Statin Wars?

[eytonxav]

AFAIK, cholesterol is needed to feed hormone production. I am on a statin due to risk factors and my LDL at the last test was 46. My PCP insists that because of my risk factors, that it remain <70. I continue to follow his advice, however, I wonder to what extent such low levels can be harming hormone production? For example, my T levels are not quite borderline.

 

[Raygun99]

I am taking Repatha Injections

I had family history for CV disease and Dr put me on Statins way back age 55 or so. I had tremendous side effects sore muscles. Finally reached a stage age 65 that stopping was worth the risks. My cholesterol doubled but my pain was almost gone after 2 years of not taking the drug. So my Dr helped me get on Repatha injections 2x per month. (No Statins) After 90 days my numbers shocked myself and my Dr. Everything came down to reasonable numbers. (1/2 of the original high levels) Now should be happy if I believe lowered cholesterol is good? Maybe nature meant for me to have higher numbers and the effects would be minimal. ( I have never failed a heart/stress test etc. ) So although psychologically I feel like I have done a good thing by going on Repatha, am I really improving any future quality of life issues . In other words even if I can keep my cholesterol inside these guidelines, why should I, and will the Repatha be the next treatment found to cause disabling side effects?

 

[gooddog]

There will be those who disagree, but Welchol is a way better way to go than the newer class of drugs. Welchol stays in the gut, binds to bile, and forces the body to draw cholesterol out of the blood stream to make more bile - thus lowering cholesterol. The single biggest advantage of this is that the Medication doesn't interact with the rest of the body (for the most part). Welchol has not been tied to dementia and a host of other problems that the newer class of medication is.

 

[Old Microbiologist]

RAE. is correct. Consider that statins are a highly profitable drug with serious side effects but are still the most prescribed drug in history and yet the morbidity to CHD has not changed since their widespread use. The scientific evidence linking cholesterol to CHD is weak at best and overtly wrong in many cases. Early studies were poorly designed and had serious problems with statistical bias. More recent studies (since 2006) do not show any correlation of HDL/LDL levels to CHD. It is very likely going to turn out to be a normal consequence to aging. Most people with CHD have normal cholesterol levels.

But, everyone must do their own research and decide for themselves. Not all clinicians do that and take the dogma at face value and do not bother to question it.

 

[Scratchy]

RAE. is correct. Consider that statins are a highly profitable drug with serious side effects but are still the most prescribed drug in history and yet the morbidity to CHD has not changed since their widespread use. The scientific evidence linking cholesterol to CHD is weak at best and overtly wrong in many cases. Early studies were poorly designed and had serious problems with statistical bias. More recent studies (since 2006) do not show any correlation of HDL/LDL levels to CHD. It is very likely going to turn out to be a normal consequence to aging. Most people with CHD have normal cholesterol levels.

But, everyone must do their own research and decide for themselves. Not all clinicians do that and take the dogma at face value and do not bother to question it.

Respectfully disagree with everything stated above, including the proposal that everyone should evaluate the evidence themselves. I don't feel qualified to do this even as a physician. I trust the American Heart Association and American College of Cardiology to have rigorously evaluated the available evidence on which fheir correct guidelines are based, so I will follow the guidelines.

Of course all are free to make their decisions based on whatever criteria they like. But my approach is certainly a reasonable one and it is what I would recommend to others. I believe few individuals are better qualified to assess the volume of conflicting data that exists on this complex topic than the AHA/ACC. And there is nothing to stop those not better qualified from writing whatever they have concluded here and in other forums, possibly misleading many.

 

[big-papa]

I had family history for CV disease and Dr put me on Statins way back age 55 or so. I had tremendous side effects sore muscles. Finally reached a stage age 65 that stopping was worth the risks. My cholesterol doubled but my pain was almost gone after 2 years of not taking the drug. So my Dr helped me get on Repatha injections 2x per month. (No Statins) After 90 days my numbers shocked myself and my Dr. Everything came down to reasonable numbers. (1/2 of the original high levels) Now should be happy if I believe lowered cholesterol is good? Maybe nature meant for me to have higher numbers and the effects would be minimal. ( I have never failed a heart/stress test etc. ) So although psychologically I feel like I have done a good thing by going on Repatha, am I really improving any future quality of life issues . In other words even if I can keep my cholesterol inside these guidelines, why should I, and will the Repatha be the next treatment found to cause disabling side effects?

