Statin question

Quoted message said:

Thank you for the information and your concern. I've looked through the Therapeutics Initiative
Letters and what they appear to be saying is that if you have high cholesterol or clogged arteries
you SHOULD be taking statins. (This is my situation.) If you don't, you should not because the
risks outweigh the benefits. That makes sense to me.

That was my take also. Would mgf agree with that assesment?

Quoted message said:

Getting back to my original point. I think you would agree that it is possible for a patient to
misidentify statins as the cause of muscle pain. I point to myself as a likely example - in part
because a while after I went back on statins, the particular pain I thought might be due to statins
went away. In any case, it is obvious that someone on statins can get arthritis - quite
independently of the statins. However, I do agree with you that there are risks to statins and, to
me, it comes down to a risk/benefit trade-off.

Bill

A sensible approach.

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"mfg" <[email hidden]> wrote in message
"]news:[email hidden]...

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news:<[email hidden]>...

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"mfg" <[email hidden]> wrote in message
"]news:[email hidden]...

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news:<[email hidden]>...

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> > "mfg" <[email hidden]> wrote in message
> >
> > Another question is: How can you tell it's the statins? I was taking

Lipitor a

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> > few years ago and was having significant back pain. I went off it

completely

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> > (on my own) for about 6 weeks, but it made no difference. I think now

it was

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> > arthritis. Now I'm having hip pain on the treadmill, so I cut back the

Lipitor

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> > from 60 to 40 mg and cut back on Niacin. Things seem a little better,

but I'm

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> > not sure. (I'm also taking CoQ-10)
> >
> > So the point is: In mild to moderate cases it may be hard for the

patient to

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> > identify the source of the problem. And in severe cases the Dr. has

probably

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> > been made aware - and can try to confirm with blood work, etc.
> >
> > Bill
>
>
> OK. But my point was that pain a patient associates with a statin may not be really be
> associated with the statin. And I'm pretty sure that was true in my case from a few years
> ago because 1. Going off Lipitor for 6 weeks did not improve the pain. 2. After I went back
> on and even upped the dose the pain went away. (I have my own theories about this - having
> to do with furniture.)
>
> However, it is true statins can cause muscle problems. It is also true it can prevent heart
> attacks. The real question is what's the trade off. If for every 50 heart attacks prevented
> one person has a severe muscle or liver problem, that, to me, is a fair trade off. If the
> numbers are reversed, it is not. Have there been any studies to show this that you know of?
> One could at least get a rough idea of a major problem by measuring the % of people taking
> statins who have a liver (or other) problem vs. those similarly situatuated who do not.
>
> Bill
>
> $$$$$$$$$$$$$$$$$$$$$$tatin$
>
> Bill
>
> Going off statins for 2 1/2 years has only marginally removed my pain. Going off statins
> does not remove the pain, because if it statin induced pain it results from cellular and
> muscle damage. Some people find the pain lessens, but does not go away. Similarly to pain
> caused by any profound injury.
>
> Mitochondrial damage remained from six months to six years in Dr. Phillips study subjects.
> See the Histopathology page of www.impostertrial.com. You access that by going into the for
> physician's section of his website. There you can read about the muscle biopsies done on
> people who had pain long after stopping statins, and see slides showing the damage.
>
> Regarding your comment that statins PREVENT heart attacks, please read this study out of
> Therepeutics Initiative, funded by the British Columbia Minstry of Health:
>
> ti.ubc.caletter48.htmOpen ↗
>
> "Conclusions: If cardiovascular serious adverse events are viewed in isolation, 71 primary
> prevention patients with cardiovascular risk factors have to be treated with a statin for 3
> to 5 years to prevent one myocardial infarction or stroke.
>
> This cardiovascular benefit is not reflected in 2 measures of overall health impact, total
> mortality and total serious adverse events. Therefore, statins have not been shown to
> provide an overall health benefit in primary prevention trials."
>
> Then read Therapeutics Initiative Letter No 49, ti.ubc.caletter49.htmOpen ↗
>
> "Conclusions: Statins provide a cardiovascular and total mortality benefit for patients with
> clinically evident occlusive vascular disease (secondary prevention) and a cholesterol of
> >3.5 mM.
>
> Large RCTs are required to test different statin dosing strategies for secondary prevention
> before making firm recommendations. "
>
> Unfortunately those taking statins and not getting liver damage were not necessarily saved
> or prevented from cardiac arrest, or death from cardiac arrest. None of the people who did
> the Therapeutics Initiative study are paid by pharma.
>
> MFG

OK. I'll take a look at those. But can you tell me what they are. I could

not

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find an author, but maybe I was not just looking in the right place. Are

they

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peer reviewed? Are they a letter or a research report?

