|
|
Post by the Scribe on Jun 20, 2023 8:48:12 GMT
July 25, 2017 / Heart Health
Taking a Statin After a Heart Attack? Why You Shouldn’t Stop
Study highlights problem of stopping statins
health.clevelandclinic.org/taking-a-statin-after-a-heart-attack-why-you-shouldnt-stop/
After you’re treated in the hospital for a heart attack, your doctor likely will prescribe a cholesterol-lowering drug known as a statin. This medication is a key part of continuing treatment that will help you avoid another heart attack after you go home.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
If you’ve thought about reducing your dose or stopping the medication, you’re not alone. But it’s a dangerous decision to make on your own, with possibly profound consequences.
Cardiologist Leslie Cho, MD, Section Head of Preventive Cardiology and Rehabilitation and the Director of Cleveland Clinic’s Women’s Cardiovascular Center, sees this in her practice.
“That happens frequently,” she says. “Patients take themselves off the medicine and don’t tell anyone.”
However, she stresses to her patients that their risk of having another heart attack increases significantly if they stop taking statins.
“No doubt about it,” she says.
Stopping statins
A recent study of nearly 60,000 people age 66 and older suggests how often people stop taking statins after a heart attack.
The study, published in JAMA Cardiology, found that within two years of having a heart attack, nearly one in five people had stopped taking statins. And nearly two in five were not taking the medicine as prescribed. They were either taking a lower dose or taking it less frequently.
These results were similar for the two age groups in the study — people who were ages 66 to 75 and those who were 75 and older.
The study’s findings highlight the importance of patient education, Dr. Cho says.
“That’s the cornerstone of cardiac rehab,” she says.
The researchers found that people are more likely to take their statins as prescribed if:
They stay in contact with their cardiologist
They participate in a cardiac rehabilitation program
Why people stop
Why did the study participants stop taking statins or took less than the prescribed dose? The study lists three possible reasons:
Cost — The study cited cost as a possible concern. But less costly generic drugs are now widely available, so cost is less a factor these days, Dr. Cho says.
Wish to take fewer medications — A common concern among people, both young and old, is that they want to take less medicine on a regular basis. “I totally sympathize with that,” Dr. Cho says. “It’s your body.” However, the doctor/patient relationship works as a partnership. And it works best when both sides share the same goal, she says. “My goal is to prevent you from having another stent, bypass or heart attack, and to have a good quality of life. If we can do it with less medication, great. But the goal is not less medication, it is to have no new heart attacks and to have a high quality of life,” she says.
Concern about side effects — Though you may worry about side effects, some concerns are unfounded, Dr. Cho says. For instance, if you have diabetes you will benefit from statins even though the medicine may increase your blood sugar. To offset any increase, you should manage your health as you would normally manage your diabetes, by monitoring your sugar regularly, following a healthy diet and exercising regularly.
Dr. Cho says that in her experience, many people worry that statins will cause heart damage. But research overwhelmingly shows otherwise.
Some patients report mild to severe muscle pain as a result of taking statins. If this is you, Dr. Cho says, talk with your doctor about your symptoms. Your doctor can prescribe a different statin or tweak the dosage amount.
Take any concerns to your doctor before you drop your statin
The life-saving benefits of statins greatly outweigh any downside, Dr. Cho says. So it’s vital that you consult your doctor before you stop or alter your medicine. Your doctor can help you manage any side effects and address your specific concerns.
“It’s really crucial to talk to your doctor before stopping a prescription,” she says.
After you complete cardiac rehabilitation, stay in touch with your cardiologist. Dr. Cho suggests annual visits. Know that you can contact your doctor at any time with questions about your medication or other concerns.
And remember, your doctor is your partner in keeping you healthy.
“It’s a partnership — we have to have the same objective,” she says.
|
|
|
|
Post by the Scribe on Jun 20, 2023 8:51:34 GMT
Why You Should Almost Certainly Stay on Statins After a Heart Attack
health.usnews.com/wellness/articles/2017-05-04/why-you-should-almost-certainly-stay-on-statins-after-a-heart-attack
The side effects are real – but so are the preventive benefits.
By Michael O. Schroeder
|
May 4, 2017, at 10:36 a.m.
U.S. News & World Report
Why You Should Almost Certainly Stay on Statins After a Heart Attack
More
If not deadly, a heart attack can be life-changing.
When the flow of oxygen-rich blood is suddenly stopped to a part of the heart muscle, a person’s mortality hangs in the balance. With heart disease ranking as the No. 1 cause of death, surviving a heart attack can shift a person’s perspective. Sometimes that can spur positive lifestyle changes, such as eating better or exercising.
But in other ways, life returns to normal.
And so while patients are routinely prescribed statins – cholesterol-lowering medications – to lower their risk of a second heart attack or another cardiac event like a stroke, research finds that many come off statins or take a less potent drug or dose than recommended. So called high-intensity statins – 40 to 80 milligrams of atorvastatin or 20 to 40 milligrams of rosuvastatin – are the current standard of care for individuals 75 and younger with coronary artery disease to lower “bad” or LDL cholesterol, as well as to reduce overall cardiovascular risk.