Have you had a CAC (Coronary Calcium) test? It's what convinced me to lower my cholesterol. I had 3 tests spaced out over several years and the score was increasing. After lowering my cholesterol the progression stopped. Your mileage may of course vary.

 

[Scratchy]

[ I trust the American Heart Association and American College of Cardiology to have rigorously evaluated the available evidence on which fheir correct guidelines are based, so I will follow the guidelines.
/QUOTE]

Typo in above, meant to write "current" guidelines.

 

[Teacher Terry]

Old Micro I totally agree with you. It’s not unusual for the medical field to change their minds after further research which I think will eventually happen with statins. They are a huge money maker. I also find it disturbing that the guidelines are consistently being lowered for many issues such as BP and cholesterol. I also think it’s important to limit how much medication you are on because of the interactions between them. I have HBP and asthma and take 6 medications. I would need compelling research results to get me to add anymore.

 

[sengsational]

Consider that statins are a highly profitable drug with serious side effects but are still the most prescribed drug in history and yet the morbidity to CHD has not changed since their widespread use. The scientific evidence linking cholesterol to CHD is weak at best and overtly wrong in many cases. Early studies were poorly designed and had serious problems with statistical bias. More recent studies (since 2006) do not show any correlation of HDL/LDL levels to CHD. It is very likely going to turn out to be a normal consequence to aging. Most people with CHD have normal cholesterol levels.

Although someone could pick around the edges at what you said, I think your statement is factual and provable. But I hope that the normal consequence of aging prediction is wrong...I believe aging is just an excuse for not controlling a disease or degenerative process


The point I made in the last thread on this topic, and picking up on the non-correlation between cholesterol and CHD, I'd like to see various statins go up against safer inflammation reduction compounds. One fact you didn't mention is that some people, quite a few are somehow really more healthy by taking a statin. Why? If cholesterol is not "it", it might be that inflammation is lowered. But you can lower inflammation in much safer ways than using a statin. So where's the high quality study that proves a statin is better at saving lives than aspirin? THAT'S the kind of study I'd like to see. One problem, though, would be that even blinded, it would be obvious to doctors and patients if they had the statin instead of aspirin because of the lipid profile. Also the drop out rate of statin cohort would be higher due to side effects (I presume). Not sure if all that could be kept under wraps. But I predict that the aspirin cohort would do as well or better than the statin cohort.

 

[youbet]

But you can lower inflammation in much safer ways than using a statin.

Really? I'm not willing to blindly accept that. Is there some reputable study or other evidence to back that up?

 

[Supermint]

Here comes personalized medicine based on your genetics, not a drug company's or other third party secret algorithm that always results in a recommendation for statins once you reach a given age. This is good news, but hasn't made its way into our family doctor's office quite yet.

We all have an enzyme system called the CYP450 pathway. One of the most common gene mutations in our society today is related to this pathway, making up to 90% of the most commonly prescribed drugs very difficult for many people to metabolize, including statins, steroids, and others.

Here is one definition of the CYP450 pathway:
A group of enzymes involved in drug metabolism and found in high levels in the liver. These enzymes change many drugs into less toxic forms that are easier for the body to excrete.

The thing is, you reach a state of toxicity MUCH faster if you have a CYP450 gene variation. Toxicity can be completely devastating to the liver and to the body as a whole.

So, no, you should not 'age into' statins, steroids, or other drugs. You can have your genes tested to see if you have this gene variation or others like MTHFR, which means that you may not metabolize substances very quickly. If you have both, as I do, you can get yourself into a tough spot by taking even regular doses of these medications. The drug companies will consider your outcome very rare, despite thousands of people having this issue.