Thanks.

Bill

Therapeutics Initiative is an epidemiologists group, from a British Columbia (Canada) medical
school. As a group, and not just for these two studies, they are funded by the British Columbia
Ministry of Health. You can see on their site the many studies they have done on all kinds of
drugs. Epidemilogists study all the studies, crunch the numbers and come up with a finding. So,
they didn't actually go into a lab themselves. They study all the other studies, and come to a
finding based on evidence. They are privvy to information not in the abstracts on
www.pubmed.org, for example.

Go to ti.ubc.cati.ubc.caOpen ↗. That is the home page. I believe it sets out their mandate etc
there.

The group is led by Dr. J. Wright, epidemiologist, and do this one thing only: assess studies
and publish their findings. Dr. Wright, just prior to the publication of Therapeutics Initiative
Letter #48 on statins, sent a warning letter to all physicians in British Columbia about statin
side effects, and how little understood they were. He was warning the doctors to look closely at
prescribing, because his group had found no reason to prescribe statins for prevention of
cardiovascular disease.

I hope you are not affected by them. I hope you've just been working out too hard. But if you do
think statins have affected an existing condition, or have created new problems, you will have
more complete information to take to your doctor for a discussion.

If you wish e-mail me privately. Some of my e-mail addresses have an
x. Remove it. (I'm catching on, slowly.)

MFG

Thank you for the information and your concern. I've looked through the Therapeutics Initiative
Letters and what they appear to be saying is that if you have high cholesterol or clogged arteries
you SHOULD be taking statins. (This is my situation.) If you don't, you should not because the
risks outweigh the benefits. That makes sense to me.

Getting back to my original point. I think you would agree that it is possible for a patient to
misidentify statins as the cause of muscle pain. I point to myself as a likely example - in part
because a while after I went back on statins, the particular pain I thought might be due to
statins went away. In any case, it is obvious that someone on statins can get arthritis - quite
independently of the statins. However, I do agree with you that there are risks to statins and, to
me, it comes down to a risk/benefit trade-off.

Bill

My understanding is TI is saying primary prevention no, secondary prevention yes. Of course it's
possible your muscle pain/joint pain is caused by something else. Have you had a sed rate test?

All of us who took statins were told our benefit would be greater than our risk. MFG

On 17 Dec 2003 20:06:36 -0800, [email hidden] (Dr. Andrew B.

Chung said:

[email hidden] wrote in message news:<[email hidden]>...

Quoted message said:

MD/PhD) said:

> Perhaps you are Andrew. We all here have to judge each other on what we see here. From where I
> sit, you've sure as hell got cojones.

They are God's "cojones" :-)

You really ARE intimate with God, aren't you?

Yes, I do love Him.

How did you come to know his cojones so well? Matt

[email hidden] (mfg) wrote in part:

Quoted message said:

Dr. Wright, just prior to the publication of Therapeutics Initiative Letter #48 on statins, sent a
warning letter to all physicians in British Columbia about statin side effects, and how little
understood they were. He was warning the doctors to look closely at prescribing, because his
group had found no reason to prescribe statins for prevention of cardiovascular disease.

In looking over the "meta-analysis" provided in letter #48, it appears that a more careful pooling
of the study results would show significant benefits from statins in primary prevention, even over
the very short time periods of treatment.

A quantitative analysis, such as a Bayesian one, would be very time-consuming, but a few things leap
out at me:

The Relative Risk result for primary prevention (MI and stroke) in the three studies described in
detail (in the order they are described) are: 0.94 (100% primary prevention), 0.91 (86% PP), 0.82
(82% PP). The authors state that when two other previous trials are included, the RR obtained from
the pooled data is 0.84 [0.78-0.90 0.05 confidence interval]. That represents a 16% reduction in MI
and stroke after treatment for only 2-5 years in a mainly primary prevention population.

After demonstrating this remarkable, positive result, the authors examine the data concerning
mortality. To show such benefits would require a long period of treatment and observation--not the
3-5 years of the studies available. Even so, the result they calculate is an all-cause mortality
relative risk of 0.95 [.88-1.02]. The 5% reduction in deaths with 2-5 years of treatment is not
(quite) statistically significant at 0.05.

My own analysis would lead me to conclude that the meta-analysis of the five studies strongly
supports the benefit of statins in primary prevention.
--
Jim Chinnis Warrenton, Virginia, USA