Author Topic: Statins, pro and con  (Read 8192 times)

Offline Mr. Bill

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Statins, pro and con
« on: September 09, 2016, 04:02:49 PM »
I'm an example of the 1 statin user out of ~40,000 who developed statin-associated autoimmune necrotizing myopathy (a nifty condition where your immune system does its best to kill all your muscles).  I got cured, too, but it sorta sucked.  Anyway, I just mention this so you understand I'm not a statin-worshipper.  But there's a lot of bad info on the Net about statins, either claiming that it's a miracle drug that everyone should take, or it's an evil poisonous nasty thing that nobody should take.

The truth is somewhere in-between.

A new pro-statin study just came out in The Lancet, and it has triggered the typical bunch of mediocre science reporting.  Here are two articles in plain English that are a lot better than mediocre:

Statins: 'Harms have been overestimated,' says review
This one explains the Lancet article, and is basically pro-statin.

Statin Trialists Try to Bury Debate With Evidence
Much of this one explains the flaws in the Lancet article, and covers legitimate concerns about statin use.

If you have any interest in statins, I highly recommend you read both articles to get a balanced view.

Offline archer

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Re: Statins, pro and con
« Reply #1 on: September 09, 2016, 04:08:19 PM »
my parents tried statins, both had extreme muscle aches and pains so stopped them. i wont even try.

Offline RitaRose1945

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Re: Statins, pro and con
« Reply #2 on: September 09, 2016, 06:13:54 PM »
I'm not buying the 1/40,000 bit.  I honestly think it's more common.


My mom's former doc put her on a statin, in spite of the data showing they don't work on women.  Ticked me off.  She started getting peripheral neuropathy and I could see a drop in her cognitive function.


Her old doc left the area, she got a new doc who took her off of everything but a blood pressure med (which is naturally high for her, so meds are understandable) and her mental function came back pretty quickly.  I'm not sure if the neuropathy was reversed or not.  She underplays every medical issue she has.


My understanding is that statins work well for older men who have already had a heart attack.  Everyone else - not so much.


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Re: Statins, pro and con
« Reply #3 on: September 09, 2016, 07:17:11 PM »
I've been on lipitor for almost a decade with no felt consequences and it's played a major role in getting my cholesterol down from 306 to 163.

Online David in MN

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Re: Statins, pro and con
« Reply #4 on: September 09, 2016, 08:59:09 PM »
I've read articles from cardiologists asserting that statins should be in our tap water. I've also read from economists that the proof of cholesterol being bad is non-existent.

I honestly don't know where to side on this issue. Both sides can make a compelling case depending on the data sampled and what analysis is used. It's an uncomfortable position for a math guy but statins (in my mind) might be saving millions of lives or doing nothing at all. If I was being prescribed these I'd likely tear into the data a lot more but what I've seen is not convincing either way.

I usually have a position based on the maths but this one is really foggy. At this point I honestly don't feel comfortable in the pro or anti sides. My gut sense is that the drugs are effective on the very high end and over-prescribed on the low end but that's just a guess.

Very tough issue.

Offline Mr. Bill

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Re: Statins, pro and con
« Reply #5 on: September 10, 2016, 06:04:58 PM »
I'm not buying the 1/40,000 bit.  I honestly think it's more common.

That was specifically for the autoimmune myopathy -- there are other statin-associated muscle problems that are more common (and easier to treat).

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Re: Statins, pro and con
« Reply #6 on: September 11, 2016, 04:09:25 AM »
I'm skeptical of the Lancet article's conclusions and tend to side with the criticisms in the last article link in the OP.

Statins do provide significant benefits when targeted towards the subset of patients at highest risk of cardiovascular disease from all factors, not just lipid abnormalities.  Reducing the 10-yr CVD risk from 1.5% to 0.8% with a statin in a pre-menopausal woman probably isn't worth the risk of side-effects, while reducing CVD risk from 15% to 8% in a 40-ish guy who just had bypass surgery (or who's father dropped dead at 50) has a much more favorable risk/benefit ratio. 

Anecdotally, my mom had elevated liver enzymes (which was fortunately reversible) while on a statin and felt like crap for a whole year before her doc finally got around to checking her labs again. 