When you put a patient on a high-intensity statin you’re going to get a larger reduction in LDL cholesterol, explains Dr. Robert Rosenson, a professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, where he serves as director of cardiometabolic disorders. That’s a larger reduction in bad cholesterol compared to what you'd get taking a so-called intermediate or low-intensity statin, or a lower dose of statin. What’s more, statins offer protection – for instance, when taken to prevent a first heart attack – that goes beyond lowering cholesterol. The drugs reduce inflammation in the blood and the arteries; this can lower the likelihood of plaque – or build-up in the arteries made up of fat, cholesterol and other substances – rupturing and “allowing the blood to clot on that ruptured plaque and obstruct the artery resulting in irreversible heart damage,” Rosenson says.
[See: How to Avoid a Second Heart Attack.]
However, a study published online in the journal JAMA Cardiology in April underscored that many don't continue taking statins as prescribed following a heart attack. Of studied Medicare patients ages 66 to 75 years hospitalized for a heart attack who filled a prescription for a high-intensity statin, less than half (about 42 percent) were still taking the drugs as initially prescribed, or with high adherence, two years following. More patients either weren’t taking high-intensity statins – and instead were on a less potent statin or a lower dose – or weren’t taking the drugs as often as recommended, and nearly one-fifth of patients (or about 19 percent) had stopped taking a statin.
“There’s very clear evidence that taking statins after a heart attack alters your outcome,” says Dr. Thomas Klevan, an interventional cardiologist and medical director of the cardiac service line at Sentara Healthcare, a health system based in Norfolk, Virginia. “It reduces mortality – the chance of dying – it reduces the chance of having a second heart attack, it reduces the chance of needing additional procedures like bypass surgery or stenting or angioplasty. It also reduces your risk of stroke.” American College of Cardiology/American Heart Association guidelines recommend patients 75 and younger with coronary heart disease take high-intensity statins.
How to Choose a Pharmacist
Don't think of a pharmacy as just a place to drop your prescription.
Amir KhanJune 18, 2014
Pharmacist speaking with a patient, including Top Recommended Health Products badge.
The thing is, experts say, many people don’t take them as recommended – even when prescribed after a heart attack – because they feel back to normal. “Sometimes people get complacent after the LDL cholesterol falls and they stop the statin therapy,” Rosenson says. “Well, it’s going to go right back where it started, [and] they’re not accounting for the anti-inflammatory and the plaque-stabilizing effects of the statins.”
Though statins are among the most commonly prescribed drugs, clinicians say that they still have a perception problem: Many patients have concerns about side effects and are inclined to take less of the drug or not take them at all.
[See: 17 Ways Heart Health Varies in Women and Men.]
Between 5 and 15 percent of people can’t tolerate a statin due to muscle aches or pain, also called myalgia, and report that to the physician, says Dr. Peter Wilson, an endocrinologist who does preventive cardiology, and a professor of medicine at Emory University School of Medicine in Atlanta. That’s a common reason people seek to go off the drugs.
But experts say it’s important to work closely with a cardiologist or another doctor to determine if, in fact, the muscle aches and pain are likely due to the statin.
Though the research published in JAMA Cardiology didn’t analyze why patients stopped statins or didn’t continue taking them as originally prescribed, it did find that those patients who saw a cardiologist more frequently and those who participated in cardiac rehab were more likely to take high-intensity statins as recommended. If you have heart attack and you’re referred to cardiac rehabilitation, you have support that not only involves oversight of your exercise. “But you’re also getting a lot of secondary preventive therapy,” Rosenson says. “You’re getting education and guidance on your medications, such as your aspirin, beta blocker, ACE inhibitor and statin, and you’re getting education about the importance of those therapies over the long-term.”
What’s more a person who can’t tolerate one statin may do just fine on another – so it’s best to first switch to another drug in the class, says Dr. Timothy Henry, chief of cardiology at Cedars-Sinai Medical Center.
The most feared side effect from statin drugs – rhabdomyolysis, a muscle injury – is quite rare, Klevan says; around 3 of every 200,000 people taking statins develop the condition, according to Mayo Clinic. “It’s more than just muscle aching that the patient feels. It’s actual muscle tissue destruction. So when that happens, there’s damage to the muscle, there’s release of all of these proteins from the muscle into the bloodstream, and in some extreme forms it can cause kidney failure,” he says. “So that’s a life-threatening complication from statin drugs that occurs very, very, very rarely, but certainly would be an immediate reason to stop statins.”
If a patient tried multiple statin drugs and always experienced side effects they couldn’t tolerate, or if they had a history of rhabdomyolysis, Klevan says, it would be worth looking at alternatives to statins. Alternatives include a new class of drugs called PCSK9 inhibitors. These drugs have shown promise but haven’t been studied to anywhere near the degree of statins – since they’re newer. And they’re expensive, clinicians point out – not yet available in generic form like statins.
[See: The Facts on Heart Disease.]
