"Lipitor Paradox"

[nun]

Perhaps it is white-coat hypertension - very common.

Or perhaps you were incensed that your doctor didn't pay enough tax.

Yes it was white coat syndrome. I was disappointed that my doctor immediately put me on hyertension meds for a one time BP measurement. I went out and bough a wrist BP cuff and when I came back a week later to tell him my BP was usually normal and I wasn't talking the meds I calibrated it against his office meter. Sure enough both devices had my BP at 150/90
to within 5mmHg

 

[TromboneAl]

At a recent physical my BP was 160/95 and my doctor wanted to get me on a hypertension medication. I knew it was a one off due to nervousness, but he insisted.

It was the opposite for me. I told the doc that my BP (132/?) was artificially low because I had lifted weights an hour before the exam, but he still treated it as if it were my normal BP.

 

[HFWR]

My blood pressure is usually pretty low, but I tell the nurse it's because I'm near death because I've had no coffee...

 

[kcowan]

But then, maybe I worry too much.

I think there is a prescription that can help with that!

 

[haha]

I think with Lipitor and many other drugs for chronic illness, the crux is how much possible benefit has been shown in absolute terms, and how to weigh that against long term ingestion of a powerful drug with known and perhaps unknown side effects.

A helpful book I read is "Worried Sick", by Nortin Hadler, MD, a rheumatologist from UNC with many published papers.

He cites what he says (as of 2008) is the most posiitve large, well designed study, the West of Scotland Study. Then he examines what benefits might be expected in the best case (young to middle aged men), for a person who has not had a previous heart attack.

While possible benefit is there, it does not amount to much. And it likely amounts to less if you are female, or over 65 or 70. A person who is already compromised is in a different category, but Hadler insists that uprating one's categorical risk should not be done solely on the basis of test readings.

I believe many people take statins largely to keep their doctor from getting angry with them.

Ha

 

[W2R]

I think there is a prescription that can help with that!

Alas, I put the pharmaceutical commercials on "mute" as swiftly as possible. If I didn't, I would know about such a drug and could badger and pester and push my doctor for such a prescription.

 

[eytonxav]

One other aspect for men, if you lower your cholesterol too much with statins, it can negatively affect your bodies ability to produce testosterone.

 

[Martha]

Well, I decided to nerd out and read the Cochrane review on use of statins for primary prevention of heart disease. I like Steve Novella's discussion of the review here: Science-Based Medicine » Statins – The Cochrane Review I could have just read his article instead.

As Novella says, there is good evidence that statins substantially reduce risk when you already have had a heart attack (secondary prevention). But if your risk of vascular events is low of course the benefits of taking a statin are not going to be as pronounced. After all, your risk already is low. Nevertheless, there is was a reduction in death and in vascular events in people who had no prior vascular events. And statins were no more risky to take than a placebo. Because people are on a continuum of risk a person has to see where they fall to judge if they should take statins. Given that the cost of statins have dropped tremendously that also effects the cost/benefit analysis. The big controversy from the Cochrane review is that the data actually supports use of statins for primary prevention but the authors were nevertheless pretty negative on the use of statins for primary prevention, from a cost/benefit standpoint, maintaining the effect size is too small to be worth it. This has lead to some people concluding that statins do not work when the data shows that they do. Just maybe not to the extent that the drug companies would want you to believe.

So, I'm staying on the statins.

 

[Rich_by_the_Bay]

I generally agree with Martha's summary. But questions remain: which lipid profiles do and don't benefit (e.g. low HDL alone improves with atorvastatin but the outcome data are unclear if the LDL is normal); the muscular side-effects (myopathy) may be more prevalent than reported and are of uncertain implication long term.

Overall I do not support their use in primary prevention, and do recommend them for properly selected patients at risk using a pretty low threshhold to treat.

 

[W2R]

So, I'm staying on the statins.