Offline RitaRose1945

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Re: Statins, pro and con
« Reply #7 on: September 11, 2016, 09:25:37 AM »
Statins do provide significant benefits when targeted towards the subset of patients at highest risk of cardiovascular disease from all factors, not just lipid abnormalities.  Reducing the 10-yr CVD risk from 1.5% to 0.8% with a statin in a pre-menopausal woman probably isn't worth the risk of side-effects, while reducing CVD risk from 15% to 8% in a 40-ish guy who just had bypass surgery (or who's father dropped dead at 50) has a much more favorable risk/benefit ratio.


Exactly.  I don't think statins are The Devil, but I do feel like they're being marketed to anyone and everyone, which does more harm than good.  It's like if we prescribed insulin to everyone that has even slightly elevated blood sugar.  Overkill, as well as dangerous and ineffective if it's not something you actually need.


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Re: Statins, pro and con
« Reply #8 on: September 11, 2016, 01:04:58 PM »

Exactly.  I don't think statins are The Devil, but I do feel like they're being marketed to anyone and everyone, which does more harm than good.  It's like if we prescribed insulin to everyone that has even slightly elevated blood sugar.  Overkill, as well as dangerous and ineffective if it's not something you actually need.

Insulin is a bit of a hyperbolic comparison, but there certainly are oral antihyperglycemic agents that fit the bill. 

The big problem is that we're susceptible to these metabolic diseases at ever increasing rates because evolution has saddled us with bodies tuned by millions of years of evolution for a lifestyle that has disappeared. In half a century the tables have suddenly turned, first for us in the west but rapidly spreading worldwide, and now we're stuck with metabolisms and appetites that are counterproductive to long term survival when we sit around all day grazing and gorging.

It's tempting to want to address the issue with a pill.  It's tempting to treat lab values as the main measure of success, while ignoring the ultimate goal, which is reducing all-cause mortality. Time after time we've fallen into that trap, only to eventually have to question whether the cure was actually worse than the disease. As a rule of thumb, most new drugs coming to market will be found to be less effective and more risky a decade later. That's a function of increased data and decreased bias in the studies examining real world effectiveness. Plus, there's ample evidence that relying on a pill causes a bunch of us to give up on lifestyle change and continue doing the things that put us in a position of needing the pill in the first place (like my mom, now that she's on one of the newer cholesterol lowering agents), which may still lead to the early death we were trying to prevent in the first place.  But lifestyle change is easy to talk about, hard to actually do.

There is typically no free lunch with medication. Ultimately most of us wouldn't need to even consider these pills if we were back on the farm plowing forty acres behind a team of mules. Or, marching twenty miles a day in the legion carrying a couple pieces of timber, in addition to weapons and supplies, for constructing a fort to sleep in each night.  But in those days forty was old and sixty was ancient and there were plenty of other more pressing existential threats than metabolic diseases, which they do appear to have been at risk for, as Otzi the ice mummy had atherosclerosis 5,300 years ago.   Most of them would look at us today and think, "Wow, how great would it be to just sit around for a lifetime, fat and happy, slowly clogging my arteries, and then die suddenly from cardiovascular disease around 60, where do I sign up?"

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Re: Statins, pro and con
« Reply #9 on: September 11, 2016, 03:56:51 PM »
...

It's tempting to want to address the issue with a pill.  It's tempting to treat lab values as the main measure of success, while ignoring the ultimate goal, which is reducing all-cause mortality. Time after time we've fallen into that trap, only to eventually have to question whether the cure was actually worse than the disease. As a rule of thumb, most new drugs coming to market will be found to be less effective and more risky a decade later. That's a function of increased data and decreased bias in the studies examining real world effectiveness. Plus, there's ample evidence that relying on a pill causes a bunch of us to give up on lifestyle change and continue doing the things that put us in a position of needing the pill in the first place (like my mom, now that she's on one of the newer cholesterol lowering agents), which may still lead to the early death we were trying to prevent in the first place.  But lifestyle change is easy to talk about, hard to do...

This brought up a couple things for me.  First, I did my best to follow my doctors orders and reduced saturated fats, cholesterol, and went to a more carb based diet when I was told to in the 2000s. I was in a nutrition class and watching my diet closely in 2007 when my cholesterol finally went over 300 and my doctor pushed me toward drugs. At that point I surrendered. I was cycling 10-14 hours a week, taking in less than 20g/day of saturated fat and couldn't think of anything else to do. My cholesterol nose dived to 186, where it remained for years. I was done trying to fix my diet and it didn't seem to matter. Then in May 2015 I gave up soda. My cholesterol plummeted to 163 and I lost 14 pounds in less than three months.