Other statin side effects, too, which range from headache to drowsiness, difficulty sleeping and nausea, can be a deterrent to taking them for someone who may be asymptomatic otherwise. But the key, experts say, is to think about the potential long-term benefits, and work closely with a doctor to weigh those against any potential concerns – rather than making a unilateral decision regarding the drug therapy. “There’s overwhelming evidence that people who have [had] heart attacks in particular benefit from statins,” Henry reiterates, “and we need to do everything we can to improve adherence.”
|
|
|
|
Post by the Scribe on Jun 20, 2023 8:57:53 GMT
go to original article for important hyperlinks
Yes, statins protect hearts. But critics question their expanding use
www.sciencenews.org/article/yes-statins-protect-hearts-critics-question-their-expanding-use
For people who haven’t had a heart problem, the benefit-to-risk balance changes
THE STATIN UMBRELLA After decades of study, a big question remains about the safety of statins: What are the risks for people who have a chance of benefit but haven’t yet had a heart attack or stroke?
JAMES PROVOST
By Laura Beil
MAY 3, 2017 AT 7:00 AM
Cholesterol is so important to life that practically every human cell makes it. Cells use the compound to keep their membranes porous and springy, and to produce hormones and other vital substances. The body can make all the cholesterol it needs, but Americans tend to have a surplus, thanks in large part to too little exercise and too much meat, cheese and grease. Fifty years ago, researchers began to suspect that all this excess cholesterol was bad for arteries. But the idea remained difficult to prove — until statins came along.
Once the powerful cholesterol-busting drugs appeared, in the 1980s, scientists were able to show that a drop in cholesterol could keep a person who had suffered one heart attack or stroke from having a second. Later studies pointed to protection for even relatively healthy people. Researchers writing in the American Journal of Cardiology in 2010 declared that the drugs were such cardiovascular heroes they could essentially neutralize the health risks from a Quarter Pounder with cheese plus a milkshake.
Brain implants for depression
Find out about the experimental treatment and the people it’s helping in our six-part newsletter, Electricity Saved My Brain, arriving weekly starting whenever you sign up.
name@provider.com
Sign Up
The news just kept getting better. Studies even floated the idea that statins could protect against cancer and influenza (SN: 5/5/12, p. 30). People joked about dumping statins into the water supply. One pioneering London heart surgeon suggested that the drugs were so good and so safe they should be made available over the counter to everyone over age 40.
Bad with the good
Statins carry the risk of side effects. Statin advocates say such effects are rare, and only diabetes and muscle pain have been confirmed.
statin side effects
EVELEEN/SHUTTERSTOCK, ADAPTED BY J. HIRSHFELD
So it may come as a surprise that there are scientists still reluctant to join Team Statin. To them, studies showing benefit for people who haven’t had a heart attack aren’t as clean or overwhelmingly convincing as patients and many doctors probably believe. The statin skeptics worry that too little is understood about unintended consequences, especially for a drug taken for years on end by nearly one-quarter of adults past middle age, according to the Centers for Disease Control and Prevention’s most recent data. After all, only after 30 years of study did researchers discover that statins could raise the risk of type 2 diabetes. Many other sobering but unconfirmed possible side effects appear in the medical literature, including cognitive decline, cataracts and kidney problems.
Muscle damage tops the list of concerns, says James Wright, chairman of the Therapeutics Initiative at the University of British Columbia in Vancouver. “Over time there could be a cumulative effect. I’m predicting we’re going to have an aging population suffering from sarcopenia, where they can’t stand up.” He calls the mass prescribing of statins “the biggest human experiment we’ve ever done.”
Subscribe to Science News
Get great science journalism, from the most trusted source, delivered to your doorstep.
SUBSCRIBE
In November, a commentary in JAMA carried the headline, “The debate is intense, but the data are weak.” And long-simmering tensions between two major British medical journals recently erupted into an all-out editorial war over the drugs. Rory Collins doesn’t hide his irritation over the enduring controversy. “I can’t think of another circumstance in health care where there is such a lot of nonsense that has been persisting for so long,” says Collins, a medical epidemiologist at the University of Oxford and one of the leaders of the Cholesterol Treatment Trialists’ Collaboration. In his view, statin naysayers are peddling distortions or outright misrepresentations of evidence. Which raises the question: How can respectable scientists see the same data and reach such different conclusions?
At its core, the debate is about how studies are designed, carried out, evaluated and sliced and diced after the fact. No one argues that the vast majority of people prescribed a statin will be taking a drug — probably for the rest of their lives — that they never needed. At issue is whether they stand a good chance of gain, and whether they are putting themselves in unacceptable danger.
“Statins are arguably the most widely studied medicines ever,” says Jeremy Sussman, a primary care provider at the University of Michigan and the Department of Veterans Affairs in Ann Arbor. “They are also among the most widely used. This makes any controversy an important one.”
Birth of a blockbuster
Like many tales of drug discovery, the statin story starts in a petri dish. During the mid-20th century, scientists worked out the chemical steps that cells, most commonly in the liver, use to convert acetyl CoA, a chemical formed during metabolism, into cholesterol. More than 30 different enzymes orchestrate the process, but one central to the assembly line is called 3-hydroxy-3-methylglutaryl-CoA (or HMG-CoA) reductase, an early step in a long line of steps.
