Statin Wars - British Style!

[msieweke]

Quote:

Originally Posted by gerntz To each their own. I'll believe this, amongst many studies: "After studying mortality over a 20-year period, researchers led by Professor Kausik Ray at Imperial showed that 40mg daily of pravastatin, a relatively weak type of statin, reduced deaths from heart disease in participants by more than a quarter.

1 - This was not a blinded study.
2 - The effect was statistically significant only for patients with LDL >190.
3 - After treating 2560 patients for 20 years, they delayed 65 deaths, which is a 2.5% absolute risk reduction. In other words they need to treat 39 people for 20 years to save 1 life. Another way to put this is that on average each person got less than 4.6 days of life extension.
4 - All the participants were men around 55 at start of trial. We know statins behave differently in women, and high cholesterol appears to be protective in those over 70, so make of that what you will.

Whenever you look at statin trials, you have to be skeptical for several reasons:
1 - Trials run by drug companies are 5 times as likely to show positive results as trials run by independent groups.
2 - People who show adverse effects early are generally excluded from the trials, which skews the adverse effect reporting.
3 - Statin trials are never fully blinded. The first time you go for a physical and get a cholesterol test, both you and your doctor know whether you're on the placebo.

[sengsational]

Quote:

Originally Posted by msieweke In other words they need to treat 39 people for 20 years to save 1 life.

Thanks for doing that leg work. I was "this close" to going to the paper to pull back the NNT myself. And that was with people that had LDL-C >190! Quite a few doctors prescribe a statin if they see over 100. Nuts!

[threegoofs]

I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap.

Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience.

The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care.

Shameful.

[Dash man]

Quote:

Originally Posted by threegoofs I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap. Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience. The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

This is why I listen to my Cardiologist instead of free advice on an internet forum.

[razztazz]

Quote:

Originally Posted by Dash man This is why I listen to my Cardiologist instead of free advice on an internet forum.

As far as I'm concerned it's just more internet stuff. I have personal experience AND all the OTHER RELEVANT studies. Not just the ones that suit my point.

Any discipline that is defined by "latest studies..." is not a discipline at all

[Chuckanut]

Quote:

Originally Posted by threegoofs I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap. Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience. The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

Perhaps with your expertise you an answer this concern of mine. I do take a low dose of statin after doing lots of research and talking to my PCP. But, to be perfectly honest, I wonder if it does much good. From what I have read literally 100+ people like me need to take the statin for 5 years to avoid one CVD event. OTOH, lowering LDL seems vital to preventing CVD, and statins do that very well.

For person with no CVD history and no CVD diagnosis, how much good does taking a statin do me? In absolute terms (not relative) how much does it decrease my chances of having heart disease? 1%, 10%, 20%?

I ask this not as a wise guy, but as a person who has never been able to get an answer based upon a well done scientific study. People are confused. You posting says "They are also quite useful in patients who are at risk and qualify for primary prevention." For starters what does 'quite useful' mean? What does 'qualify for primary prevention' mean?

Again, I am not trying to put you or anybody else on the hot-seat. I just want to understand.

Signed,
One Very Confused Consumer of Medical Services

[Teacher Terry]

I don’t think anyone here is trying to convince people to not take statins. People are stating what they personally do. It’s a individual decision.

[ls99]

Quote:

Originally Posted by threegoofs I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap. Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience. The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

Perhaps an in depth analysis of the NNT as applied to the various forms of statins by expert such as you would enlighten the rest of us.

[Rianne]

Quote:

Originally Posted by threegoofs The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

Really? I never thought my opinions were 1/2 informed. Nor did I think offering my opinion/personal experience would put anyone at risk. Did anyone ask for your opinion? No, you just gave it.

[msieweke]

Suppose you're at a gathering with 99 friends and someone tells you that 3 of you will have a heart attack some time in the next 5 years. "But I have a drug that will prevent 1 of those heart attacks. The problem is that we don't know who is sick or who will benefit." You all decide to take the drug. After 5 years 2 of your friends had heart attacks, and you find out that you are the one who was saved. Pretty good, huh?

But there was a cost. Each person paid $100/month for the drug or $6000 over 5 years. That was a good deal for you, but not for your friends. In total your friends paid $594,000 to prevent your heart attack, and they gained no benefit. Does that still sound good?

But there's another cost. Ten friends developed muscle pain that may or may not have gone away after discontinuing the drug. One developed transient complete amnesia that went away after discontinuing. One developed abnormal liver test results, and is being watched. Two had increased mental confusion, which their doctors ascribed to aging. Six developed type 2 diabetes (who would not have otherwise) and had to go on medication for it. All to prevent your heart attack. Does that still sound good?