The advice some doctors are giving out is jacked up. I replaced most soda with water, but I've gone from drinking a half gallon of 1% mile a week to 1.5 gallons of whole milk a week, plus an occasional pint or two of chocolate milk if I'm at work and want a late afternoon treat. Any doctor who says it's ok to drink soda but recommends reducing fats is living with 1970s programming that is killing Americans by the hundreds of thousands.

Recently I tried phasing out of my Lipitor, going from 30mg/week to 20mg/week and my cholesterol jumped back up to 229. Since I appear to have no ill side effects from it, I'm back at 30mg/week for now. If it ain't broke, don't fix it.

I'm not asking to live forever, I just want quality over quantity. 70-75 good years would be preferable to 90 years with waning health for the last 20 years. Maybe it's living with an ICU nurse and seeing just what those last few years can look like that makes me this way. Maybe it's just the pessimist in me that thinks in 20 years we are unlikely to still have a healthcare system that can afford to spend $15,000 per day on an old fart who's unlikely to pay the system back before he passes.  Either way, at this point I feel I have gotten my money's worth out of this life. I've lived a damn good life and I'd be blessed to receive another decade or two.

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Re: Statins, pro and con
« Reply #10 on: September 11, 2016, 07:14:25 PM »
I hear you.

Online David in MN

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Re: Statins, pro and con
« Reply #11 on: September 11, 2016, 09:03:28 PM »
This brought up a couple things for me.  First, I did my best to follow my doctors orders and reduced saturated fats, cholesterol, and went to a more carb based diet when I was told to in the 2000s. I was in a nutrition class and watching my diet closely in 2007 when my cholesterol finally went over 300 and my doctor pushed me toward drugs. At that point I surrendered. I was cycling 10-14 hours a week, taking in less than 20g/day of saturated fat and couldn't think of anything else to do. My cholesterol nose dived to 186, where it remained for years. I was done trying to fix my diet and it didn't seem to matter. Then in May 2015 I gave up soda. My cholesterol plummeted to 163 and I lost 14 pounds in less than three months.

The advice some doctors are giving out is jacked up. I replaced most soda with water, but I've gone from drinking a half gallon of 1% mile a week to 1.5 gallons of whole milk a week, plus an occasional pint or two of chocolate milk if I'm at work and want a late afternoon treat. Any doctor who says it's ok to drink soda but recommends reducing fats is living with 1970s programming that is killing Americans by the hundreds of thousands.

Recently I tried phasing out of my Lipitor, going from 30mg/week to 20mg/week and my cholesterol jumped back up to 229. Since I appear to have no ill side effects from it, I'm back at 30mg/week for now. If it ain't broke, don't fix it.

I'm not asking to live forever, I just want quality over quantity. 70-75 good years would be preferable to 90 years with waning health for the last 20 years. Maybe it's living with an ICU nurse and seeing just what those last few years can look like that makes me this way. Maybe it's just the pessimist in me that thinks in 20 years we are unlikely to still have a healthcare system that can afford to spend $15,000 per day on an old fart who's unlikely to pay the system back before he passes.  Either way, at this point I feel I have gotten my money's worth out of this life. I've lived a damn good life and I'd be blessed to receive another decade or two.

There's a wonderful section of Taleb's Antifragile where he breaks down the errors in diet and health science. He posits that perhaps it is the rigors of Eastern Orthadox fasting rather than a Mediterranean diet that extends life. In other words, the lurking variables are so vast we have no idea what the "healthiest" foods are.

I don't blame the people who work to improve health. For me it's the lack of statistical knowledge that is the problem. "Oleo is healthier than butter" is very, very different from "2+2=4". A person with even a modicum of knowledge of statistics begins to pick apart virtually everything he is advised throughout the day. Understanding confidence, R squared, the Gaussian, ANOVA, T and Z tests, standard deviation.. these are necessary to understand the information we are being told. But bring them up to the common man and he'll loudly shout about learning mean, median, and mode and recite some archaic quote from Twain as though he's bested the brightest mathematical minds at work today.

I'm of the opinion that a lot of science would be ignored if we all could judge the results.

