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?

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

Did he measure TSH, out of interest?

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:

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:)

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.

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.

From the CG67 pathway, para 1.7.1

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

Technically you could, all be it rarely.

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.

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

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

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.

Renal failure is recognised as a risk according to QRisk2

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

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.

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.

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!

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.:)

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

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.

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

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,

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.

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???

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.

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?

gingernut

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

Side effects of omeprazole - Indigestion and excess acid - NHS Choices

Another Claim against Statin use
 

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.

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 !' !

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?

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.

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.

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.

statins worrying research on memory loss
 

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

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.

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?

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

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)

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!

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.

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 .