In the late 1960s, Japanese microbiologist Akira Endo was inspired to search for an HMG-CoA blocker during a two-year stint in New York, where he was struck by the fatty excesses of the American diet. Returning to Japan, he happened upon a compound in a fermented broth of Penicillium citrinum, a rice mold taken from a shop in Kyoto, that blocked the action of HMG-CoA reductase. In 1978, scientists at Merck & Co. found another microbe-produced chemical that also disabled HMG-CoA reductase. The Japanese discovery fizzled in laboratory trials, but Merck’s compound eventually emerged as the first cholesterol-lowering drug, lovastatin (brand name Mevacor).
Story continues below graphic
Cholesterol blockers
Most cholesterol is made in the liver, through a series of chemical steps that convert acetyl CoA into cholesterol. Statins block the action of an enzyme, HMG-CoA reductase, which is essential to the process.
cholesterol blockers
J. HIRSHFELD
Lovastatin targeted low-density lipoprotein, or LDL, cholesterol, often referred to as the “bad” cholesterol because it contributes to plaque buildup inside arteries. The drug didn’t lower another type of cholesterol, high-density lipoprotein, or HDL, which was thought to protect against heart disease because it scavenges cholesterol from arteries and ferries it to the liver for recycling. Today, HDL’s role is less clear (SN: 6/16/12, p. 14). Although statins demonstrated their ability to combat LDL cholesterol, proof that they saved lives was not established until a watershed study appeared in Lancet in 1994.
In that experiment, researchers from a collective of Scandinavian countries, and funded by Merck, followed more than 4,400 patients who had chest pain or had suffered a heart attack. After about five years, 8 percent of patients who took simvastatin (a synthetic version of lovastatin, marketed as Zocor) had died, compared with 12 percent who took a placebo, a 30 percent lower mortality rate. Doctors cheered. A blockbuster was born.
In the years following, a posse of other cholesterol fighters joined simvastatin to create what would become a $20 billion–plus annual market: pravastatin (Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor), cerivastatin (Baycol), rosuvastatin (Crestor) and finally pitavastatin (Livalo). The drugs are now available as lower-priced generics, poised to further drive consumption. Together, statins have been subject to more than two dozen large clinical trials that have collectively included about 175,000 people with and without heart disease. And yet, some doctors worry that even this avalanche of data isn’t enough.
16.3
percent
Americans 40 and older using statins in 2003–2004
23.2
percent
Americans 40 and older using statins in 2011–2012
Source: CDC
“The reality is there is more we don’t know than we do know,” says Wright. Among the conundrums he cites: The drugs vary widely in their ability to lower cholesterol, yet regardless of their potency, they appear to have the same potential to prevent a second heart attack or stroke. “Fluvastatin is the least potent,” he says. “Yet it appears to reduce cardiovascular events as much as rosuvastatin, which is the most potent. There’s something we’re not getting.”
Primary cares
To be clear, little if any disagreement exists over “secondary prevention,” or using the drug to prevent a second heart attack or stroke in someone with established disease. The contention arises over “primary prevention” — when an otherwise healthy person, whose main concern is simply elevated cholesterol, takes the drug to keep from taking that ambulance ride in the first place. This is a crucial context. If you have already survived one attack, you know you’re at increased risk for another. You’re willing to tolerate a certain level of side effects.
But healthy people, even healthy people whose cholesterol is too high, start with much lower odds of dying from cardiovascular disease than people already afflicted. It’s less certain whether they need the drug at all. A healthy person takes on the same risk of side effects as someone already struck by disease, but for potentially much less gain. That makes it vital to understand the true risk and benefit balance — and that’s precisely where the dispute lies.
The 500-pound gorilla of the statin research world is the Cholesterol Treatment Trialists’ Collaboration, commonly referred to as the CTT. Formed in 1994 and headquartered in the United Kingdom and Australia, the CTT consists of about 150 researchers who compile and interpret clinical trial data on statins. Their funding comes primarily from government sources and foundations. The individual trials the CTT evaluates were largely funded by the pharmaceutical industry.
Since in science no one study is a final answer, CTT gathers data from numerous clinical trials and feeds them into a meta-analysis — a calculation that combines data from different studies to come up with a wide-angle view. Scientists also obtain results by using systematic reviews, which compare the bottom line of different studies to determine where the true impact probably lies. Done well, these methods of blending data can provide a result with strong statistical power, finding an effect that might be missed in a single study.
But they are only as good as the studies that go into them. Depending on which studies are included (or excluded) and how they are analyzed, compilations can distort results or amplify biases and weaknesses in the research.
Timeline: A brief history of statins
The CTT published its first meta-analysis of 14 clinical trials for secondary prevention in 2005, concluding that for every 39-point drop in LDL cholesterol (roughly equivalent to 1 millimole per liter of blood) among people who took a statin, the odds of a heart attack or stroke dropped by 21 percent, and mortality from coronary artery disease fell by 19 percent. More CTT-authored publications have appeared in the decade since, including analyses that extend the benefit to stroke prevention. Most recently, Collins and more than two dozen collaborators authored a 30-page review in Lancet last November, bolstered by more than 300 references. That analysis of published large randomized trials calculated that each 77-point drop in LDL cholesterol (a 2 millimole per liter drop) reduced the risk of a major cardiovascular event — heart attack, stroke or the need for a coronary-clearing procedure — by 45 percent. Those kinds of LDL drops are realistic, at least in the short term. A 2015 review of studies of the widely prescribed drug atorvastatin found LDL reductions averaging 64 to 90 points in studies of three to 12 weeks, depending on the dose of drug used.