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Re: Statins, pro and con
« Reply #12 on: September 12, 2016, 12:59:28 AM »
I don't blame the people who work to improve health. For me it's the lack of statistical knowledge that is the problem. "Oleo is healthier than butter" is very, very different from "2+2=4". A person with even a modicum of knowledge of statistics begins to pick apart virtually everything he is advised throughout the day. Understanding confidence, R squared, the Gaussian, ANOVA, T and Z tests, standard deviation.. these are necessary to understand the information we are being told. But bring them up to the common man and he'll loudly shout about learning mean, median, and mode and recite some archaic quote from Twain as though he's bested the brightest mathematical minds at work today.

You've brought this up before and I can assure you that no competent medical studies have been performed in the last half century without some serious statistical brainpower overseeing the process.  Stats is relatively easy and straightforward with good data.  It's proper study design, time, money, and clean data that's hard.  And don't forget, a single great study is still a suspicious pile of crap until it's been replicated, again, and again, until somewhere along the line it becomes trustworthy.  Why do you think these recommendations change over time?  It's because repeat testing fails to replicate the glowing findings of the initial studies.  There's no quick and easy way to go about it.  Science is a slog, two steps forward, one step back, with lots of face-plants into the mud.  With medicine, the sad reality is that patients and their doctors are all tied to this wagon of progress, too, and getting jerked around in the process is inevitable.


I'm of the opinion that a lot of science would be ignored if we all could judge the results.

It is a veritable sea of crap out there.

Online David in MN

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Re: Statins, pro and con
« Reply #13 on: September 12, 2016, 08:23:53 AM »
You've brought this up before and I can assure you that no competent medical studies have been performed in the last half century without some serious statistical brainpower overseeing the process.  Stats is relatively easy and straightforward with good data.  It's proper study design, time, money, and clean data that's hard.  And don't forget, a single great study is still a suspicious pile of crap until it's been replicated, again, and again, until somewhere along the line it becomes trustworthy.  Why do you think these recommendations change over time?  It's because repeat testing fails to replicate the glowing findings of the initial studies.  There's no quick and easy way to go about it.  Science is a slog, two steps forward, one step back, with lots of face-plants into the mud.  With medicine, the sad reality is that patients and their doctors are all tied to this wagon of progress, too, and getting jerked around in the process is inevitable.

I do often feel like the lone nut screaming about how data is improperly being reported and how findings in many areas of science are not repeatable and are questionable. Then the Editor in Chief of the Lancet resigns for just such a reason.
http://www.collective-evolution.com/2015/05/16/editor-in-chief-of-worlds-best-known-medical-journal-half-of-all-the-literature-is-false/

And it turns out the former editor of The New England Journal of Medicine agrees.
https://ethicalnag.org/2009/11/09/nejm-editor/

To be fair, this isn't specific to medicine as it involves food, economics, climate science, and many other industries. In fact the dietary industry probably has the worst track record. But you can't lose sight of the fact that this is an area of politicized science. Studies are being done by companies looking for a result and by organizations looking to promote a sector (think a dairy council). So the scientist running the study knows where his bread is being buttered.

Having worked with the FDA using their guidelines (on the food side) I'll say it is 100% regulatory capture. And we treat it so. When a product boasts "Now with lycopene which may reduce cardiovascular disease" we treat it as a truck advert with "Best in-class towing". Meaningless.

When I look at drug data it often seems the same. A drug that has some effect on some of the population suddenly needs to be marketed as broad as possible. I see small data sets, multiple studies, odd confidence intervals, failed repeatability, etc. Worse yet, many things taken for granted are sampled from surveys that provide thin data at best.

I do believe that some of the best and brightest math minds are pouring over this data. But I feel they are doing it a manner to massage results in the right direction, not as a consumer watchdog group. I could be wrong about all of this. I'll accept that. I hope I am.

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Re: Statins, pro and con
« Reply #14 on: September 12, 2016, 10:25:57 AM »
There's no getting around the fact that all medical research is prone to bias. Even the most conscientious researcher has to assume that they could be subconsciously subverting their own findings.  This is why repeatability is so crucial, as well as having as many minds from a variety of fields looking at the data.

Honestly, until we get AI working on research, diagnosis, and treatment, medicine is going to be subject to all the normal human failings. And everything will be wonderful, right up to the time they turn us into copper tops.

