It 'may' have something to do with showing a need for even further lengthy studies and funding in order to prove it as fact somewhere down the line. :)

It's because of the drug manufactures don't want to make claims they can't back up. Using the word "may" leaves those unable to sue if later someone else claims they lied or are trying to miss lead the public. It's another of those drugs that is cheap to make so manufactures want it used for everything. Recently it was suggested that Statin's cause problems with glucose in blood for diabetics. Sales dropped, now they want people other than just those with high cholesterol to buy in to their scheme.

It's because of the drug manufactures don't want to make claims they can't back up

Thats not it at all. As direct proof of this, its not only drug studies that use the word "may". MOST medical studies use this word, in fact, most scientific journals as a whole

Its very hard, if not impossible, to prove something to an absolute certainty. Thats why you'll hear the term "medical certainty"

Statin's cause problems with glucose in blood for diabetics. Sales dropped, now they want people other than just those with high cholesterol to buy in to their scheme.

Statins are generic now. Plus, this study was carried out in Israel, which does not have the US profit motive

The word MAY is used because this is not a scientific certainty. In scientific writing, if there is still doubt, the word may is used. In this case, the use of Statins in lowering cancer risk looks promising but there is much that is still not understood about the mechanism.

Actually, this suggestion that statin drugs may lower certain cancer risks has been around for several years. So why is this being treated as some kind of new revelation?

They use MAY because even researchers will not give a definitive answer. Doing so MAY leave them open to lawsuits.

Its evidence. Belief is irrelevant

You either understand the facts, or you don't

Notice the utter ignorance in votes for comment #2.

Amazing.

Statins may be the newest wonder drugs as evidenced by studies..hope so been taking this crap for years.

Millions of stories are now coming out about the permanent side effects, everything from organ damage to the more common permanent muscle damage

B.S. Do you have proof? The rate of permanent muscle damage is <1%. Much less

"organ damage"?? Care to be more specific? You have more than one organ,you know...

The eventual lawsuits on statins will set records

Unlikely as every study has showed the benefits outweigh the risks

Statins may have an impact on some cancers but they are increasing the likely-hood of Alzheimer Disease and Dementia.

Not true. source please?

I can provide evidence to the contrary

The focus on cholesterol is off base

so then explain familial hypercholesterolemia to me. And explain why all statin trials,even those performed by the NIH and independent scientists, not just the drug companies, have shown a benefit

The so called good cholesterol (HDL) and bad cholesterol (LDL) are actually not cholesterol - they are lipoproteins that transport cholesterol mostly manufactured in the liver to all parts of the body.

Not really. An LDL or HDL molecule by definition is a protein combined with a cholesterol molecule. the protein is either apoA or apoB. And they transport both dietary and endogenously produced cholesterol. Im not sure why you think its "mostly" manufactured in the liver. Do you have evidence of this?

Cholesterol is a vital part of many essential parts and functions of the body, most importantly brain function

So are brain cells. But too many of those is called brain cancer. Dose is important, grasshopper.

I would like to list some links to back up my statement but this site does not allow me to post them for some reason?? That's unfortunate as it would definitely add to the discussion. Alzheimer's is a devastating disease whose incidence is clearly on the rise in America. Fortunately, a significant number of research dollars are currently being spent to try to understand what causes Alzheimer's. ApoE-4, a particular allele of the apolipoprotein apoE, is a known risk factor. Since apoE plays a critical role in the transport of cholesterol and fats to the brain, it can be hypothesized that insufficient fat and cholesterol in the brain play a critical role in the disease process. In a remarkable recent study, it was found that Alzheimer's patients have only 1/6 of the concentration of free fatty acids in the cerebrospinal fluid compared to individuals without Alzheimer's. In parallel, it is becoming very clear that cholesterol is pervasive in the brain, and that it plays a critical role both in nerve transport in the synapse and in maintaining the health of the myelin sheath coating nerve fibers. An extremely high-fat (ketogenic) diet has been found to improve cognitive ability in Alzheimer's patients. These and other observations described below lead me to conclude that both a low-fat diet and statin drug treatment increase susceptibility to Alzheimer's,

you are using the term "allele" incorrectly. An allele is a gene locus--you are referring to apoE, which is a protein. Thats a clue that you may be dealing with concepts you don't fully comprehend

Since apoE plays a critical role in the transport of cholesterol and fats to the brain, it can be hypothesized that insufficient fat and cholesterol in the brain play a critical role in the disease process

Firstly, I disagree. Define "insufficient". The LDL of infants is in the 40s. By your theory, infants, who have the highest demand for brain building blocks, would not be able to complete this process. Yet they all do. Clearly they are smaller than full grown adults, but again, their brains are growing at a much more rapid rate, meaning they would require even MORE cholesterol than full grown adults, who's brains have stopped growing for the most part

Hypothesis disproven

These and other observations described below lead me to conclude that both a low-fat diet and statin drug treatment increase susceptibility to Alzheimer's,

Your facts can be summed up as follows: brain need cholesterol, statins inhibit cholesterol, thus statins cause brain disease

Lets test your theory

If it were true, people with the highest cholesterol would be at the absolute lowest risk for alzheimers. It should be almost unheard of in this group

http://www.ncbi.nlm.nih.gov/pubmed/22232009

http://www.ncbi.nlm.nih.gov/pubmed/22842870

Clearly thats not the case

This shows that while hypothesizing is great, its no substitute for evidence

Careful, now - the first of those two abstracts (the only one that seems relevant to your case) makes reference to the "apolipoprotein E4 allele," and I'd hate to have to conclude that those authors don't fully comprehend what they're talking about. FWIW, when you have a protein-coding gene and the gene and the protein are given similar names, it is common to speak of the statistically observed effects of such-and-such allele despite the fact that the effects (if they really exist) are caused by the protein variant and not the DNA sequence. I wish I had a dollar for every time I have seen the term "apo E4 allele" used.

Also, one might argue that the reason babies have such low blood cholesterol is that they are incorporating cholesterol into their growing brains faster than it can build up in their blood. And it's been shown that essential fatty acids improve babies' intelligence. It sounds to me like none of us yet have a full picture of the influence of lipids on cognitive function (or any other aspect of health, for that matter, since it now appears probable that cholesterol is, except in extreme cases, not itself the primary cause of heart disease but a marker for excess inflammation).

