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:

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.

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.

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.

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 :\

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

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?

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

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

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.

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.

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% ?

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.

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.:)

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?

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.

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!

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.

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.:)

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


Warning over grapefruit juice and cholesterol pills | Mail Online

Grapefruits can trigger overdoses in dozens of medicines researchers warn - Yahoo! Lifestyle UK

Pace

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

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

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

Statins, Yay or nay ?
 

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

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.

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

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

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

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

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.

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

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

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.

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

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

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.

TSH levels
 

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

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

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/sr...lies/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