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Re: Statins, pro and con
« Reply #15 on: September 12, 2016, 10:32:07 PM »
Speaking of medicine, nutrition, and research bias.......

How about today's revelation of the Harvard/Big Sucrose hanky-panky from the '60's?

Offline Morning Sunshine

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Re: Statins, pro and con
« Reply #16 on: September 13, 2016, 06:04:51 AM »
Speaking of medicine, nutrition, and research bias.......

How about today's revelation of the Harvard/Big Sucrose hanky-panky from the '60's?

I, for one, am not at all surprised.  I just hope that enough people hear about this and take away 1) research is biased 2) Harvard is not god.

Online David in MN

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Re: Statins, pro and con
« Reply #17 on: September 13, 2016, 08:15:22 AM »
Speaking of medicine, nutrition, and research bias.......

How about today's revelation of the Harvard/Big Sucrose hanky-panky from the '60's?

My God I just got to this story.

http://www.independent.co.uk/life-style/health-and-families/health-news/sugar-industry-lobby-paid-scientists-heart-disease-sweet-food-play-down-role-a7243096.html

I'm at a loss. As a skeptic nothing upsets me more than to be constantly proven right. So "low fat, low cholesterol" was built on false data and my gripes on this thread were more a portent than I'd have liked.

I, for one, am not at all surprised.  I just hope that enough people hear about this and take away 1) research is biased 2) Harvard is not god.

No, aware people are not surprised. But this could mean that every well-meaning doctor checking cholesterol and advising against saturated fat was working with bad data. This has the possibility of effecting millions of people and the loss of years of life is immeasurable.Tricking legions of good people into doing bad work that potentially costing lives is something I can't imagine. It's what we hate in politics and cannot be allowed in science.

Falsifying data should have the highest criminal penalty possible. It's where I start to think life in the oubliette is fitting.

Offline RitaRose1945

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Re: Statins, pro and con
« Reply #18 on: September 13, 2016, 08:17:34 AM »
Just ask your doctor, "How do you feel about me eating eggs?"


If they tell you they're a nutrient packed food, then they're good.  If they tell you to never eat more than one a day, find a new doc.


Offline Ms. Albatross

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Re: Statins, pro and con
« Reply #19 on: September 13, 2016, 08:27:44 AM »

Falsifying data should have the highest criminal penalty possible. It's where I start to think life in the oubliette is fitting.

So thanks to David, I learned a new word today:  Oubliette

Quote
An oubliette (from the French oubliette, literally "forgotten place") was a form of prison cell which was accessible only from a hatch in a high ceiling. The word comes from the same root as the French oublier, "to forget", as it was used for those prisoners the captors wished to forget.


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Re: Statins, pro and con
« Reply #20 on: September 13, 2016, 10:26:35 AM »
Yup, the first I've seen of this story. Absolutely sickening.

How many millions of lives has Harvard cut short for that $50,000? 

Offline RitaRose1945

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Re: Statins, pro and con
« Reply #21 on: September 13, 2016, 07:23:12 PM »
Yup, the first I've seen of this story. Absolutely sickening.

How many millions of lives has Harvard cut short for that $50,000?


And when you're talking that realm, $50,000 is pretty much nothing.

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Re: Statins, pro and con
« Reply #22 on: September 13, 2016, 07:54:51 PM »
I couldn't really find much to disagree with after watching this nutritionist's interview.

http://www.pbs.org/newshour/bb/sugar-industry-paid-experts-downplay-health-risks/

Hit a lot of the points we've been hashing out in this thread.

Offline Applejack

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Re: Statins, pro and con
« Reply #23 on: February 04, 2018, 06:56:02 PM »
My husband was on Lipitor for Chol. for years. He lost so much muscle that he will never get it all back. That was the reason we had to get another heart doctor. He needed a pacemaker and heart doctor said no despite the fact that 2 other doctors and 3 nurse practiitoner said he needed the pacemaker. Doctor was getting a kickback on lipitor. I fired that doctor got his records and got another heart doctor. He got his pacemaker within one week and was told he will never prescribe Lipitor, Zocor, nor Crestor to any of his patients. Hubby was put on 10 ml of Pravastatin which is a much older drug and has had no problems. Anyone that can't take the above 3 and still needs to be on something for Chol. I would ask doc about the pravastatin. Much less side effects.