Careful, now

Im always careful

he first of those two abstracts (the only one that seems relevant to your case) makes reference to the "apolipoprotein E4 allele," and I'd hate to have to conclude that those authors don't fully comprehend what they're talking about.

Note I said the poster didn't comprehend what he was talking about, not the authors. When they say "apolipoprotein allele" they are referring to the gene product of said allele. I doubt the poster understands that

it is common to speak of the statistically observed effects of such-and-such allele despite the fact that the effects (if they really exist) are caused by the protein variant and not the DNA sequence. I wish I had a dollar for every time I have seen the term "apo E4 allele" used.

obviously. But again, I doubt the poster understood that. Maybe he did, who knows...

that the reason babies have such low blood cholesterol is that they are incorporating cholesterol into their growing brains faster than it can build up in their blood

I guess thats possible, but there is no evidence of increased cholesterol transport to the brain

And it's been shown that essential fatty acids improve babies' intelligence. It sounds to me like none of us yet have a full picture of the influence of lipids on cognitive function (or any other aspect of health, for that matter,

The best data we have suggests no effect to a slight negative effect of lipids on cognitive function

since it now appears probable that cholesterol is, except in extreme cases, not itself the primary cause of heart disease but a marker for excess inflammation).

So explain familial hypercholesterolemia then? Why would cholesterol behave differently in this "extreme case"

Or the clear association between increased cholesterol and heart disease seen in framingham?

Or the fact that the most potent anti-inflammatory agents have no effect, or even a negative effect on heart disease (steroids, Vioxx?)

Or why statins appear to help heart disease, yet are only mild anti-inflammatory agents compared to the above?

Explain why a couple other classes of cholesterol-lowering drug have been embarrassed in clinical trials when it turned out that, though they lowered cholesterol, they jacked up the heart attack risk. Explain why people on a vegetarian diet see cardiovascular risk markers improve even if their cholesterol doesn't. Explain how statins could possibly be claimed to lower cancer risk by lowering cholesterol even though it is now solidly demonstrated that people with naturally low cholesterol levels have higher cancer risk?

If you have genuinely abnormal amounts of any substance in your blood, it's liable to harm you. But it's become clear to most that "the evil molecular cholesterol" is not the root cause of Western lifestyle-induced heart disease; excessive chronic inflammation more likely is. That doesn't mean that any anti-inflammatory pharma drug will reduce heart disease; drugs can have negative effects to go with their positive effects.

Jane, explain why people with high cholesterol die from heart attacks.

JM, explain why people with low cholesterol die from heart attacks.

I asked you first.

Heart attacks can occur for various reasons...easy to look up.

But this article is discussing statins, which you seem to be arguing against. If my family history shows premature death from clogged arteries...you bet I'm going to try statins, proper diet and exercise. If a growing pool of evidence suggests use of statins may prevent certain cancers, that's a bonus.

I can live with the side effects as they are insignificant compared to the alternative.

jane,

I have to agree with JM here. You cannot answer a question with another question. It seems like you might be trying to dodge something.

I have answers for all the questions you posed, but I'd like to hear your thoughts first.

I would have to agree with Jane.

Additionally, maybe you can explain why we were told trans-fats were a healthy alternative to natural fats.

That advice didn't turn out so well.

What is more likely to cause inflammation? Saturated fats or polyunsaturated fats?

See Dr. Eric, the medical community is still giving out the wrong advice.

Also, statins are starting to be recognized in neurological impairment. As a pretend cardiologist, you should know this by now. You should be warning your patients of this side effect.

biff,

are you stalking me? This is the second post you have responded to me directly on two seperate threads. Wow. Im sure you'll claim its all a coincidence, but man, you are obsessed

Additionally, maybe you can explain why we were told trans-fats were a healthy alternative to natural fats.

They were wrong. It happens. It doesn't automatically mean everything you hear is wrong

Plus, trans fats were not primarily touted as a healthy alternative. Their primary claim to fame was increased shelf life

What is more likely to cause inflammation? Saturated fats or polyunsaturated fats?

Saturated fats

See Dr. Eric, the medical community is still giving out the wrong advice.

see above. Im sure you've been wrong once or twice in your life. Does that automatically mean every word out of your mouth is a lie?

Also, statins are starting to be recognized in neurological impairment.

Nope. Actually, a paper came out today that disputes this very claim

http://content.onlinejacc.org/article.aspx?articleid=1351850

As a pretend cardiologist, you should know this by now.

Think about what you are saying for two seconds because it makes no sense. If im a "pretend cardiologist" then I really shouldn't know about this, right?

As a pretend intelligent poster, at least be consistent in your insults, dillweed

You should be warning your patients of this side effect.

I'll tell you what. You graduate high school first, then maybe you can give advice, mmkay?

"Plus, trans fats were not primarily touted as a healthy alternative. Their primary claim to fame was increased shelf life"

Increased shelf life and firmness at room temperature. What causes the margarine and oil spreads to spoil? Oxidation due to unsaturation.

Now you're telling me that saturated fats are more likely to cause inflammation than unsaturated fats?

I thought the Western diet was too high in N-6 fatty acids and too low in N-3.

We were told to increase our diets with N-6 fatty acids/ trans fats and eliminate natural sources of saturated fats. Remember the heart smart days in the early 1980s?

Natural saturated sources of fat=bad

Man made cooking oils high in N-6 fats=good

What gives?

Oh wait, now we understand that high N-6 fatty acid diets are actually causative of inflammation and disease. Now we need proper balance of N-6 to N-3 fatty acids to avoid inflammation and disease.

Please explain Dr. Eric. I thought saturated fats were more likely to cause inflammation than unsaturated fats.

Now you're telling me that saturated fats are more likely to cause inflammation than unsaturated fats?

yes, surprised as you may be to learn this, your local supermarket and your body operate somewhat differently

Again, your ignorance of basic high school chemistry is showing. Unsaturated fats are themselves more likely to be oxidized, meaning they are strong reducers, not oxidizers

This is why I laughed at you on the other thread when you were claiming to be an expert in "redox" and cellular metabolism

I thought the Western diet was too high in N-6 fatty acids and too low in N-3.

both of those are unsaturated

Please explain Dr. Eric. I thought saturated fats were more likely to cause inflammation than unsaturated fats.

they are

http://content.onlinejacc.org/article.aspx?articleid=1137827

I thought N-3 and N-6 fatty acids caused anti-inflammatory and pro-inflammatory effects. I guess I was wrong again. It's saturated fats that cause these effects.