You have to ask: Are these numbers realistic? Myalgia (muscle pain) reported rates are from 1-10%, and it is a common reason for discontinuing statins. The mental effects are disputed, but there are a lot of anecdotal and case reports. The adverse event rate is probably higher than 10%. Most doctors tell their patients that muscle pain and mental confusion are normal for their age, so they are not entered in the DAERS. The diabetes number comes from a published study. Transient global amnesia is a known but rare side effect.

How much do these numbers need to change for the risk to be acceptable?

[Teacher Terry]

Definitely not acceptable to me.

[PatrickA5]

Quote:

Originally Posted by threegoofs I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap. Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience. The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

Fortunately, I think most people are smart enough not to take what they read on the internet as the "truth".

I have known CV disease. I've had zero side effects from taking my $4 per month statin. I've discussed my statin many times with my PCP and Cardiologist. The both insist on me keeping taking the drug (since I don't have any side effects). If I'm the one (out of however many) that the drug prevents dying from a heart attack, I think it's worth it.

[gerntz]

Quote:

Originally Posted by msieweke But there was a cost. Each person paid $100/month for the drug or $6000 over 5 years. How much do these numbers need to change for the risk to be acceptable?

My statin costs me $0.57 every 3 months.

[gerntz]

Quote:

Originally Posted by threegoofs I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap. Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience. The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

Thank you. My LDL was around 170 & HDL around 38 b4 I started taking the statin 18 years ago. LDL is now around 100 & HDL close to 50.

[Doribe]

Quote:

Originally Posted by Chuckanut Note conclusion 22. https://peterattiamd.com/the-straigh...terol-part-ix/

Thanks for this information. I take my statins and appreciate your information. With statins, my total is slightly above 200. With out statins it goes to just under 300. My HDLs are always high, contributing to the high total number.

I have never had muscle problems and the diet and exercise route is not enough.

[flintnational]

Quote:

Originally Posted by threegoofs I just have to say, as a trained clinical pharmacist specializing in cardiovascular disease who’s spent 30 years doing statin trials, reading statin trials, interpreting statin trials, teaching students, pharmacists and physicians about statin trials, and committed to high quality care in patients, most of this thread has opinions that are absolute crap. Statins are ridiculously effective in patients with established CV disease. They are also quite useful in patients who are at risk and qualify for primary prevention. Their safety is very good- literally hundreds of millions of patient years experience. The people disseminating their ridiculous, half informed opinions on this issue here are putting people at risk...and are probably both unaware of that and don’t care. Shameful.

You appear to be in a unique position to provide useful information on this topic. However, in your post you did not provide any data or references. You simply chose to belittle and criticize those that do not agree with you. I suggest there is a better approach. We would appreciate your thoughtful participation in this thread.

[msieweke]

Quote:

Originally Posted by gerntz My statin costs me $0.57 every 3 months.

When Lipitor was on patent it cost $165 per month. I didn't realize the prices had come down so far. I guess that's why they want to put it in the water supply and give them away free at McDonald's.

[Oz investor]

i have been on Crestor ( one or the statins ) since November 2016 , initially prescribed by the registrar in charge of the MRI unit ( very quickly after the MRI results were developed )

i am currently being monitored ( yearly ) from type II diabetes , peripheral circulation problems some muscle wastage but am still alive with 'chronic heart failure ' AFTER medical intervention .

i guess it boils down to which risks you take

in my case a decline in heart health will result in a triple bypass , a heart transplant ( or death ) and the statins are creating their own serious problems . despite keeping me alive for the 15 weeks leading up to the intervention procedure .

i suggest an INFORMED choice each option has it's risks ( which do you take ?? )

[gerntz]

Quote:

Originally Posted by msieweke When Lipitor was on patent it cost $165 per month. I didn't realize the prices had come down so far. I guess that's why they want to put it in the water supply and give them away free at McDonald's.

I was on simvastatin b4 Lip existed & still am.

[sengsational]

Quote:

Originally Posted by threegoofs ... effective.....

I don't recall any post in this thread saying there were zero cohorts where the drug class was effective. Based on your in-depth background, maybe you can confirm that some non-trivial amount of benefit in the cohorts that showed a level of effectiveness came from reducing inflammation (as opposed to altering levels of lipoprotein). What is that amount? Where is the study comparing a proven effective statin to a baby aspirin?


As to the shamefulness, I'd say we have quite the pot calling the kettle names situation here. We have posts above that reference the fact that studies that don't show what the manufacturer wanted never see the light of day. We have campaigns designed to lead busy doctors into over prescribing unless they take the extra time to get into the details. Maybe if the industry wasn't so obviously disingenuous, threads like this would not exist.