Thursday, June 23, 2011


I have reported earlier, that high dose simvastatin, should be used with caution, as advised by the US FDA. Read June 9th, Dangers of simvastatin 80mg. Well, in the 22nd June issue of the Journal of the American Medical Association, Dr Kansik Ray and colleagues from the St Georges University, London, reported their results of a meta-analysis of 5 major clinical trials on high dose versus medium dose statins, and its cardiovascular effects and benefits. They also measured fasting glucose and in some of them, HbA1c. Well, these 5 mega trials, had 32,752 who were not diabetic to start. After an average of 2-5 years of followup ( not so long ), they found, on the average, a 12% increase in the incidence of T2DM, diagnosed in the usual way. High dose statins, would be Atorvastatin 80mg simvastatin 80 mg and rosuvastatin 80mg. Actually this current meta-analysis did not include rosuvastatin.
The effects of high dose rosuvastatin, increasing the incidence of T2DM, was first noted folowing the JUPITER study, in 2009. In 2010, there was a paper in Lancet which showed that high dose statins was associated with an increase incidence of T2DM. This recent paper just serves to confirm it.
They worked out that if you use high dose statins, you would need to treat 155 patients at risk, to reduce 1 incidence of major adverse cardiac events, whereas you would need to treat 498 patients with high dose statins, to inccur one case of T2DM. So they concluded that it was still worthwhile using high dose statins.
I must say that, personally, I do not believe in lowering LDL-C to super low levels, despite the "alleged" evidence. I believe that some of the evidence is massaged by big pharmas to push the sales of their drugs. I would lower LDL-C significantly, using diet and medium doses of statins.
This recent spate of articles on the dangers of high dose statins, just serves to re-inforce my view, that taken all the adverse effects of high dose statins, together, the risk may outweigh the benefit, or the alleged benefit, of super low LDL-C.
I suppose there is a price to pay, for trying to be perfect. God did give us LDL-C for a reason, and so abolishing it totally, may be against the order of nature. Reducing it so that our CV risk is reduced, makes sense.
Anyway, I do not wish to be preachy. Each of us must decide, which part of the spectrum, we wish to be. Just be warned that high dose simvastatin has muscle problems, and high dose statins ( lipitor and zocor ), has the potential of inducing T2DM. The mechanism and the reason why, has not been clearly worked out yet.

No comments: