"How Statins Kill You One Cell at a Time"

[JSFolk]

http://www.amazon.com/Statin-Drugs-Really-Lower-Cholesterol/dp/0615618170

So, my dad is taking statins for high cholesterol. He recently mentioned this book to me, asking for my "skeptic sense" as one of his brothers has jumped whole-hearted (no pun intended) onto the book's bandwagon. Everything I have seen about the book looks like typical woo BS:

Self-published by the author.

Apparently (I've not read it) details "conspiracy" to get these "dangerous drugs" approved.

Author's comments on youtube video include: "Amazon.com for $14.99. It was written as a go-by for civil litigation. If you've been injured, bring it to your attorney." (I think this was in response to a question, but she didn't post it correctly.)

When people comment on YouTube asking about how to lower their cholesterol without statins, author replies "Buy the book!"

Author's blog: http://statininjuryvictims.blogspot.ca/ (This has more info on their claims.)

So, anyone out there with better knowledge of medical stuff who can point me to some good info on statins? It looks like complete BS to me, and I've told my dad that, but I'd prefer some better info.

Thanks!

 

[Professor Yaffle]

Cochrane review summary - statins for primary prevention of cardivascualr disease:

Cardiovascular disease (CVD) is ranked as the number one cause of mortality and is a major cause of morbidity world wide. Reducing high blood cholesterol which is a risk factor for CVD events is an important goal of medical treatment. Statins are the first-choice agents. Since the early statin trials were reported, several reviews of the effects of statins have been published highlighting their benefits particularly in people with a past history of CVD. However for people without a past history of CVD (primary prevention), the evidence is less clear. The aim of this systematic review is to assess the effects, both in terms of benefits and harms of statins for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE until 2007. We found 14 randomised control trials with 16 trial arms (34,272 patients) dating from 1994 to 2006. All were randomised control trials comparing statins with usual care or placebo. Duration of treatment was minimum one year and with follow up of a minimum of six months. All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations. Statin treatment reduced blood cholesterol. Taking statins did not increase the risk of adverse effects such as cancer. and few trials reported on costs or quality of life. This current systematic review highlights the shortcomings in the published trials and we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.

http://summaries.cochrane.org/CD004816/statins-for-the-primary-prevention-of-cardiovascular-disease

 

[Zeuzzz]

^ And based on that ...

/ end thread.

Good post, Yaffle.

Doctors have long ago given up the practise of prescribing drugs they are not 99.9% sure they are safe. Theres entire systems of ethics, clinical trials and very rigousous processes that have to be done before anything can be prescriubed now. Got so much stricter after the whole brief "benzos are fine and not addictive" fiasco decades ago.

 

[casebro]

What, Yaffle, no numbers for the results, only "All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations. "

And Zeuzzz, did you read the last sentence: " This current systematic review highlights the shortcomings in the published trials and we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk. "

I'm off to read more.

ETA: I did. Last sentence of the abstract:

"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."

Hey, after taking vitamin K2 for a couple months, I just got some lipids done. My HDL is up to 49. And I believe that according to the lipid hypothesis, that is the biggest risk factor. But I'm no believer in said lipid theory. Seems calcium is a much larger risk factor, things like calcification of arteries and valves. And osteoporosis is also a HUGE risk factor of CAD,

So eat your green leafy veggies and make sure you have e-coli in your system, since that is where K2 comes from. And the fiber link to CAD? Seems fiber feeds the e-coli.

Best source of dietary K2 is cheese and Pate Fois Gras. Goose grease. Or organ meats from animals with salmonella. Germs = health.

 

[Professor Yaffle]

What, Yaffle, no numbers for the results, only "All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations. "

And Zeuzzz, did you read the last sentence: " This current systematic review highlights the shortcomings in the published trials and we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk. "

I'm off to read more.

That was just the summary. It links to the full Cochrane review.

 

[casebro]

Hey Prof, make sure to read my ETA.

 

[casebro]

And another thought that pops up in my toilet bowl of a mind, COQ-10 is supposed to be good for the heart muscle. And also the other muscles. I've been taking it for 10 years for a mitochondrial style myopathy. I found I don't need it with the K2. The K2 I take is- MK-7, Mena-tetra (K)uinone-7, meaning it has 7 quinones. I assume COQ10 is 'Co-enzyme with 'Quinones-10', isn't it? Sounds like quinones can be important stuff.

I've know for years that calcium is very close the the root cause of my myopathy, as a neurotransmitter. My latest reading tells me that there is a calcium-K-metbolism based myopathy. So I'm really hopeful that MY problems are K based. I am optimistic about K2-7, could be my panacea. If it only gets tied to adult onset diabetes. Maybe the calcium that lacks the K2 to transport it, builds up in the insulin receptors of cells, making me insulin resistant?

Some things to google: <Syndrome X + calcium> <hypertension + Vitamin K>

Anyway, I see that Cochrane report as the potential start of a "Statin Gate", where in the consensus that fat = death is tossed out the window, to be replaced with Fatty Organ Meats = Life. Remind me to buy Pate' futures!

C.T. caution: the UHC will tell us NOT to take K2, because what is society to do with all those folks who don't die on time?

 

[JSFolk]

Thanks, Yaffle. I found the Science-Based Medicine blog discussion of the Cochrane Review, and it's just what I was looking for.
http://www.sciencebasedmedicine.org/index.php/statins-the-cochrane-review/

 

[ectoplasm]

Thanks, Yaffle. I found the Science-Based Medicine blog discussion of the Cochrane Review, and it's just what I was looking for.
http://www.sciencebasedmedicine.org/index.php/statins-the-cochrane-review/

As usual SBM explains the controversy clearly.

Because this is ultimately a judgment call, the results of this study can be spun to a variety of conclusions. The study authors chose to present an overall negative conclusion – that the effect size is too small to be worth it. While other experts, looking at the same data, have come to the opposite conclusion – that statins are worth it. It is important to emphasize that the debate is not about whether or not statins have a real effect – they do, but about the cost-benefit of statins as an intervention for primary prevention

.

 

[casebro]

I read the Science Based Blog post linked above.

So treating 1000 people for one year will postpone one death.

For how long? I'm going to assume for the whole one year. No info to claim less, no info the credit more. If it postpones the one death from Jan 1 to Jan 1, that means those 1000 people will average 8 hours, 46 minutes. Per year of treatment? Of course, the patients in those studies are usually of an age group where death is rare- they usually study 60yo, not 75 year olds. But if we maintain the same death rates, not the accelerating death rates of the elderly, 15 years of usage extends the average lifespan by 5 1/2 days. And that is precisely how much a "30% improvement in death rate" is worth to the batch of us.

And so far as the 'rare' side effects, the studies I'm familiar with have a 95% drop out rate. Huh? How can you come to any conclusion with a 95% drop out rate? You would have to use VooDoo math. Which they do. They compare the two groups on a month to month basis, monthly rates, not total incidents. NOT in the whole group over the typical five year study. Saves lots of money to pare the subjects from 17,990 to 500.

So I can sure see taking a position of Statins being worthless.

OOh, QALY? That is a figure in $$$ for treatment to extend on life one year. So, QALY for statins is 1000 times the cost of treatment. Must be ummm pills are cheaper now, $30/month, a couple Dr visits, a couple lab test, can we guess $500/year. times 1000 patients? QALY for Stain drugs, $500,000 ? Yes, we should all have FREE health care. Paid by__________?

eta: Okay my Voodoo math is wrong. Hers is a page
http://www.theheart.org/article/191979.do which will interest posters here:

"Only one quarter of the risk subgroups (all comprising patients with multiple risk factors) had cost-effectiveness ratios below $100 000 per QALY. " They used 240 sub-groups to find the greatest efficacy.

Seems 75 yo with previous MI can live 4 months longer.

 

[ThunderChunky]

The OP's post refers to someone with high cholesterol... a very different situation than someone with low risk of cardiovascular disease.

 

[Bikewer]

I've been taking statins for about 20 years. When I first signed up for the university's HMO,
I had my cholesterol tested and it was a whopping 360. This even with cycling 100 miles per week.
My doc decided this must be heriditary and put me on Lipitor, which knocked the readings back down to the "optimal" range.
Since then, with the vagaries of the HMO, I have gone back and forth with several different drugs... Zocor, the generic of Zocor, Simvastatin, Simvastatin with a drug "Welchol" that removes cholesterol from your gut, and finally back to Lipitor which has now gone generic and the HMO will pay for it...
Through all that time, my levels have stayed pretty much in the normal range.

So, from my standpoint, I was cruisin' for a bruisin' and the statin drugs have prevented any such.
However, I am aware that (just like with vaccinations) there is an "anti" feeling; I had a guy on another forum talking about people "dropping like flies" of heart disease since the start of widespread statin therapy.
Whereas, from listening to Science Friday religiously, I've listened to several programs talking about reduced death rates and other benefits as well..

 

[casebro]

The OP's post refers to someone with high cholesterol... a very different situation than someone with low risk of cardiovascular disease.

But it comes down to a question of how high is too high. My MD wanted mine lower- my LDL was 100, 'optimum' is "lower than 100". Damn pedant. Yet my HDL was 40, ratio HDL to LDL supposed to be the real standard, mine was 2 1/2 to 1, optimum is lower than 5 i think. Damn pedant, remembers a lot of medical fact but can't think.

So, like I said above, I'd like to see the curve of longevity to cholesterol level. I very seriously doubt that lowering my LDL ONE POINT, from 100 to 99, would make me live 15 seconds longer.

 

[casebro]

Bikewer, my own total cholesterol was at one point 440. But I was in mortal pain constantly from sciatica. Seems cholesterol can be an indicator of stress, and who does not believe that stress shortens lives?

Hmmm, and while typing that, another Big Pharma factoid arose in my mind. Most studies of Satain are done ina n aging population. Like, near retirement age. A friend is a psychologist, and we were talking about how so many of his patients relax, calm down, and become 'normal' as the stress of normal life abates with age. No more babies to worry about, no more job security worries, with impending retirement, no more financial worries. Yes, aging is the number one risk factr for heart troubles * but perhaps in a sub set of us, retiring itself lowers stress AND cholesterol levels? Is that corrected for, or matched between groups in statin studies? It only needs to be in one in a thousand to negate ALL of the low risk statin prevention.

* About 20 years ago my HMO told me what the 5 major risk factors for CAD were. #1-age, 2-weight, 3 height, 4 hereditary, Cholesterol was #5 . Since than they've learned that weight is only a factor if diabetic. Only one thing we can do to prevent aging. Nobody say we should get our femurs surgically shortened. Your genes are beyond control. So just how much change can be made by changing the #5 risk factor anyhow?

 

[JSFolk]

I finally figured it out. The author is one of those "eat right and you can cure anything" nuts. http://www.amazon.com/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&sort=relevancerank&search-alias=books&ie=UTF8&field-author=Hannah%20Yoseph

Cholesterol? Check (arguable)
Lou Gherig's Disease? Check
Lupus? Check
Multiple Sclerosis? Check
Weight loss while eating all you want? Check

 

[trusetheeker]

I finally figured it out. The author is one of those "eat right and you can cure anything" nuts. http://www.amazon.com/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&sort=relevancerank&search-alias=books&ie=UTF8&field-author=Hannah%20Yoseph

Cholesterol? Check (arguable)
Lou Gherig's Disease? Check
Lupus? Check
Multiple Sclerosis? Check
Weight loss while eating all you want? Check

JSFolk, this discussion was going pretty good but you had to spoil it by a cheap attack on the author. IMO, you've just proven that you're incapable of thinking outside the accepted mainstream health (ahem, disease) paradigm. 1000s of people are living the dream of eating as much as they want of healthy foods and either losing weight or maintaining their desired weight (tip: troll the 30bananasaday website and start counting the successful ones). I, on the other hand, eat as much as I want of healthy foods plus an unreasonable portion of unhealthy foods and cannot put weight on yet I'm as fit as a fiddle at age 55 and in better shape than my teen years. Anecdotal? Yes. To be dismissed out of hand? Only by the wilfully ignorant.

How about people who have experienced "spontaneous remission" (according to their doctors) after changing their diets and/or undergoing a water-fast. Of course, it couldn't have anything to do with changing their diets or the water-fast so it must have been one of those "spontaneous remissions" that just happen sometimes.

Want proof? Make enquiries directly to Dr Paul Goldberg as I'm sure that he will be happy to provide reasonable assistance.

I now return you to the regular propaganda broadcast...

 

[Jodie]

I went to a conference about 6 months ago and the speaker put it very simply, it depends on the goal in treatment and your risk factors. This goes back to the art of medicine. Is your physician a cook book doctor or does he actually look at your profiles and history to decide the risk versus the benefit of the drug?

I'm female and 50, every statin I took caused excruciating cramps and face numbness. Lipitor caused memory problems after 4 months. It was to the point that I forgot where a destination was that I had been to many times before and nearly burned the house down forgetting that I left something cooking on the stove.

After a couple of MRI's with nothing found, my sister who is a pharmacist, suggested my memory problems might be related to the Lipitor. I stopped taking it and within 3 weeks I felt like a fog had been lifted from my mind.