The degree of benefit depends on whether you’ve already had a heart attack or stroke. The CTT researchers calculated the number of patients who need to be treated to benefit one person. They estimated that if 10,000 people with heart disease lowered their LDL cholesterol by 77 points, 1,000 of them would be spared a second major event over the next five years. If 10,000 seemingly healthy people lowered their LDL by the same amount, an estimated 500 of them would be spared.
Insurance policy
What about those 9,500 healthy people who gained nothing from taking the drug those five years? The reality is, there is no way to sort them out ahead of time. Collins likens it to buying insurance. Everyone pays with the understanding that no one knows who is going to have an accident. If it’s your car, though, that policy can be a lifesaver.
“In insurance, you don’t know which people are benefiting,” he says, you just know that some people will. “The important thing is, there are heart attacks and strokes that are being prevented.” Also, he says, data suggest that the benefits continue to accumulate. If 500 people are spared a heart attack or stroke over five years, “over 10 years the number would double,” Collins says.
So the bottom line, according to the CTT estimates, is that for 5 percent of healthy people taking a statin, the drug means the difference between life and death, health or disability. And in return, the other 95 percent aren’t putting themselves at much risk for dangerous side effects.
Wright, of the University of British Columbia, remains unconvinced. He thinks that the numbers in the Lancet review go far beyond what the data show. The CTT numbers, he says, are based on extrapolations of cholesterol reductions greater than those achieved in reality. In a response to the Lancet review published in March, he and colleagues noted that the average cholesterol reductions actually achieved among lower risk groups in the trials were far below the 77 points that formed the basis for the conclusions.
Wright’s research group has performed its own analysis of primary prevention, published in 2010. In that calculation, the number of people who would avoid a cardiovascular event is not 5 percent, as the review in Lancet estimated, but somewhere between 1 and 2 percent — which means only 100 or at most 200 of every 10,000 healthy people taking a statin would benefit.
On the rise
Since their introduction in 1987, statins are among the best-selling drugs in pharmaceutical history. By 2011, they were prescribed to more than 40 million Americans 18 and older.
increasing statin use
J. HIRSHFELD
Source: AHRQ
Even considering the seriousness of nonfatal heart disease, the ultimate test is not whether statins keep a person from an angioplasty or even heart attack, but whether the drugs save lives. Studies of primary prevention, because they start with healthy populations, have a much higher hurdle to show a reduction in mortality. Over the typical length of a major clinical trial, the overall risk of death is low to begin with.
Still, Collins points to evidence that lives are saved. In 2012 in Lancet, a CTT meta-analysis of 27 randomized trials found that even among people with no previous vascular disease, those who had a 39-point decrease in LDL had a 9 percent lower overall mortality risk over about five years.
But there’s another way to look at those data: a straight-up comparison of low-risk volunteers who take the drug with those taking a placebo. Following the Lancet publication in 2012, Wright and colleagues recalculated the numbers and did not find a mortality benefit among people who had less than a 20 percent chance of having a heart attack in the next five years, based on established prediction measures.
After that analysis appeared in BMJ in 2013, Collins demanded a retraction, but two independent statistical reviews concluded that the paper did not meet any criteria for withdrawal.
Downsides debated
Mortality is not even the most contentious issue in the statin wars. That prize goes to the question of harm: How much might healthy people — the ones who weren’t going to have a heart attack or stroke anyway — be hurt by the drug. To Collins and other CTT leaders, side effects, especially serious ones, are rare and clear up when people stop taking the drug. To others, the story is not that simple.
Critics talk mostly about effects on muscles, particularly pain and weakness. One early statin called Baycol was withdrawn from the market in 2001 after it was linked to 52 deaths from a breakdown of muscle tissue. Studies following the scandal suggested that statins might impede protection from oxidative stress or alter other chemical reactions in muscle cells.
It’s important to note that randomized studies haven’t found side effects even remotely as prevalent as critics contend. Back to that theoretical population of 10,000 in the November Lancet review, only five people would experience muscle problems, and just one would have a serious breakdown of muscle tissue.
And even those small numbers might overestimate what occurs in everyday life, says Richard Hobbs, head of the department of primary care health sciences at the University of Oxford, who defended statins last year in BMC Medicine. He points out that clinical trial volunteers are regularly quizzed about possible side effects — and says that asking the question may plant the suggestion in their minds. “The trials, because they are searching for adverse effects, may overstate them,” he says.
The reason for the stark difference in opinion over side effects comes down to how much weight is given to patients who were not included, or not counted, in meta-analyses, says Rita Redberg, a cardiologist at the University of California, San Francisco and a prominent voice of concern over statins. In some trials, she says, people who complained of side effects beforehand were not allowed to participate, dropped out before the studies were completed or were not counted because the criteria for being put in the side effects category were so narrowly defined.
