Wednesday, July 01, 2009
A few years ago my total cholesterol got a bit high, and my doctor (a TigerHawk reader, in fact) put me on a statin (Vytorin, the combination of Zetia and Zocor). I did not, in my heart of hearts, believe that I needed it, because my HDL number was a high proportion of the total (a trait that runs in my family) and, besides, I do not really have cardiovascular problems in my background. In my family, we get cancer young or live to a ripe old age.
That said, I went on Vytorin anyway because I had read that statins were thought to confer protective benefits beyond the mere reduction in the production or absorption of cholesterol. It increasingly appears that was the right decision.
Any physicians out there who want to take the other side?
That's fine if you can tolerate statins. Some can't; the nastiest reaction is the one which results in muscle pain and weakness ... in severe cases, death through overweakened heart muscle. Next most serious are liver problems, which is why statins have disclaimers about monitoring liver function.
I have a few patients who have shown measurable carotid artery plaque reabsorption while on statins (measured by duplex ultrasound). There are those who say that anyone with measurable plaque by doppler examination should be on a statin, regardless of their cholesterol profile.
The right thing to do is probably to do a risk profile, measure the cholesterol ratios and be selective.
These drugs can have nasty side effects (as noted above)and they are definitely NOT CHEAP.
Personally, if I can get somebody to stop smoking and get off their ass and exercise, I think that I have done them far more good...and it saves them money.
Duane Graveline, M.D. in "Lipitor, Thief of Memory" claims he experienced transient global amnesia as a result of the drug.
I have not seen this reported elsewhere, nor any reference to any mental disturbances related to statin use.
I am a physician. I stopped taking a statin. Statins have not been shown to have a significant mortality benefit. For example:
I think the standard dogma regarding low fat diets to prevent heart disease is also incorrect. I eat a high fat diet.
I am a doc and not by nature a big pharmaceutical basher, but you do have to remember to take ALL medical studies with a wheelbarrow full of salt. The benefits are almost always greatly overstated (doesn't mean there is no benefit).
Can't say I know anything about statins, but I did enjoy reading Ben Goldacre's Bad Science. Having read it, I have a hard time believing any news report about medical trials, especially in British newspapers.
"Statins cut the risk of heart attacks by 30 per cent even in healthy people, researchers say." My question, is what's the typical risk of a heart attack among healthy people? I'd guess it's pretty low. So a 30% improvement on something that's pretty low probably doesn't mean much.
Plus it's always questionable when a drug that does one thing (lowers cholesterol) is suddenly reducing "the chances of death from all causes by 12 per cent."
Hopefully Goldacre will comment on this study at his blog, badscience.net
What do you know, he's commented about similar studies before.
“Heart attacks were cut by 54 per cent, strokes by 48 per cent and the need for angioplasty or bypass by 46 per cent among the group on Crestor compared to those taking a placebo or dummy pill”, said the Daily Mail. Dramatic stuff. And in the Guardian, we said: “Researchers found that in the group taking the drug, heart attack risk was down by 54% and stroke by 48%”.
Is this true? Yes. Those are the figures on risk, expressed as something called the “Relative Risk Reduction“. It is the biggest possible number for expressing the change in risk. But 54% lower than what? This was a trial looking at whether it is worth taking a statin if you are at low risk of a heart attack (or a stroke), as a preventive measure: it is a huge market – normal people – but these are also people whose baseline risk is already very low.
If you express the exact same risks from the same trial as an “Absolute Risk Reduction“, suddenly they look a bit less exciting. On placebo, your risk of a heart attack in the trial was 0.37 events per 100 person years, and if you were taking rosuvastatin, it fell to 0.17 events per 100 person years. 0.37 to 0.17. Woohoo. And you have to take a pill every day. And it might have side effects.
And if you express the risk as “Numbers Needed To Treat“, probably the most intuitive and concrete way of expressing a benefit from an intervention, then I reckon, from the back of this envelope in front of me (they naughtily don’t even give the figure in the research paper), that a couple of hundred people need to take the pill to save one life.
Not a doctor but have had this exact conversation many times with many of them. One of them used to be a doctor, then taught medicine, and now is a venture capitalist who reads all the research reports to invest profitably. They all said, and the VC in particular, that if you want to prolong your life, regardless of your weight, your blood pressure, or your cholesterol level, you should immediately start taking a statin and immediately lower your blood pressure. The health benefits totally overwhelm those from exercise. Sure, you don't want to be morbidly obese and at risk for diabetes. Sure, get some exercise if it feels good. But if you actually want to live longer, take the drugs.
I took Vytorin for two years. It controlled my cholesterol somewhat. BUT I wound up in the hospital with poor liver and kidney function and because no other cause could be found it was blamed on the statin. My doctor says she will never prescribe any statin for me again. And what's more I wouldn't take it if she did. My liver and kidney functions are now normal.
Ok, fair question here. If I reduce my chance of having a heart attack (which is treatable) by .17 Events Per Person Years by taking a drug that increases my chance of having a liver failure (which is treatable only by extreme measures) by more than .17 EPPY, have I gained anything, or am I just contributing money to the drug company? Can I gain the same or better net benefit by taking a baby aspirin a day?
FYI: This post has encouraged me to get off my fat * and go for a lunch walk. Thanks!