Old 23rd Nov 2012, 10:08
  #97 (permalink)  
 
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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.
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Old 23rd Nov 2012, 10:29
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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 time of year to get this thing diagnosed!
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Old 23rd Nov 2012, 16:36
  #99 (permalink)  
 
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Fenofibrate

I always wondered why Fenofibrate is not prescribed more often:

Fenofibrate - Wikipedia, the free encyclopedia

"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.

Last edited by Taras B; 23rd Nov 2012 at 16:39.
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Old 23rd Nov 2012, 19:11
  #100 (permalink)  
 
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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.
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