Saturday, June 24, 2006

Statins: Grumbling about lower is better

It was not so long ago, 1 year to be exact, when we were all hailing the major "advance" that the lower the LDL-C achieved, the better the CVS survival. This followed the well timed release of PROVE-IT and TnT which compared high dose Lipitor (80 mg) with pravastatin (40 mg) and high dose Lipitor (80 mg) with low dose lipitor (10 mg), respectively. However, the later release of A-Z (Zocor 20 mg Vs Zocor 80 mg) and IDEAL (lipitor 80 mg Vs 10 mg) did not quite support this concept, although high dose statins were used.

We now hear grumblings of the dangers of high dose (lipitor 80 mg) statins. The JAMA June 7, 2006 issue carried many letters to the editor, questioning the truth that the lower LDL-C the better. It appears that in IDEAL, high dose lipitor did not do any better then usual dose Zocor. The authors of the letters also presented their interpretation of the side effects of high dose statins including muscle aches, liver dysfunctions and other minor irritants, including diarrhea and abdominal pains.

High dose lipitor is not as innocuous as they were made out to be. In this months issue of BMJ, there were two articles on the dangers of high dose statins. The authors even alleged that the interpretation of the side effects in the "high dose statin trials" may have not been accurate. It would appear that the initial enthusiasm with high dose statins (as wi htall wonder drugs) is giving way to a more realistic appraisal of how statins should be used, lower LDL-C to 100 mg%, and this will certainly reduce MACE and prolong life. If you want to push the LDL-C lower till 70 mg%, know that you will achieve a slightly lower MACE but you must be prepared for a higher side effects rate.

Is that worth it. For the drug companies, the answer isa quick yes. Each medical practitioner must decide for himself or herself, for the sake of that particular individual patient. The hard data here is still somewhat controversial.

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