Friday, May 21, 2010

PUTTING THE USE OF STATINS IN PERSPECTIVE, THE GOOD AND THE BAD

The 20th May issue of BMJ ( British Medical Journal ), carried an interesting piece of work by Prof Julia Hippisley-Cox and colleagues from the University of Notthingham. They studied about 2 million patients prescribed statins by 350 GP group practices throughout UK. They were studying the adverse reactions to statins, hoping to see some patterns and set up a computer algorithm, so that GPs can use statins more wisely and hope to get the benefits of statins without getting the side effects. That is all well and good, as we are all aware that the benefits of statins far outweigh the harm of statins and this study des give us more evidence of that, from the GP practice in UK.
However, I did learn a few things reading the article. It looks like ( as we all know ), many of the liver dysfunctions and myopathies, are somewhat dose related. When you use superstatins or statins at superdoses ( rosuvastatin 20mg and above, atotvastatins 40mg and above, simvastatin 20 mg and above ) you must be prepared to accept some adverse effects. In fact, in their study, Prof Julia found that for every 10,000 high risk women treated with statins, there were 74 more cases of liver dysfunction, 23 more cases of acute renal failure, 307 more cases of cataract and 39 more cases of myopathy. These adverse effects were not any statin specific and seemed to be a class effect. However, what was surprising was that fluvastatin ( in the British experience ) seemed to be associated with a higher incidence of liver dysfunction. However, it must also be said that for the 10,000 high risk women treated by statins, 271 less CVS events were recorded. I will take this with a pinch of salt as all the high risk women in UK must be on statins by now, so that there cannot be a control arm to measure against.
I suppose, the point to make is that statins are good for the heart. It definitely reduces major adverse cardiac events, but it must not be carelessly used as there could be profiound adverse reactions. It is true that most of the adverse reactions are reversible, but some maybe too severe and some have resulted in deaths.
The study also does make a statement that they did not see an increase incidence of cancers in the 2 million or so patients treated, and in fact, they claimed a reduction in the incidence of oesophageal cancers in the study cohort.
Certainly, their algorithm is helful for those of us who sees high risk CAD patients. It will help us to make better decisions as to who to teat and with what dose. Whatever it is, always use a drug only when it does more good then harm. If it cant do much good ( low risk group ), then any potential harm is not acceptable.