Thanks Dr. Eric.

You are truly a wealth of information.

"Again, your ignorance of basic high school chemistry is showing. Unsaturated fats are themselves more likely to be oxidized, meaning they are strong reducers, not oxidizers"

Ah yeah, more likely to oxidize and create inflammation if not kept in control. Controlled oxidation is essential for proper cellular responses. Uncontrolled oxidation is detrimental to cellular responses. So if polyunsaturated fatty acids are much more vulnerable towards oxidation than saturated fatty acids, why are saturated fatty acids more likely to cause inflammation?

Um, Um...Um

Thanks Dr. Eric.

You are truly a wealth of information.

anytime

Ah yeah, more likely to oxidize and create inflammation if not kept in control.

Again, youre confusing the actor and that which is being acted upon

When an unsaturated fat is oxidized, it reduces that which oxidized it.

So unsaturated fat reduces body tissue, fat does not oxidize body tissue

So if polyunsaturated fatty acids are much more vulnerable towards oxidation

I cannot make it simpler for you...I suggest remedial high school chemistry

Again, not to mention that being oxidized in a grocery store is completely different from cellular oxidation in the body.

That should go without saying

in addition, im not certain that oxidized fatty acids is equivalent to unsaturated fats....

Its a little beyond both my and own, and surely your expertise

If you disagree, please provide a source that discusses oxidized fatty acids with respect to polyunsaturated vs saturated fats

There isn"t any data that supports these fears about statins. The study sited that points to an anti-cancer effect has a large population and while not definitive is much stronger than anything suggesting alzheimers and organ damage. There is some incidence of muscle pain with statins which can be dealt with by quarterly liver tests and discussion with one's doctor. If muscle pain develops a person is either taken off the statin, moved to a different statin or has their dosage reduced. Fact is folks with diseases of the circulatory system including diabetics gain great benefit from statins. Scaring such people away from them with unsubstantiated fears is cruel.

Sure Singe, keep eating the big lie. I had a heart arrhythmia one day when I was 31yo. Instantly the docs put me on a cocktail of drugs, including a statin. Within weeks, my healthy and fit body could barely walk up the stairs from weakness and pain - and good lord the brain fog, i think it helped get me canned from that job. 12 years later without any statins: my cholesterol is fine, but could use a little more "good" levels. My 30% artery blockage remains the same, with no problems.

Hmm, lets see: after a few months on the drugs, I still 12 years later deal with permanent low-level muscle pain/weakness and minor brain fog.

Conclusion: don't take statins unless you are in dire circumstances that may lead to death otherwise.

WalkWithMeInHell:

What tests have you undertaken during the past 12 years to determine that your "30 percent" artery blockage is stable? Every decade, your blockage increased by 10%. Sounds like you are on a very dangerous road that suggests by 50 or 60, you'll be looking at bypass surgeries or worse.

If you had a 30 percent blockage at such a young age, that is something to be very concerned about.

There are many statin options. Have you tried different ones to see if the negative side effects can be avoided? Over the course of several years I tried numerous statins that caused side effects. Then I found Tricor and the side effects are barely noticeable. I am 47 and am unaware of any blockages, but have enormously high cholesterol readings, which are not lowered by diet and exercise, alone.

Actually, my Cardiologist at the time didn't seem too shocked by the 30% blockage - back then he said that much blockage was surprisingly common. But because of the blockage they tried to keep me on statins, but even then the muscle damage issue was already coming to light about ALL statins. And yes, I have had all manner of tests over the years to show no real changes. I agree some people "need" to be on them, because of genetics - but that is the exception not the rule. And studies are starting to show that a lot of people, not all, with genetic cholesterol do not need statins because that is their natural state an their bodies evolved to deal with it. In my case switching to a "Mediterranean Diet" has done more for my levels than a statin ever did. Americans need to be on such a volume of statin poison because this country is filled with stupid fat lazy slobs, who think Twinkies are a food group.

The problem,WalkWithMeInHell, is that to properly see arterial blockages, one must undergo an angiogram. MRI's, nor CT scans show arterial walls adequately.

Since the costs and risks are high, angiograms are not typically prescribed before symptoms appear.

Like high blood pressure, many people ignore their high cholesterol levels because it usually does't cause pain as the conditions worsen.

We all must, sooner or later, make informed decisions regarding our health and any significant family histories that may affect us. There is plenty of information out there, including consultations with your doctors.

Best of luck! Keep well.

WalkWithMeInHell I would get a different Cardiologist if were I you. If he was not ordering CMP, CBC, etc. labs every six months while you were on statins, and virtually all other drugs, he was not doing his job but in the end it is the job of the patient to learn as much as possible regarding their medical problems and become proactive in the treatment path. Too many Americans just was a pill to make it go away.

he was not ordering CMP, CBC, etc. labs every six months while you were on statins, and virtually all other drugs, he was not doing his job

Thats acutally not in the guidelines anymore. The ACC doesn't even recommend yearly liver tests anymore because the incidence of liver damage with statins is virtually nothing

It's true that liver failure is one of the less common side effects of statins, but it does happen. My father-in-law was given statins without blood tests until one day somebody noticed that he had turned yellow, and it turned out his liver function was seriously compromised. His statin prescription was otherwise reasonable, since it was for secondary prevention, i.e., he'd had previous heart attacks. Shortly after that he had a fatal heart attack for which my mother-in-law has always, probably wrongly, blamed the statin.

My father-in-law

Well, my uncle's sister in law's neighbor's brother's cousin once heard of statins making someone grow two heads

You really are adorable! So you apparently think that testing a large group of people's blood twice a year to save one of them from liver failure is a waste of time and effort, but having the same group of people swallow a pill every day and suck up the side effects to save 1% or so from having a heart attack is a great deal. That's entirely dependent on individual value judgements, and patients need to be aware of all possible risks so that they can make their own value judgements.

By the way, in case you are in a patient care field, let me make sure you're aware that there's a difference between "It's unlikely [a priori] that this drug will cause this symptom" and "If you're on this drug and have this symptom, it's unlikely that the drug is causing it." Tragically, studies have shown that the majority of patients who complain of drug side effects to MDs are blown off and told the drugs can't be responsible even when the side effects in question are well known in the literature (that is, of course, only for those who read the literature).

