Friday, January 21, 2011


"Statins" is a very useful drug in the prevention of heart disease. Because of this fact, pharmas with statins make plenty of money. This is a billion dollar industry. Much advertisement and promotion is done to hype up the usefulness of statins so that all and sundry will buy it, so-called " to protect their heart ". I have friends who would ingest a statin, after taking a cholesterol rich meal, purely to pacify their conscience. Then they also do not have to diet.
Because of all the widespread publicity, hype and promotional marketing it has brought about its own controversy. After a while, even good, evidence base doctors have difficulty separating the "truth from the facts ".
The latest controversy result from the just released Cochrane Report. There is a Cochrane Database in the London School of Hygiene and Tropical Medicine. They undertook a meta-analysis of 14 mega statin trials, which included 34,272 patients. They took the trials that compared the use of statin against placebo on standard medical treatment at that time, to see if statin use was beneficial. They concluded from their meta-analysis that statin use in patients at moderate or high risk of CAD was obviously beneficial, but statin use in patients with low risk ( less then 10% chance of CAD in 10 years ), was of minimal benefit. In fact in this group, the statins may do more harm than good. In other words, statin use should not be for those at low risk of heart disease. Most of us will define low risk as those individuals without established CAD and less then 2 major coronary risk factors, like dyslipidemias, hypertension, diabetes, cigarette smoking, family history of heart disease.
If you are keen on numbers, it goes something like this. The use of statins in this low risk group of 1,000 patients, over 1 year, will safe 1 life. Wheres in may cause 1.7 renal problems, 25.2 cataracts. 6.5 liver dysfunctions, and 3.2 cases of myopathy. Putting in this light, the use of statins should be carefully considered and individualised by the medical practitioner.
These facts are seldom emphasized by the pharmas in their promotion. But those are the facts.
Before I am completely misunderstood, statins are very useful in individuals at moderate or high risk of heart disease, and especially in those who are known to have heart disease. In this group, statins are obviously beneficial, and side effect risks may have to be accepted, as statins clearly do more good than harm in this group. However, in this group, the pharmas have also driven their own controversy by trying to push LDL-Cholesterol level to 70mg/dL ( to under the ground I call it ). It is true, that the lower the LDL-C, the lower the risk, BUT one must not forget that the higher the dose of statins, also the higher the risk of side effects. Again, in my view, the risk benefit ratio, does not support the use of statins to lower LDL-C to 70 mg/dL.
As always in all of us who share in blogs, if you are on statins, before you change anything, please talk to your own doctor, who is better to advise you on your case.
For me, the lure of money, both by pharmas and practitioners, may be partly to blame for this controversy, in the use of a very important drug.

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