Me too, but with my insurance I only have to pay about $35/month to do so. One reason I'm staying on the statins is that the cost is not much for me, and my mother lived to age 98 on statins so that demonstrates to me that they are probably had a good or neutral effect on her longevity. Granted, that is just one data point.

Continuing with statins could be a tough decision for those who have to pay the full amount for them.

F. had side effects on statins and is taking a non-statin medication to reduce his cholesterol, but the cost is high for that medication too.

 

[GregLee]

... I like Steve Novella's discussion of the review here: Science-Based Medicine » Statins – The Cochrane Review I could have just read his article instead.
...
So, I'm staying on the statins.

But Novella recommends statins only for patients with high cholesterol who won't improve their diet and exercise. (Well, this is close to what he says.) I have marginally high total cholesterol, good blood pressure, never a sign of any heart disease, and I do the diet and exercise thing. So, I'm staying off statins.

 

[JakeBrake]

I had a pleasant surprise this week when I refilled one of my meds. It seems the med had gone generic since my last refill and this week's refill cost $150 less for a 90 day refill than the previous refill.

 

[W2R]

I had a pleasant surprise this week when I refilled one of my meds. It seems the med had gone generic since my last refill and this week's refill cost $150 less for a 90 day refill than the previous refill.

Woo-hoo!! That really IS a pleasant surprise!

 

[eytonxav]

Also, for those taking Statins, taking a CoQ10 supplement is highly recommended, as presumably the Statins deplete your hearts CoQ10 stores.

 

[ERD50]

Also, for those taking Statins, taking a CoQ10 supplement is highly recommended, as presumably the Statins deplete your hearts CoQ10 stores.

Who recommends it?

Coenzyme Q10: Can it prevent statin side effects? - MayoClinic.com

At this time, coenzyme Q10 is not universally recommended for preventing statin side effects.

...

Some researchers think that taking a coenzyme Q10 supplement may reduce the risk of serious muscle damage (rhabdomyolysis). And some small reports suggest that troubling side effects — muscle and joint aches — from statins might be reduced if you take coenzyme Q10 along with a statin. However, no large studies have confirmed this theory, so current guidelines don't recommend routine use of coenzyme Q10 in people taking statins.

Coenzyme Q10 doesn't cause side effects for most people. However, as with other herbal and dietary supplements, it's not regulated by the Food and Drug Administration.

-ERD50

 

[haha]

Who recommends it?

Coenzyme Q10: Can it prevent statin side effects? - MayoClinic.com

-ERD50

I have no real opinion on this, as I do not take the stats, but "not universally recommended" no big deal. I doubt that even bathing regularly is universally recommended.

Ha

 

[eytonxav]

Who recommends it?

Coenzyme Q10: Can it prevent statin side effects? - MayoClinic.com


-ERD50

Dr Oz for one, but I first heard of this from a friend who had bypass surgery and his surgeon recommended it.

 

[Rich_by_the_Bay]

To my knowledge there is no definitive or even decent suggestive evidence that COQ10 improves outcomes in or prevents statin-induced myopathy. At least not so far.

 

[Katsmeow]

Well, I decided to nerd out and read the Cochrane review on use of statins for primary prevention of heart disease. I like Steve Novella's discussion of the review here: Science-Based Medicine » Statins – The Cochrane Review I could have just read his article instead.

Thanks for the article. I've taken Lipitor for several years. When I first started it I was a little overweight (but not obese) and had tried improving my cholesterol numbers through diet and exercise.

When I first took Lipitor I had an extremely dramatic positive effect on those numbers at a very low dose. No side effects and I've never had to increase the small dose. I've gone off it periodically but the bad numbers always come back. My doctor believes that I am just genetically predisposed to not very good cholesterol numbers.

Currently I'm working on getting back to a normal weight (I did gain some weight over the years) and am exercising more and eating even better. Once I do get to a normal weight, I plan to stop Lipitor and see what happens. If the numbers change, however, I'll go back on it.

 

[Martha]

I figure that I am a lifer on statins. I was not overweight at all and ate close to a vegetarian diet when I started them 25 years ago.