Tragically, studies have shown that the majority of patients who complain of drug side effects to MDs are blown off and told the drugs can't be responsible even when the side effects in question are well known

SOURCE? Tragically, you fail to source your material.

My doctor and I have tried at least 5 different statins, until I found Tricor, which is well tolerated by me. The majority of patients you talk about need to have their heads examined or find a new doctor.

Ah, the old "Your leg pain is all in your head" gambit. JM, I don't write reviews on the command of anonymous strangers, and they're probably not welcome in MSN's comments, but here's one reference.

Golomb BA, McGraw JJ, Evans MA, Dimsdale JE. Physician response to patient reports of adverse drug effects: implications for patient-targeted adverse event surveillance. Drug Saf 2007;30:669-675.

The abstract, available free on PubMed, is worth reading by anyone who feels sure that their allopath would not sneer at their complaints if there were really any reason for concern.

jane,

I find your posts needlessly condescending and rude. Im not sure why you resort to such behavior. Maybe the anonymity of the internet allows some of your real world frustrations to be released--there was an interesting article on here a few weeks ago regarding that tendency

Its a shame because you seem very smart and well educated, and well read on this subject. I would enjoy our conversation much more without these childish antics

At any rate Im sure docs dismiss some patients' complaints as nonsense, and don't connect them to the drugs. Im also sure that some patients do have a negative placebo effect, and feel pain that is more connected to the act of taking meds rather than any true physiologic effect. Before you dismiss me as noncaring, the placebo effect, both good and bad, is well documented

That's why the best, most reliable comparisons are done in controlled, prospective, PLACEBO CONTROLLED trials. If you have such data that demonstrates a concerning side effect profile for statins, I'd love to see it

you apparently think that testing a large group of people's blood

No, its not what I think. Its what the AHA and ACC think. Its what was in their most recent guideline update, which is based on all available data

but having the same group of people swallow a pill every day and suck up the side effects to save 1% or so from having a heart attack

Your statement is misleading. It is a 1% absolute risk reduction for some people, but not all. that number is for primary prevention of low risk patients--those patients, that best we can predict, are among the LEAST likely of all to develop significant coronary artery disease. Its really a tribute to statins that they show any effect at all in these patients

I am very clear to this group of patients in telling them what their risks are and what the benefits are. Most seem to want to give it a shot, and then stop if side effects develop. I think that's a reasonable course

However, there are many patients, the majority of my patient population, in whom the risk of adverse cardiac events is much, much higher than 1%. These are patients with known CAD or multiple risk factors that put their 10 years of adverse coronary events at 10% or more. In this patients I strongly urge statin use as the side effects are very unlikely to outweigh the potential benefits

No gambit here, Jane.

Sorry to disappoint.

Eric - You began the personal hostility by calling me a liar when I provided a one-sentence summary of an abstract that you did not like, although my summary would not, I think, have been objectionable to the authors of this study.

I suspected that you were an MD; MDs unfortunately often aren't trained in epidemiology or statistics. (Example: a recent study - look it up yourself if you like - found that most doctors thought a study showing a big increase in 5-year survival was better evidence of the efficacy of a cancer screening method than a study showing a very small increase in long-term all-cause mortality, whereas the exact opposite is true.) If we assumed that people with a 10% 10-year risk of having a heart attack would have that risk reduced 50% by statins (a more optimistic view than can be justified by most major studies), they would experience a 5% absolute risk reduction from 10 years' worth of statin use. (That also assumes that the [usually smaller] statin benefits seen in 2-year trials persist through a much longer period, which is not clear; beyond a certain age, it's almost certainly not true.) That doesn't equate to exactly 0.5% benefiting per year of statin use, but that's a fair rough estimate. You have to treat roughly 200 people for a year to prevent one heart attack. If they get no side effects, fine. If they acquire a brand-new disability, they may not think a nearly 100% chance of its persistence is a fair deal in exchange for such a small chance of benefit. If their blood sugar goes up on statins, and you want to then put them on the metformin-insulin intervention cascade, they might even say "Gee, I'd rather have an extra 5% chance of having one heart attack in the next decade than be diabetic for my whole life."

Or they might not. These are value judgements. Unfortunately, all too many MDs think that their values are the only correct ones, which everyone should hold or else be badgered into behaving as if they held. Incidentally, telling patients they have psychological problems or are suffering from a nocebo effect when they complain that the same symptoms recur every time you put them back on the same drug is, IMHO, an imposition of your values. I hope you are giving your patients accurate, unbiased information then allowing them to make their own decisions about what sort of old age they wish to have. Best wishes to you!

calling me a liar

I never called you any name, including liar. If you disagree, please feel free to quote where I said it

here's what I said:

but the outright deception on your part regarding the above study has soured me for now

I said you were deceptive about the results of the study, I comment which I stand by. You quoted a "modest reduction in cognitive ability" where the authors did not conclude anything close to as dramatic. If you did not intentionally make this mistake, then I apologize

You began the personal hostility

Really jane? Do you honestly believe that?

o please do not embarrass yourself by whipping out the Shill argument.)

that comment preceeded my deceptive comment. Do you call that nice? Its a little hostile. Not to mention your obvious obnoxious behavior in every other post. the "aren't you cute" garbage

Not that it really bothers me, but Im a little worried about the fact that you can't see it

MDs unfortunately often aren't trained in epidemiology or statistics

Lets not generalize here. You have no idea about my training

If we assumed that people with a 10% 10-year risk of having a heart attack would have that risk reduced 50% by statins (a more optimistic view than can be justified by most major studies), they would experience a 5% absolute risk reduction from 10 years' worth of statin use

That 10% 10 year risk was moderate level. The framingham study showed the highest risk individuals had a 32% 10 year risk

http://www.framinghamheartstudy.org/risk/coronary.html

Using your same math (too late to back out now) its a 1.6% ARR annually. Over 30 years, thats almost a 50% reduction! And thats absolute, not relative!!

Thats huge!