To qualify as having muscle weakness in the CTT studies, a person had to not only feel muscle aches, but also have elevated levels of a certain enzyme (a criterion Collins says is necessary to show the drug caused the effect). Redberg also worries that there are still problems that might be undetected because no one is looking for them, diabetes being a case in point. A link between diabetes and statins wasn’t discovered until a 2008 analysis of almost 18,000 people published in the New England Journal of Medicine, which found that 216 people taking a placebo developed type 2 diabetes while 270 taking a statin did.
I can tell you side effects are quite common. Among my patients, the most common are muscle problems, also malaise, fatigue, feeling in a fog.
— Rita Redberg
Redberg says observational data — which follow real-world patients on statin therapy — report side effect risks much higher than those in the CTT analyses. In one routine-care study, reported in 2013 in Annals of Internal Medicine, 8 percent of patients stopped taking statins because of side effects. One study from an international team of researchers, published in JAMA in 2016, found that among people who previously complained of problems with taking statins, 43 percent developed muscle pain after taking the drug in the study, atorvastatin, compared with 27 percent who took a dummy pill.
“I can tell you side effects are quite common,” Redberg says. “Among my patients, the most common are muscle problems, also malaise, fatigue, feeling in a fog.”
Redberg and others have also criticized the CTT for not releasing the raw data of clinical trials, which would allow other independent researchers to mine the data for adverse reactions. When asked about this, Collins counters: “It’s not our data.” The results that have informed CTT calculations were provided with the understanding that the numbers belonged to the original investigators. And, he says, the CTT doesn’t have data on side effects beyond what has been reported.
In the end, the potential risk that any patient is willing to take may hinge on how much danger they are in to start with. Guidelines released in 2013 by the American Heart Association and the American College of Cardiology say that people between the ages of 40 and 75 should take a statin if their risk of cardiovascular disease is 7.5 percent or higher over the next 10 years. In the United States, that makes an estimated 78 million adults eligible for statin prescriptions. European guidelines set a higher threshold: between 10 and 20 percent risk over the next 10 years. The U.S. Preventive Services Task Force updated its recommendations in November, saying adults should consider statins if they have one or more major risk factors for heart disease.
Sussman, of Michigan, refers to one of several online calculators that can help determine what that risk number is for any particular person. These kinds of tools take into account each person’s unique set of circumstances. In one online tool, a sedentary 60-year-old white male with a weight of 250 pounds, a total cholesterol of 225, no high blood pressure and no personal or family history of heart disease might have a 9 percent risk of having a heart attack in the next 10 years. A 60-year-old African-American woman with diabetes but all other parameters the same would have a 13 percent risk.
The guiding principle Sussman tells his patients is that the lower your risk of disease in the first place, the less you have to gain from statins. Patients also have to factor in their own sense of how much they fear a heart attack or stroke — all the while knowing there are other means of prevention with almost no risk that can get lost in the statin debate, including weight loss, exercise and a better diet. That theoretical 60-year-old man with a 9 percent risk could drop his risk to about 5 percent with 20 minutes of moderate activity each day and better eating habits.
“You say to a patient, ‘Here’s a pill, and the odds of benefit are small, but you’ll have to take it the rest of your life,’” says Sussman. Over the coming decades, the drug may cause you problems you never would have had. But one of the people who hits the jackpot — and dodges a devastating heart attack or stroke — might be you. “That’s a hard choice.”
This article appears in the May 13, 2017, issue of Science News with the headline, “The Statin Umbrella: Yes, the drugs protect hearts. But critics are questioning their expanding use.”
Questions or comments on this article? E-mail us at feedback@sciencenews.org | Reprints FAQ
A version of this article appears in the May 13, 2017 issue of Science News.
CITATIONS
R. Collins et al. Interpretation of the evidence for the efficacy and safety of statin therapy. The Lancet. Vol. 388, September 8, 2016, p2532. doi: 10.1016/S0140-6736(16)31357-5.
R.F. Redberg et al. The debate is intense, but the data are weak. JAMA Internal Medicine. Vol 316, November 15, 2016, p. 1979. doi:10.1001/jama.2016.15085.
Cholesterol Treatment Trialists’ Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. The Lancet. Vol 380, August 11, 2012, p.581. doi: 10.1016/S0140-6736(12)60367-5.
C. Mercado et al. Prevalence of Cholesterol Treatment Eligibility and Medication Use Among Adults — United States 2005–2012. MMWR Weekly Report. Vol. 64, December 4, 2015, p.1305.
F. Godlee. Adverse effects of statins. BMJ. Vol. 348, May 15, 2014. doi: 10.1136/bmj.g3306.
F. Taylor et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. January 21, 2013. doi: 10.1002/14651858.CD004816.pub5.
S.P. Adams et al. Atorvastatin for lowering lipids. Cochrane Database of Systematic Reviews. Published online March 11, 2015. doi: 10.1002/14651858.CD008226.pub3.
R. Hobbs et al. Is statin-modified reduction in lipids the most important preventive therapy for cardiovascular disease? A pro/con debate. BMC Medicine. Published online January 14, 2016. doi: 10.1186/s12916-016-0550-5.