 

[Martha]

Me too, but with my insurance I only have to pay about $35/month to do so. One reason I'm staying on the statins is that the cost is not much for me, and my mother lived to age 98 on statins so that demonstrates to me that they are probably had a good or neutral effect on her longevity. Granted, that is just one data point.

Continuing with statins could be a tough decision for those who have to pay the full amount for them.

F. had side effects on statins and is taking a non-statin medication to reduce his cholesterol, but the cost is high for that medication too.

I just checked my Target price for Simvastatin and it was $10.69 for three months. My insurance deductible hasn't been met, so that is the entire cost. I checked because a friend quit taking statins a while back because of the cost and I wanted to convince her that the cost had gone down considerably with this generic option. (The other generic statin, lovastatin, disagreed with her.)

I also checked the price for the Parkinson's drug I take for RLS, Pramipexole. IIRC, someone mentioned the high cost of some of those drugs. For a ninety day supply (and that is more than one pill a day), I paid a bit over $25.00.

Both of these drugs seem like best buys to me.

 

[Moemg]

)

I also checked the price for the Parkinson's drug I take for RLS, Pramipexole. IIRC, someone mentioned the high cost of some of those drugs. For a ninety day supply (and that is more than one pill a day), I paid a bit over $25.00.

Both of these drugs seem like best buys to me.

I have developed RLS . It doesn't bother me every night but often enough to bother me . My SO bought me a Pure Energy bracelet for flexibility but amazingly it has relieved my RLS . I usually think these products are crazy but crazy or not this has worked .They usually sell for $35.00 but he got it on ebay for $9.99 with free shipping .

 

[eytonxav]

To my knowledge there is no definitive or even decent suggestive evidence that COQ10 improves outcomes in or prevents statin-induced myopathy. At least not so far.

Rich, I don't doubt your opinion, but I believe there are enough medical experts recommending CoQ10 use, especially for older individuals, and although there may be no "major" clinic trial studies to date to confirm its efficacy, I don't plan to stop taking it.

Dr Oz
Statins and CoQ10 Deficiency

Coenzyme Q10

Statin Drugs May Lower CoQ10 Levels

 

[ERD50]

Rich, I don't doubt your opinion, but I believe there are enough medical experts recommending CoQ10 use, especially for older individuals, and although there may be no "major" clinic trial studies to date to confirm its efficacy, I don't plan to stop taking it.

Dr Oz
Statins and CoQ10 Deficiency

Coenzyme Q10

Statin Drugs May Lower CoQ10 Levels

That's all well and good, but I have to ask myself why are medical experts recc it if there are no major studies to back it up? From your own links:

However, research on whether Co q10 supplements are beneficial in people taking statins is still inconclusive.

It may still be a good risk/reward decision if the side effects are so minimal, but I get nervous about supplements that are not monitored by the FDA or have some other kind of quality assurance. Didn't some of the fish oil supplements have some nasty concentrations of bad stuff (mercury, lead?)? How do you know what you are getting?

-ERD50

 

[Rich_by_the_Bay]

Rich, I don't doubt your opinion, but I believe there are enough medical experts recommending CoQ10 use, especially for older individuals, and although there may be no "major" clinic trial studies to date to confirm its efficacy, I don't plan to stop taking it.

Well, for one thing, if you accept possible efficacy in the absence of evidence, it is logical and consistent to assume a level of long-term undocumented risk as well. MIlions of people on such inadequately tested drugs could spell disaster. Remember Tryptophan? It was a "'supplement" for insomnia manufactured by an Asian pharmaceutical company and a contaminant killed patients before it was discovered. Risk for benefit is rational, but risk in the absence of demonstrated benefit makes no sense to me.

In addition, COq10 is rather expensive, esp over decades.

It may turn out that it is safe and effective with further research. Or not.

I have advised it in special circumstances with the patient at high risk and with full understanding of the issues -- rarely.