And thats only primary prevention! The numbers are even higher for secondary prevention

Now clearly there are some limitations to the above calculations--I know risk won't increase linerally to infinity. But it just gives you an idea how you might be underestimating the value of statins. If you respond, I'll post some real world data

If they acquire a brand-new disability, they may not think a nearly 100% chance of its persistence is a fair deal in exchange for such a small chance of benefit.

People somehow seem to lose the ability to do math when they are trying to prove harm. I come across the same thing from the anti vaccine people. Please show me the risk of developing a disability from a statin as demonstrated in a large trial. I'm willing to bet money its less than a tenth of a percent of the chance of benefit

ocebo effect when they complain that the same symptoms recur every time you put them back on the same drug is, IMHO, an imposition of your values. I hope you are giving your patients accurate, unbiased information then allowing them to make their own decisions about what sort of old age they wish to have. Best wishes to you!

With all due respect, I don't need to take lessons in how to practice medicine from an anonymous person online who has never spent a day in med school or residency. To be blunt, you lack the experience or knowledge to make such a recommendation, regardless of its validity

I learned all I needed to know from my mentors, my professors, and my patients.

The longer you try to extrapolate and the higher a percentage you use, the more wrong your numbers will be, just in terms of fundamental mathematics. Also, I gave you an extreme, exaggerated value of 50% reduction of events, but even that was assuming we are talking about the 50-65-year-old males who make up a disproportionate percentage of the patients in the major clinical trials. Someone looked back at key trials and discovered that there was no significant benefit at all in the elderly who had been included in those studies. This makes sense for a couple of reasons: firstly, the cholesterol level that appears to be healthiest for the very old is 240-280, and secondly, there's a difference between preventing premature death and preventing death period. People have to die of something, and while you can often delay death, you can't prevent it. (There's no evidence that you can eternally prevent cardiovascular-specific death either, but if you could, it would arguably violate the principle of nonmaleficence, causing a huge number of the "saved" old-old to die a far worse death of Alzheimer's or dementia instead.) So the available clinical trials suggest that the benefits of statins will increase with age up to some point (as you get older, and your risk increases) and then decline (as you get too old for them to make much difference, or as it becomes obvious from your lack of illness that you're not actually likely to suffer from CAD anyway).

You yourself plainly aren't familiar with some major primary literature sources or the issues associated with their interpretation. That's okay. Doctors are not research scientists and scientists are not doctors; neither becomes a criticism unless a doctor has such a god complex that you he insists his dogmas trump the findings of scientific research. Or trump human experience. I cannot believe you do not get the point I am making, that while probably less than 1% of statin users suffer irreversible disability from the drugs, those who do suffer significant disability while on them will almost certainly continue suffering forever if they do not quit (or for some lucky ones, cut back on) the drug. You are pretending not to get this point to avoid acknowledging that any patients ever suffer severe problems from statins. Non-allopaths are not mindless fools. They are capable of finding out if cutting off their statin for six months to see if their fatigue or confusion goes away has a 99.5% chance of not doing them any harm, and deciding for themselves where their values lie.

Anyone who has seen multiple cases of medical malpractice and medical fraud inflicted on their own loved ones, which I have - and none of them sued the guilty parties, BTW - has the knowledge needed to say that doctors have a moral obligation to permit patients to hear all the facts when they are making life-altering decisions.

Also, I gave you an extreme, exaggerated value of 50% reduction of events,

It seems a little disingenuous to back away from the figure now after it gives you a result you don't like. Same with the "extrapolation" argument

Anyway, real world data shows a NNT of 14 in some studies, which works out to similiar numbers as in my example

Someone looked back at key trials and discovered that there was no significant benefit at all in the elderly who had been included in those studies

No, youre confused here. They were looking at framingham data and found that the elderly with higher cholesterol levels had less mortality. In this population, very low cholesterol levels are associated with cancer, malnutrition, or other chronic processes that are life threatening. Unless you have one of these processes, a higher cholesterol is associated with a worse mortality

You yourself plainly aren't familiar with some major primary literature sources or the issues associated with their interpretation.

As Ive shown above, it is you who are not familiar. In addition, had to correct you on another thread about the proper use of FFR, so I think I may know a little more about this subject than youBut thats fine, whatever makes you feel better.

Doctors are not research scientists

May I ask what you do that gives you such an entitled attitude and inflated self ego?

I cannot believe you do not get the point I am making, that while probably less than 1% of statin users suffer irreversible disability from the drugs, those who do suffer significant disability while on them will almost certainly continue suffering forever i

Jane, its not that I don't understand your argument. Its quite simple. Unlike you, though, I am burdened by evidence and rationality. You have cited one small study in which there was minimal fatigue, and suddenly 1% of statin users have "irreversible disability"

Unfortunately, the evidence does not show this. Not even close. It would be nice to to have to be bothered with facts and statistics, and just make up your own to suit you own preconcieved notions

I can't bring myself to do that

http://www.ncbi.nlm.nih.gov/pubmed/20031900

nnt of statins in jupitor was 20 over 5 years, giving an ARR of 1% per year, right in between our number. That number, just per year, multiplied by all the similiar people in the world (normal cholesterol with elevated CRP) is huge

Athyros VG, Papageorgiou AA, Mercouris BR et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. The GREek Atorvastatin and Coronary-heart-disease evaluation (GREACE) study. Curr Med Res Opin.2002;18:220-228.

ARR of 7% over 3 years in secondary prevention. Again, huge benefit

Actually it won't but keep believing it.

bobbski is correct.

Scott, have you tried blood tests before and after using statins and fish oil. Have you been blood tested when you only take a statin or only take fish oil? I take concomitantly a statin and 2000 mg of fish oil everyday. I have experimented to see if my blood results changed and they absolutely did, when taken together. Fish oil, alone, did not achieve the desired results (anecdotal, of course).

Also Scott, too much fish oil can be problematic, as well. Broken blood vessels on the eye (like pink eye) , indigestion, burping and reflux are common and unpleasant.

It would be wonderful if our medical science was always perfect and understood everything. That is a goal and not a reality. Nonetheless, in most cases, western medicine is state of the art and the practice continues to improve.

Scott----You actually mean B-3 (Niacin but NOT the flush free )

Yes. This is always the classic flaw in these suspect studies. People who engage in a study, do so for a medical issue. Their awareness of the issue will make them more self aware of their habits, with a significant percentage taking steps to a healthier lifestyle anyhow. So in such a study they will always show some "positive" side effect of the medication, from those motivated people.