One source for more info on this: https://ghr.nlm.nih.gov/primer/genefamily/cytochromep450

 

[PatrickA5]

Respectfully disagree with everything stated above, including the proposal that everyone should evaluate the evidence themselves. I don't feel qualified to do this even as a physician. I trust the American Heart Association and American College of Cardiology to have rigorously evaluated the available evidence on which fheir correct guidelines are based, so I will follow the guidelines.

.

I'm with you by trusting my doctors and the guidelines set by AHA and American College of Cardiology, but as I understand it, many don't believe those groups because studies are funded by Big Pharma and have a conflict of interest. Maybe I'm just super naïve, but I have a hard time believing that these groups, whose primary objective is to reduce heart disease would knowingly give out false information just to keep their funding.

Oh well. Off to my Cardiologist appointment this morning.

 

[RAE]

Really? I'm not willing to blindly accept that. Is there some reputable study or other evidence to back that up?

Here's one:
https://www.bmj.com/content/327/7426/1264.full


Basically, they found that aspirin was much more cost-effective than a statin drug, per coronary event prevented.

 

[RAE]

Respectfully disagree with everything stated above, including the proposal that everyone should evaluate the evidence themselves. I don't feel qualified to do this even as a physician. I trust the American Heart Association and American College of Cardiology to have rigorously evaluated the available evidence on which fheir correct guidelines are based, so I will follow the guidelines.

Again, with all due respect, Scratchy, I have very little faith in whatever the AHA recommends, based on their history and the fact that they receive virtually all of their funding from either drug companies or big processed food companies. The article at the link below (which was co-authored by a cardiologist, by the way) is mostly about the AHA's dietary advice (and how wrong it is), but I think it demonstrates just how biased they are, and always have been. It all comes down to money, really - drugs like statins and highly processed foods are BIG money-makers, so the companies that produce those products are happy to fund organizations like AHA, which write article after article about how important those things are for good health. People trust the AHA, because it sounds like a quasi-government organization that must be looking out for the public's best interests (and health). Wrong..........

https://www.medscape.com/viewarticle/882564?src=soc_tw_160817-pm_mscpedt_news_neuro&faf=1

 

[RAE]

Consider that statins are a highly profitable drug with serious side effects but are still the most prescribed drug in history and yet the morbidity to CHD has not changed since their widespread use. The scientific evidence linking cholesterol to CHD is weak at best and overtly wrong in many cases. Early studies were poorly designed and had serious problems with statistical bias.

Yes, what you say is correct, based on most of the studies I have reviewed. Here is one from 2010 that found that statins do not reduce all-cause mortality in intermediate to high-risk individuals without a history of CVD:

https://www.ncbi.nlm.nih.gov/pubmed/20585067

This is from the Data Synthesis and Conclusions Sections of the paper:

DATA SYNTHESIS:

Data were combined from 11 studies and effect estimates were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I(2) statistic. Data were available on 65,229 participants followed for approximately 244,000 person-years, during which 2793 deaths occurred. The use of statins in this high-risk primary prevention setting was not associated with a statistically significant reduction (risk ratio, 0.91; 95% confidence interval, 0.83-1.01) in the risk of all-cause mortality. There was no statistical evidence of heterogeneity among studies (I(2) = 23%; 95% confidence interval, 0%-61% [P = .23]).
CONCLUSION:

This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.

 

[youbet]

Here's one:
https://www.bmj.com/content/327/7426/1264.full


Basically, they found that aspirin was much more cost-effective than a statin drug, per coronary event prevented.

But, but, but........ The statement I refuse to blindly accept (from post #109) was:

But you can lower inflammation in much safer ways than using a statin.

It's the "safer" not the "cost-effectiveness" that needs to be discussed.

How did you get "cost effectiveness" out of "safer?"

 

[Rianne]

Here comes personalized medicine based on your genetics, not a drug company's or other third party secret algorithm that always results in a recommendation for statins once you reach a given age. This is good news, but hasn't made its way into our family doctor's office quite yet.