This is just my personal experience, everyone responds differently to these drugs and I would not recommend anyone stop taking their medication without consulting their physician. It may take more than one try to find the right one for you. There are risks in not taking the statins if you are genetically predisposed to high cholesterol levels. Research shows these people have a significant risk of infarcts before the age of 40.

http://www.netdoctor.co.uk/diseases/facts/familialhypercholesterolaemia.htm

Here is a good basic link from the Mayo clinic that explains the risks and the decision making process for prescribing:

http://www.mayoclinic.com/health/statins/CL00010

Also be aware that the statin issue is now becoming a political issue for healthcare costs:

http://http://www.wsws.org/articles/2010/apr2010/stat-a09.shtml

I always tell people to read the research for themselves, both pro and con, looking at the sample size, other variables not included , and how the statistics are presented before deciding whether to accept the conclusion as sound.

Based on my own experience I think more research should be done on the benefits for statin drug use in women. Tolerance of statins and efficacy might also be related to genetic tendencies.

Within the next year technology will allow us to make medical decisions based on personal genetic profiles so that regimens can be tailored specifically for the person. This opens up a whole new area of pharmaceutical research but I think it's an exciting new approach to medicine and may add some clarity to the statin debate.

http://www.mayoclinic.com/health/personalized-medicine/CA00078

 

[Dr. Imago]

Whereas, from listening to Science Friday religiously, I've listened to several programs talking about reduced death rates and other benefits as well..

The rate of "widow-maker" myocardial infarctions since the advent and widespread use of the statin class has dwindled. This is a real effect that is palpable and discussed widely among primary care docs and cardiologists who are seasoned and have been practicing medicine for a lot longer than I have. The anecdotes are supported by the data.

There are no perfect drugs. They all have side-effects. But, "dropping like flies"? No, quite the opposite. And, this is in the face of a horrendous obesity epidemic in this country (U.S.) where people are fatter and unhealthier than ever.

~Dr. Imago

 

[casebro]

The rate of "widow-maker" myocardial infarctions since the advent and widespread use of the statin class has dwindled. This is a real effect that is palpable and discussed widely among primary care docs and cardiologists who are seasoned and have been practicing medicine for a lot longer than I have. The anecdotes are supported by the data.

There are no perfect drugs. They all have side-effects. But, "dropping like flies"? No, quite the opposite. And, this is in the face of a horrendous obesity epidemic in this country (U.S.) where people are fatter and unhealthier than ever.

~Dr. Imago

Link to that data please. And do they correct for concommitant use of aspirin?

 

[Dr. Imago]

These results demonstrate that MDCT-determined plaque composition as well as volume could be changed within 3 weeks after intensive lipid lowering. This may explain acute effects of statins in treatment of acute coronary syndrome.

http://www.ncbi.nlm.nih.gov/pubmed/22720196

Perioperative statins reduce risk for myocardial infarction and atrial fibrillation in statin-naïve patients.

http://www.ncbi.nlm.nih.gov/pubmed/22711103

In conclusion, statin use before the onset of [acute myocardial infarction] might have effects on coronary plaque morphology of the AMI culprit lesion with less necrotic core and greater fibrous and fibrofatty component.

http://www.ncbi.nlm.nih.gov/pubmed/22679133

In overall patients, necrotic core volume significantly reduced (15.7 to 13.7 mm(3), p = 0.010) and fibrofatty plaque volume increased (4.3 to 5.5 mm(3), p = 0.006) after statin treatments for 1 year. ... Serial volumetric VH-IVUS analysis showed that statin treatments might be associated with significant changes in necrotic core and fibrofatty plaque volume in overall patients.

http://www.ncbi.nlm.nih.gov/pubmed/19628193

Withdrawal of statin therapy in the first 24 hours of hospitalization for non-ST-segment elevation myocardial infarction is associated with worse hospital outcomes.

http://www.ncbi.nlm.nih.gov/pubmed/15505131

Results from multiple clinical trials, primarily with the class of lipid-lowering agents known as statins, have shown that reductions in low-density lipoprotein (LDL) cholesterol are associated with reduced risk of coronary artery disease.

http://www.ncbi.nlm.nih.gov/pubmed/22697388

Bottom line is that statin therapy stabilizes vessel-wall plaques and possibly has anti-inflammatory effects on vascular endothelium. This effect is meted out by the reduction in the overall number of potentially catastrophic, ST-elevation MI's we are seeing clinically. The anecdote is backed-up by the evidence.

~Dr. Imago