I have worked on Medical Device design, and the FDA approval that goes with it. EVERYBODY lies to get approval. No different that the financial industry fiascos, if you set up rules we just find new ways to circumvent it.

Too often "studies" are paid for or begun by those who have a vested interest in a "positive" result. I understand double blind etc used to ensure unbiased results; I just don't buy into it the money is too great and greed a strong motive.

Wrong, sometimes eating right and having cholesterol numbers people would die for still does not mean an MI and CAD is not in your future.

He didn't order BMP. CBC, etc.s tests every six months?

Finally an intelligent comment. Indeed, when taking statins, or any drug FTM, frequent labs are an imperative. CMP. CBC, etc. only a fool would continue taking drugs without the lab work. I've been on statins for over 14 years after having 6 stents a quad CABG and a Dual CABG in a two year time period 14 years ago. My arteries both native and bypasses are patent.

umm...there's no way to have both native vessels and grafts patent. Grafts are dependent on flow to maintain patency...

Exactly! And as we figure out out the true downstream molecular targets, we can develop better drugs to target those specifically which will help to minimize many of the side effects.

Scientific studies have now confirmed that a significant fraction of users suffer muscle problems, and there's a research team working on the cognitive-decline issue that's published some relevant papers. If you start having symptoms bad enough to affect your daily life, you might look into those. If you suffer no harm, well, no need to look into it. Please keep in mind that the big statin trials (like JUPITER, inappropriately terminated early to make sure the unusually large apparent benefit didn't shrink) are funded by manufacturers. They have no motivation to explore side effects more than they are required to. Do they give cognitive function tests to everyone at the start and end of the study period? Certainly not; that would both cost more money and create a major new risk of generating results that would lower sales. Unless you're found staggering around not knowing how to find your house anymore, any mental fuzz you may suffer isn't going to be asked about or recorded as a side effect.

I agree we should all be vigilant. Big Pharma does big studies in part so they won't be big sued if it turns out their product is harmful - they don't intentionally put out bad product. Sure mistakes are made and they occasionally lose big lawsuits. But compared to NO testing of folk medicines, I'll still take my chances with the science until I find it's flawed. It's not so much that folk medicines are dangerous, just ineffective.

jane,

you have made some extraordinary claims on here...i'd love to see your sources

Eric - If you want to consider the mention of well-known side effects "extraordinary," go right ahead. If you read clinical trials regularly, you are familiar with PubMed and can start by looking up "Golomb statins" - Beatrice Golomb's research group has published several of the recent papers relating to statin-induced fatigue and cognitive dysfunction. (No, I do not have any professional or personal connection to any of them, so please do not embarrass yourself by whipping out the Shill argument.) Her group reported results of a randomized trial to study the muscle issue just a few weeks ago online as a letter in Archives of Internal Medicine, which reported that as many as 20 to 40% of statin users may suffer fatigue, especially those using high-dose statins and women (who still have virtually no demonstrated net benefit from statin use for primary prevention). I also have a copy of a review by Fernandez et al., Cleveland Clinic J Med 2001;78:393-403, which indicates that while clinical trials of carefully screened patients usually report a myopathy rate of 5% or less, observational studies in the general population find much higher rates. It cites a study called the PRIMO study, in which rates varies with various statin treatmens from 5.1% (fluvastatin) to 18.2% (simvastatin). The more potent statins may plausibly do more muscle damage. Golomb's group (Pharmacotherapy 2010;30:541-553) reported on a series of 354 case studies of reported statin-induced muscle pain in 300 of which probable or definite causality, by standard definitions, was demonstrated by rechallenge. I point out that the demonstrated benefits of a lifestyle program including exercise for CAD exceed anything statins will do for you, so if your statin renders you unable to exercise, this is unlikely to be a net health benefit.

There is one randomized study showing modest reduction of cognitive function with simvastatin use (Muldoon et al. Amer J Med 2004;117:823-829). There are also one or two publications by Golomb's group on this subject. One (Pharmacotherapy 2009;29:800-811 is a study of 171 patients, for 75% of which causality was considered probable or definite. Of the 84% who stopped statins, 90% showed recovery, on average beginning within 2.5 weeks; some thereby cured what had been labeled by their MDs as dementia or Alzheimer's. They also (QJM 2004;97:229-235) reported on six people who suffered personality disruptions and became abnormally aggressive, engaging in acts such as road rage, and recovered themselves when they stopped statins. It used to be openly discussed that one of the apparent reasons statins didn't lower all-cause mortality in a couple of seminal trials, though CV mortality was reduced, was that rates of accidental and violent death were higher in the statin group - consistent with mild cognitive impairment, which clearly doesn't happen to everyone, but clearly does happen to some. There are thousands of reports from people who reversed cognitive decline by quitting their statins.

While we're lauding population studies, there are a couple that find significantly higher rates in statin users of cancers perhaps of more concern than lymphoma. A British set of case-control studies (Vinogradova et al. BMC Cancer 2011;11:409 reported that the relative risk of blood cancers was 22% lower in statin users, but that more than 4 years of statin use was associated with higher risks of colon cancer (23%), bladder cancer (29%) and lung cancer (18%). There was also a study using a British database of some 2 million patients, including over 200,000 on statins (Hippisley-Cox and Coupland. BMJ 2010;340:c2197, available free from PubMed) in which, among other things, the increased cataract risk was high enough in women that over 5 years, as many as 1 in 33 statin users would get an extra cataract. And there was a Taiwanese case-control study (Chen et al. World J Gastroenterol 2011;17:5197-5202) that reports a 9-10% higher risk for colorectal cancer in statin users - except the risk was no higher for people with fewer than 105 "defined daily doses", 7% higher for those with up to about 300 "DDDs" and 30% higher after that. Since statins are anti-inflammatory they are being argued to reduce cancer risk, but there's also been an argument made that they may serve as promoters of existing tumors. Some of the clinical trials showed significantly higher cancer rates within a year or two (implying promotion rather than causation), while some showed rates that were no different or even slightly lower than the placebo group, but taken altogether there's clearly no solid evidence of a net benefit for cancer.