We all have an enzyme system called the CYP450 pathway. One of the most common gene mutations in our society today is related to this pathway, making up to 90% of the most commonly prescribed drugs very difficult for many people to metabolize, including statins, steroids, and others.

Here is one definition of the CYP450 pathway:
A group of enzymes involved in drug metabolism and found in high levels in the liver. These enzymes change many drugs into less toxic forms that are easier for the body to excrete.

The thing is, you reach a state of toxicity MUCH faster if you have a CYP450 gene variation. Toxicity can be completely devastating to the liver and to the body as a whole.

So, no, you should not 'age into' statins, steroids, or other drugs. You can have your genes tested to see if you have this gene variation or others like MTHFR, which means that you may not metabolize substances very quickly. If you have both, as I do, you can get yourself into a tough spot by taking even regular doses of these medications. The drug companies will consider your outcome very rare, despite thousands of people having this issue.

One source for more info on this: https://ghr.nlm.nih.gov/primer/genefamily/cytochromep450

This is interesting information. Makes me think of kidney and liver function as body metabolizes medicine. I can take one low dose (325 mg) Tylenol and I'm done. My pain is relieved. Some people have to take so much more of any med, NSAIDS to get relief and it's toxic to the kidneys and liver.

How one metabolizes medicine is unique to that person AND the dosage. There is not one size fits all.

 

[Scratchy]

RAE, the study you quote below is from 2010. It is simply outdated information.

Yes, what you say is correct, based on most of the studies I have reviewed. Here is one from 2010 that found that statins do not reduce all-cause mortality in intermediate to high-risk individuals without a history of CVD:

https://www.ncbi.nlm.nih.gov/pubmed/20585067

This is from the Data Synthesis and Conclusions Sections of the paper:

DATA SYNTHESIS:

Data were combined from 11 studies and effect estimates were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I(2) statistic. Data were available on 65,229 participants followed for approximately 244,000 person-years, during which 2793 deaths occurred. The use of statins in this high-risk primary prevention setting was not associated with a statistically significant reduction (risk ratio, 0.91; 95% confidence interval, 0.83-1.01) in the risk of all-cause mortality. There was no statistical evidence of heterogeneity among studies (I(2) = 23%; 95% confidence interval, 0%-61% [P = .23]).
CONCLUSION:

This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.

In 2016 the US Preventative Services Task Force, based on a review of 19 trials, more current and involving more patients than the one you described above, found a clear benefit for statins for primary prevention of cardiovascular disease in some adults:

"Results Nineteen trials (n = 71 344 participants [range, 95-17 802]; mean age, 51-66 years) compared statins vs placebo or no statin. Statin therapy was associated with decreased risk of all-cause mortality.....

Conclusions and Relevance In adults at increased CVD risk but without prior CVD events, statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefits in patients at greater baseline risk."

Here is a link to the USPSTF 2016 Recommendation:

https://www.uspreventiveservicestas...l/statin-use-in-adults-preventive-medication1

The AHA/ACC Guidelines are even more current, last updated March 2019, also found benefit for statins for primary prevention of cardiovascular disease in some adults.

 

[RAE]

But, but, but........ The statement I refuse to blindly accept (from post #109) was:



It's the "safer" not the "cost-effectiveness" that needs to be discussed.

How did you get "cost effectiveness" out of "safer?"

Statins have a long list of potentially very serious side effects, as you probably know (including muscle tissue damage, diabetes, and even cancer). I just read the other day that almost half of all patients who start taking statins quit taking them within the first year or so, mainly due to muscle pain (that is one reason you don't see too many studies on the long-term effects of statins.......many statin users drop out of those studies early due to statin side effects). The only potentially serious side effect with aspirin is a small risk of GI bleeding. I don't want to minimize that risk, as it can be serious, but a relatively small number of people taking the low-dose aspirin experience any GI bleeding.