J. D. Abramson et al. Should people at low risk of cardiovascular disease take a statin? BMJ. Published online October 22, 2013. doi: 10.1136/bmj.f6123.
E.M Sarpong, and S.H. Zuvekas. Trends in Statin Therapy among Adults (Age ≥ 18), United States, 2000 to 2011. Statistical Brief #458. November 2014. Agency for Healthcare Research and Quality, Rockville, MD.
Cholesterol Treatment Trialists’ Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. The Lancet. Vol. 366, September 27, 2005, p. 1267. doi: 10.1016/S0140-6736(05)67394-1.
J. Abramson et al. Safety and efficacy of statins. The Lancet. Vol 389, March 18, 2017, p. 1097. doi: 10.1016/S0140-6736(17)30713-4.
S.E. Nissen et al. Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients With Muscle-Related Statin Intolerance. JAMA. Vol. 315. April 19, 2016, p. 1580. doi:10.1001/jama.2016.3608.
P.M. Ridker et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. The New England Journal of Medicine. Vol. 359, November 20, 2008, p. 2195. doi: 10.1056/NEJMoa0807646.
R. Chou et al. Statins for prevention of cardiovascular disease in adults: Evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. Vol. 316, November 16, 2016, p. 2008. doi:10.1001/jama.2015.15629.
|
|
|
|
Post by the Scribe on Aug 15, 2023 17:12:58 GMT
Doctors Are Switching From Statins To This…🤫
Natural News with Danny Curtin
31,706 views Jun 28, 2023 #statins #drberg #paulstamets
Join me as I discuss the controversial topic of statins for the reduction of cholesterol, and new research that challenges the belief that statins are considered "miracle drugs."
I'll also dispel misconceptions about the benefits and dangers of cholesterol, in addition to its role in the formation of arterial plaque, and how blood viscosity, shear rate, and vascular injuries are much more important factors when it comes to CHD risk.
And finally, I'll give you actionable items that include supplementing with natural systemic enzymes like nattokinase, that will have a tremendous impact on your overall cardiovascular health.
Favorites:
Nattokinase Product 1 - Neprinol AFD (15,000 FU per cap) - bit.ly/nattvid
Nattokinase Product 2 - Nattovena (4,000 FU per cap) - bit.ly/40OfQBE
Vitamin K2 Product - KD Ultra - bit.ly/3RKPo7L
Studies:
Statin Wars: Have We Been Misled?.... - bit.ly/444zJp5
Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors - bit.ly/3CLwUgP
RBC Aggregation and WBV - bit.ly/3SX0Uxl
Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment -https://bit.ly/3JzjnN7
How Statistical Deception Created The Appearance That Statins Are Safe And Effective In Primary And Secondary Prevention Of Cardiovascular Disease -https://bit.ly/3NpWqx2
Atherosclerosis & Hyperlipidemia Study - bit.ly/3lYzudT
#nattokinase #cholesterol #statins #blood #cardiovascular #vitamins #dietarysupplement #amazon #amazonshopping #drberg #nattokinase #nowfoods #news #healthylifestyle #healthnews #nndc #paulstamets |
|
|
|
Post by the Scribe on Sept 22, 2023 7:16:03 GMT
Atorvastatin Decreases Renal Calcium Oxalate Stone Deposits by Enhancing Renal Osteopontin Expression in Hyperoxaluric Stone-Forming Rats Fed a High-Fat Diet
pubmed.ncbi.nlm.nih.gov/35328466/
Chan Jung Liu 1 2, Yau Sheng Tsai 3 4, Ho Shiang Huang 1 2
Affiliations expand
PMID: 35328466 PMCID: PMC8954580 DOI: 10.3390/ijms23063048
Free PMC article
Abstract
Calcium oxalate (CaOx) is the major constituent of kidney stones. Growing evidence shows a close connection between hyperlipidemia, cardiovascular disease (CVD), and the formation of kidney stones. Owing to their antioxidant properties, statins control hyperlipidemia and may ameliorate CaOx stone formation. The present study was designed to investigate the suppressive effects of statins on CaOx urolithiasis and their potential mechanism. We used rats fed a high-fat diet (HFD) to achieve hyperlipidemia (HL) and hydroxyproline (HP) water to establish a hyperoxaluric CaOx nephrolithiasis model; the animals were administered statins (A) for 28 days. The rats were divided into eight groups treated or not with A, i.e., Control, HP, HL, HL + HP. HL aggravated urinary calcium crystallization compared to the control. Due to increased expression of renal osteopontin (OPN), a key anti-lithic protein, and reduced free radical production, the calcium crystals in the urinary bladder increased as renal calcium deposition decreased. The levels of the ion activity product of CaOx (AP(CaOx)) decreased after statins administration, and AP(Calcium phosphate) (CaP) increased, which suggested the dominant calcium crystal composition changed from CaOx to CaP after statin administration. In conclusion, atorvastatin decreases renal CaOx stone deposits by restoring OPN expression in hyperoxaluric rats fed a HFD.
Keywords: atherosclerosis; atorvastatin; calcium oxalate; hydroxyproline; hyperlipidemia; urolithiasis.