If you want to consider the mention of well-known side effects "extraordinary," go right ahead.

they are neither well known nor common. They are in fact very, very rare

so please do not embarrass yourself by whipping out the Shill argument.

slow down. No need for that

letter in Archives of Internal Medicine, which reported that as many as 20 to 40% of statin users may suffer fatigue, especially those using high-dose statins and women (who still have virtually no demonstrated net benefit from statin use for primary prevention).

Beatrice Golomb's research group has published several of the recent papers relating to statin-induced fatigue and cognitive dysfunction

The fatigue article showed a barely statistical significant drop in exercise tolerance. Something on the order of 5 minutes per week. Big deal. Not impressive

Her cognitive function study was a survey sent out to 171 people on statins. Take it from someone who has conducted survery studies--you can make the results whatever you want by asking the right question.

For example, "have you ever forgotten anything in the past year since you were started on the statin?"

Boom. cognitive defects

If you want a trial on the cognitive effect of statins, I suggest you check out a cochrane review. It involves many more patients than 100, which is a pitiful amount. It also has a placebo arm, and is a meta analysis--more powerful than your retrospective study

And the most recent, largest trial to date DOES show a primary prevention benefit for women

http://www.ncbi.nlm.nih.gov/pubmed/20176986

observational studies....

stop right there. You are going to try and substitute a lower form of evidence (observational study) for a higher form (prospective, placebo controlled, randomized)

There are a reason observational studies are hypothesis generating rather than proving. You have no placebo group. So every adverse event is assumed to be related to therapy instead of a negative placebo effect

No way. That dog don't hunt

There is one randomized study showing modest reduction of cognitive function with simvastatin use (Muldoon et al. Amer J Med 2004;117:823-829).

Actually, it did not show a "modest reduction" at all. It actually showed NO CHANGE. Here were the authors REAL conclusions

For the three tests specifically affected by simvastatin, effects on cognitive performance were small, manifest only as failure to improve during the 6 months of treatment (compared with placebo), and were confounded by baseline differences on one test.

Maybe I'll look at the rest of your studies later, but the outright deception on your part regarding the above study has soured me for now

Also, you cite case control studies while there is voluminous data in the form of meta analysis you are ignoring. the only reason to cite weaker data in the face of stronger data is rigidly held pre conceived notions which are incompatible with true scientific discourse

If you are familiar with pubmed, then type in "cochrane" and "statin" and read what comes up

Deception? Hee hee - you're so cute! Here's how this works, since apparently you're not at all familiar with this type of study. If you have people do certain types of mental task more than once, they often get better at it, because familiarity makes it easier. If the placebo group gets better at the task between the start and the end of the study and the statin group does not, that implies that the statin group is exhibiting a reduced ability to learn.

I looked up "Cochrane statins cognitive" and got few hits; the most recent reference that's actually a Cochrane review is one in which they solidly recommend against pushing statins for Alzheimer's prevention since randomized trials did not show benefit. Is that the one you wanted me to see?

If non-randomized studies have no value - well, we can stop talking about this one, for one thing, but we can also pretty much give up on trying to estimate the net benefit of any drug treatment. Nobody is going to fund a clinical trial with tens of thousands of people whose purpose is to try to uncover every single harm a drug can cause, and rare serious effects still will not be discovered until the drug is brought into general use. There are generally accepted guidelines for the estimation of causality, which I bet you would accept if they were showing, say, an alternative treatment to be toxic in some individual. If you start a statin and lose your marbles, stop it and get them back, start it again and lose them again, then go through this yet a third time, it is indeed possible to conclude that the statin is the cause. There are a lot of people in that position.

The average person loses little ability to exercise and little mental function on most statins. That doesn't mean that the harms are always small; it doesn't work that way. Most people notice no harm whatsoever, some have bearable symptoms; a few have symptoms so severe that they feel they've aged 20 years, that force them to give up recreational activities or quit jobs. The percentage of people who are "saved" from a heart attack, especially in primary prevention, is tiny; the percentage of people who suffer severe or irreversible damage is tiny. A priori, for some population subgroups, the net benefit favors statin use. But if you start taking them and your brain or your leg muscles turn to mush, it's no longer 1 or 2% chance of benefit versus 1 or 2% chance of harm; it's 1 or 2% chance of benefit versus 100% chance of harm. Rationally, people in that position should view the benefits very differently.

Deception? Hee hee - you're so cute!

clearly here youre making an obvious attempt to be condescending. Its weird

ere's how this works, since apparently you're not at all familiar

You are flat out wrong. Please show me any source at all which states that your description of the results is "how those studies are done". Any source at all. Any.

If the placebo group gets better at the task between the start and the end of the study and the statin group does not, that implies that the statin group is exhibiting a reduced ability to learn.

Here's how the english language works. You said statins caused a moderate decline in cognitive function. They did not, by any measurable standard

In addition, the placebo group showed no difference compared to the statin group. repeat after me: no difference. The placebo group did not show improvement

If you lie about the results of a study, you can prove anything. Until you try and show them to people who have actually written studies

ochrane review is one in which they solidly recommend against pushing statins for Alzheimer's prevention since randomized trials did not show benefit. Is that the one you wanted me to see?

Yes, thats exactly the one I wanted you to see. It clearly showed no difference between statin treated patients and non statin treated patients with regards to dementia. It also showed an inconclusive difference with regard to lipid levels

Far from what you were claiming earlier

If non-randomized studies have no value

I never said that. I simply questioned the fact that you cite small, nonrandomized trials when there are larger, more robust trials that answer the same question. It reeks of confirming a bias--not a good trait in a scientist

a few have symptoms so severe that they feel they've aged 20 years,

The problem you are running into here is a lack of evidence. You show evidence of negligible effect in small, observational studies and then not only want to generalize that to the population as a whole, but exaggerate the effect 100 fold

It just doesn't work like that

The percentage of people who are "saved" from a heart attack, especially in primary prevention, is tiny

Incorrect. The percentage of people "saved" from a heart attack in LOW RISK primary prevention is low. Moderate or high risk primary prevention is substantial

100% chance of harm

Please cite the study that showed 100% chance of harm

All right, one more response for the sake of any onlookers and then I will leave the field to you; if I want to put up with badly argued scientism there are other blogs for that.