I would personally take a daily low-dose aspirin (which, by the way, has been shown to reduce the risk of colon cancer, also) before I ever took a statin drug. But again, that's my decision based on the research I have done........YMMV.

 

[Scratchy]

Here's one:
https://www.bmj.com/content/327/7426/1264.full


Basically, they found that aspirin was much more cost-effective than a statin drug, per coronary event prevented.

This study you quote is from 2003! In evaluating cost effectiveness, the benefit and cost of each therapy is compared. There is an enormous amount of new data on the benefits of these drugs, and the costs are also different (statins are now much cheaper). So this study's findings are completely outdated.

Even more important, the study's findings are irrevelant to the point at hand. As youbet already noted, the point being discussed was a statement from sengsational:

"But you can lower inflammation in much safer ways than using a statin."

This statement is certainly not one broadly accepted by experts in cardiovascular medicine. (Also, it sidesteps the possibility that inflammation may not be an important mediator of the benefits of statins.) It was rightly questioned by youbet who requested something to back this up. A study that says aspirin was a more cost effective way to treat cardiovascular disease in 2003 is not relevant to the questions of inflammation and safety.

 

[youbet]

Statins have a long list of potentially very serious side effects, as you probably know (including muscle tissue damage, diabetes, and even cancer). I just read the other day that almost half of all patients who start taking statins quit taking them within the first year or so, mainly due to muscle pain (that is one reason you don't see too many studies on the long-term effects of statins.......many statin users drop out of those studies early due to statin side effects). The only potentially serious side effect with aspirin is a small risk of GI bleeding. I don't want to minimize that risk, as it can be serious, but a relatively small number of people taking the low-dose aspirin experience any GI bleeding.


I would personally take a daily low-dose aspirin (which, by the way, has been shown to reduce the risk of colon cancer, also) before I ever took a statin drug. But again, that's my decision based on the research I have done........YMMV.

I guess I'm just less inclined to blindly accept these generalizations RAE. I don't see anything in your ramblings that would indicate that " you can lower inflammation in much safer ways than using a statin."

 

[SnowballCamper]

Skeptical because of bias

I recall reading about a key factor in the spread of opioid prescriptions. A single doctor, with a good reputation, had said that the risk of addiction was not a concern for short term outpatient pain management. And poof the word spreads, and a couple decades later we have the opioid epidemic.

Your doctor likely doesn't have the time to review all the research, because reviewing research thoroughly is a full time job. Just ask any graduate student or professor.

Combine that with the attached article about the structural problems in any research program, the placebo effect, and it's a wonder that we know what little we do about maintaining health.

 

[Scratchy]

Statins have a long list of potentially very serious side effects, as you probably know (including muscle tissue damage, diabetes, and even cancer). I just read the other day that almost half of all patients who start taking statins quit taking them within the first year or so, mainly due to muscle pain (that is one reason you don't see too many studies on the long-term effects of statins.......many statin users drop out of those studies early due to statin side effects).

RAE, where are you reading that? My impression has been different and from what I see online, for example the study below from 2016, 5% to 10% of patients have side effects, usually muscle symptoms. In many of these, the dose of statin is lowered or the statin is switched and the patient maintained on statins. Some studies have reported higher numbers of patients having muscle pains, up to 30 % but more rigorous analysis found that 30 % of patients taking placebos also reported muscle pains with the real incidence in the 5 % to 10 % range.


https://www.ncbi.nlm.nih.gov/pubmed/27199064

 

[Teacher Terry]

Aside from the muscle pain what about the increase in diabetes and dementia? My uncle’s memory took a big dive when he went on them and improved when he got off.

 

[youbet]

Aside from the muscle pain what about the increase in diabetes and dementia? My uncle’s memory took a big dive when he went on them and improved when he got off.

While I always appreciate your interesting posts TT, it's tough to blindly accept that we'll all react to statins as your uncle did. (If in fact it was the statin he was reacting to, why it was suggested he choose to take a statin, what dose, which specific statin, over what time period? etc.)

Best wishes and continued good health to your uncle.