Conflict of interest statement
The authors declare no conflict of interest.
|
|
|
|
Post by the Scribe on Nov 12, 2023 19:41:25 GMT
Statins and Your Brain Health
I CARE FOR YOUR BRAIN
531,136 views Nov 9, 2022
In this episode of I CARE FOR YOUR BRAIN with Dr. Sullivan, board certified neuropsychologist Dr. Karen D. Sullivan discusses the different types of cholesterol, the different statins prescribed for treating high cholesterol, and the latest research on how statins affect brain health. Learn more at www.icfyb.com or follow us on Facebook at www.facebook.com/icareforyourbrain
Transcript
Follow along using the transcript.
Show transcript
comments
@kf4wnf
@kf4wnf
6 months ago (edited)
Let me tell you my story. My doctor started me on Pravastatin about 13 - 14 years ago. I had no problems with BP and no other health issues, other than mildly elevated LDL, according to the medical industry. My dad died at 55, but he smoked, used alcohol and ate unhealthy...etc. But because he passed away at 55, my doctor wanted to start me on statins. He said he took them and they were safe...so I believed him. I started those around age 44-45. I walk at least 1 mile every other day, when possible. Around age 55 I started noticing my lower leg muscles (both legs), right along my shin bones, were like rock hard and felt numbish...for lack of a better description. This went on for a couple of years and I would complain at each doctor's visit I had. He chalked it up to "shin splints"...even though it seems to get better when I walked...kind of the opposite of "shin splints".
After continuing to complain...he ran about every blood panel he could, as a general dr., found nothing. I then went to an Arthritis doctor, he ran about every blood test he could, found nothing. I went an orthopedic specialist, did all kinds of X-Rays and found nothing. By now, I was starting to have tightness in my shoulders and across the top of my chest and lower neck area and with all this, it was about to drive me nuts.
So, I kept complaining and finally my general doctor ordered at nerve conduction test. The test showed "Peripheral Neuropathy" in my lower leg. I'm like, why in the crap would I have this. Also, my blood sugar levels were creeping up each year. Finally, went to the neurologist, he also found absolutely nothing and he simply said he couldn't explain why I had.
So, this past December, I had a visit with a cardiologist, basically to get established. Did the regular stress test...passed fine, did ultrasound...passed fine, did the Calcium Score test and it showed a 61, which was a little shocking to me, even though that is not high, I didn't expect that. The cardiologist suggested I switch from Pravastatin to Crestor. I got the prescription filled then decided to do some research why my calcium score was higher than I expected, before I considered starting this new statin.
After doing a very deep dive research into Statin drugs, I found A LOT of alarming information and I immediately took myself off all Statins and scheduled a follow up visit with my cardiologist. What I found was, ALL Statin drugs will increase your Calcium in your arteries and will increase your Calcium score, this is directly related to plaque and plaque buildup in your arteries, if you are not following me yet. My Cardiologist even told me that in my original visit when he gave me the Crestor prescription. He said, "when you go on a Statin drug or increase a Statin drug dosage, it will cause your calcium score to rise". I asked him, is that reversible and he said no. So, that's what originally made the light bulb go off...were statins truly safe or not. I 100% attribute my elevated calcium score of 61 to directly using statins for all those years.
Once I came off of the Statin drugs, my "Peripheral Neuropathy" is completely gone. The muscle tightness I was having in the lower neck and top of my chest, completely went away. My blood sugar has dropped and is most mornings either in the low - mid 90's, which while on Statins, it was running 100 - 115 most days...which is crazy, because I am not a candidate for high blood sugar. My blood pressure is perfect, weight is perfect...etc.
I'm not telling anyone what to do, but my cardiologist agreed with me, for me to come off of Statin drugs. It was slowly killing me. My cholesterol total usually runs around 250+, LDL around 150-170, while not on statins, but I'm okay with that, your body doesn't make mistakes, it make cholesterol for a reason and your body uses it.
What causes Plaques and Plaque build up in SUGAR. Sugar creates inflammation, causes oxidized LDL (which is really what is bad), and all kinds a terrible things in your body.
Finally, My Statin Decision!
I CARE FOR YOUR BRAIN
105,277 views Sep 4, 2023
In this episode of I CARE FOR YOUR BRAIN with Dr. Sullivan, board certified neuropsychologist Dr. Karen D. Sullivan reveals her decision to take a statin or not. As she shared in her December 2023 "Statins and Your Brain Health" (available to watch at
• Statins and Your Brain Health ), there are multiple considerations when deciding to take a statin, not just your LDL cholesterol. For the last few months, she has been researching and looking to partner with a local lipidologist to inform her final decision. Things didn't go as planned and she is here to share the journey with you in hopes that you too will become empowered with high-quality information and be your best advocate. Learn more at icfyb.com
Find the CoQ10 supplement she takes here: amzn.to/3L90PUI
Disclosure: Links contain affiliates. When you buy through one of our links we will receive a commission. This is at no cost to you. Thank you for supporting the I CARE FOR YOUR BRAIN with Dr. Sullivan program and allowing us to continue to bring you valuable content.
Transcript
|
|