1. You are now claiming that in the one randomized controlled trial of the effects of a statin on cognition, there was no difference between the placebo group and the statin group. This is not what the authors of the study claim. They say that the placebo group improved in the performance of a task in which the statin group didn't. If you want to argue that they're lying and the peer reviewers stupid, well, go for it. Though this is not my field, I have seen quite a few studies, both in humans and in animals, where task performance naturally improves over time and so the trajectory in a treatment group is compared to that in a placebo group. This is really basic. If the ability to learn is natural, the inability to learn represents harm.

2. I never claimed that statins cause Alzheimer's or dementia; that was some other guy. Reading comprehension fail.

3. I never said that all persons using a statin would feel that they'd aged 20 years. Some say that they do. I am not exaggerating their experience one whit, nor am I generalizing it to all users. Reading comprehension fail.

4. In ANY primary prevention group, at most a few percent of people will be spared a heart attack over a period of years of statin use. The absolute chance of benefit is therefore small. Also, there are major primary prevention studies in which the overall death rate does not decrease. Even disregarding nonfatal side effects, nobody wants to just trade a heart attack death for a cancer or accidental death.

5. I specifically said most people suffered NO harm, but that if you were one of those people who suffered major fatigue or memory loss whenever you were put on a statin, YOUR individual chance of harm was 100%. Reading comprehension fail. Again, I hope you realize that if a person's upfront chance of suffering myopathy were only 5 to 10%, it would not mean that when a person went on statins and then suffered myopathy, there was only a 5 to 10% chance that the statins were responsible.

Over to you. Do try to be more careful.

again, I addressed the childish behavior in an earlier post, so i'll just ignore it from now on. Ive said my piece

Further, you attribute many statements to me that I did not make, then accuse me of poor reading comprehension when you show that these statements (the false ones you attribute to me) are indeed, false

There is a quote function in this program, which I find quite useful. If you like, you can quote me and highlight the parts of interest. I think that would do a lot to clear up any confusion

Regarding the cognitive impairment study, I understand your point about failing to improve. I just don't equate that with "modest cognitive decline". Its a subjective label. For example, what would you call it if the experimental group did worse after taking a statin? Severe? is that standardized?

Plus, I found the actual results of the study needlessly confusing. What is a "statin sensitive test" What makes a test "statin sensitive". And the authors themselves conceed that many tests did not show a statistically significant difference, and confounders impaired any conclusions about another. Fairly inconclusive results I think

And again, the low numbers of the population studied really limits the power and generalizability of this study

I never said that all persons using a statin would feel that they'd aged 20 years. Some say that they do. I am not exaggerating their experience one whit, nor am I generalizing it to all users. Reading comprehension fail

Ok. Lets re-examine what you said:

a few have symptoms so severe that they feel they've aged 20 years, that force them to give up recreational activities or quit jobs

So that seems to me as if you are claiming that some people have very severe symptoms that are lifestyle limiting. You also imply these symptoms are permanent (or else why would they have to quit their job?)

So my response to this was:

The problem you are running into here is a lack of evidence. You show evidence of negligible effect in small, observational studies and then not only want to generalize that to the population as a whole, but exaggerate the effect 100 fold

Note I never accused you of saying "all people" feel this symptoms--just that a small, nonrandomized study which shows a small percentage of people with slight symptoms does NOT mean the the population at large will have a similiar percentage of people complain of these symptoms. Also, the study you cited showed a very small amount of fatigue, nothing approaching your claims. So it seemed like you claims are far in excess of your evidence

Maybe the term 'generalizable' was confusing to you. This does not mean you expect everyone to experience the outcome of a study, only a simliar percentage as was found in that particular study

I never claimed that statins cause Alzheimer's or dementia; that was some other guy. Reading comprehension fail.

Please quote where I said you did.

In ANY primary prevention group, at most a few percent of people will be spared a heart attack over a period of years of statin use. The absolute chance of benefit is therefore small

I think there's more to it than that. First, you can't simply lump all primary prevention trials together, and then cite the data that most fits your perspective

The benefit is clearly higher in the higher risk patients

Secondly, a small benefit in a very prevelant disease becomes significant. For example, the NNT of some higher risk groups shows a benefit of 1 in 14 patients. And thats only over 5 years. Translated to 30 years, to the millions of patients worldwide that suffer from CAD, this becomes very significant

I for one, cannot just brush off the potential millions of lives saved. If you disagree, please show me mathmatically where I made an error

Also, there are major primary prevention studies in which the overall death rate does not decrease.

Um, having a massive MI that leaves you with severe CHF is not all that pleasant, and should not be so easily brushed aside just because you live through it. Mortality is a major endpoint, arguable the most important, but certainly not the only important one

Even disregarding nonfatal side effects, nobody wants to just trade a heart attack death for a cancer or accidental death.

I don't understand what you are trying to say here

but that if you were one of those people who suffered major fatigue or memory loss whenever you were put on a statin, YOUR individual chance of harm was 100%. Reading comprehension fail.

yes, this is definitely a true statement, but not very helpful when you are trying to advise a patient. They depend on you to tell them the most likely scenarios, while at the same time giving an accurate description of the risks.

Its somewhat misleading too. I could easily say if this saves you from a heart attack, then your chance of benefit is 100%. Unfortunately, thats a little tougher to prove, and again, equally as unhelpful

"Articles" or studies? It's "been said" or it's been proven. There's a big difference.

The problem that will arise is the increase of breast cancer in women taking statins by as much as 800%.

Id really like to see where you got this number

There's no study I know of that shows anything like an order of magnitude increase in any cancer. There's a very recent meta-analysis of observational studies - which would, as I noted above, be biased in favor of statins for two major reasons - in which long-term statin users had a non-significant 3% higher risk of breast cancer. That's 3% relative risk, not 3% absolute risk. Since the average woman has a very small risk of being diagnosed with breast cancer during a given decade anyway, 3% of that risk would be too weensy to be worth much worry (unless, perhaps, you are a radiologist). More worthy of concern is that primary prevention studies have mostly been done in males, that those done in females tend not to show as much benefit as in males, if any net benefit at all (a couple of recent publications have tried to hide that fact through lame statistical games), and that women may be more likely to report fatigue with statin use.

Info from the Your Health show with Dr. Richard Becker in his university's studies update section.

I agree! Eric is a pompous a$$ who's in love with himself, I feel sorry for anyone who is his patient. A schill for big pharma.

reported

jeanart,

fair enough. I can't say I agree, but im probably a little biased :)