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Statins - miracle or menace?

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Statins - miracle or menace?

Old 30th Nov 2012, 11:56
  #121 (permalink)  
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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?
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Old 30th Nov 2012, 12:16
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HFD, I would be sprinting away from statins full pelt, with those results!

Did he measure TSH, out of interest?
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Old 30th Nov 2012, 12:20
  #123 (permalink)  
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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
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Old 30th Nov 2012, 22:24
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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.

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
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Old 30th Nov 2012, 22:28
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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.

Last edited by misterblue; 30th Nov 2012 at 22:31.
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Old 30th Nov 2012, 23:34
  #126 (permalink)  
 
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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.
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Old 1st Dec 2012, 07:58
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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?

Last edited by misterblue; 1st Dec 2012 at 08:00.
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Old 1st Dec 2012, 08:47
  #128 (permalink)  
 
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Technically you could, all be it rarely.
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Old 1st Dec 2012, 10:29
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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.
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Old 1st Dec 2012, 17:42
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there is a study describing unintended cosequences of statins (renal falure) but it hasn't the power to change practice.
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Old 2nd Dec 2012, 10:22
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Coo, just love that; "Unintended consequences" ! Must be a Lawyer. Wish all pilots could take out "Unintended Consequence" Insurance!
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Old 2nd Dec 2012, 18:46
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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.
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Old 2nd Dec 2012, 20:41
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Renal failure is recognised as a risk according to QRisk2
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Old 4th Dec 2012, 08:47
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"risk" of statins, or "risk" of IHD.
I think we're talking about separate things here.
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Old 4th Dec 2012, 15:31
  #135 (permalink)  
 
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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.
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Old 4th Dec 2012, 16:20
  #136 (permalink)  
 
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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.
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Old 4th Dec 2012, 16:45
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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!
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Old 4th Dec 2012, 21:24
  #138 (permalink)  
 
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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.
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Old 5th Dec 2012, 10:54
  #139 (permalink)  
 
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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.
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Old 5th Dec 2012, 20:16
  #140 (permalink)  
 
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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
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