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pcovers 12-26-2003 06:36 PM

Statins: Awfully compelling evidence...
 
The following quote is from:

[i]Lipids Online: Educational Resources in Atherosclerosis[/i]

[b]Several large-scale, controlled, randomized clinical trials have provided evidence that statins are effective in reducing CHD events in both primary- and secondary-prevention populations. Their efficacy in CHD risk reduction is truly impressive. Nonfatal myocardial infarction and CHD death were reduced by about 25-40% after just 5 years of treatment; ischemic events requiring hospitalization were reduced by 26-36% after just 18 months of statin therapy. All the statins studied demonstrated the ability to reduce CHD risk—lovastatin in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), simvastatin in the Scandinavian Simvastatin Survival Study (4S), and pravastatin in the Cholesterol and Recurrent Events (CARE) trial, Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial, and West of Scotland Coronary Prevention Study (WOSCOPS). Neither the Atorvastatin versus Revascularization Treatment (AVERT) nor Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial showed significant reductions in hard CHD endpoints; both were short-term trials and not powered to show such a difference. A trend toward benefit on CHD events was shown in the Lipoprotein and Coronary Atherosclerosis Study (LCAS), but this angiographic trial was not powered for clinical events; the effect of fluvastatin on CHD events is being studied in the ongoing Lescol Intervention Prevention Study (LIPS) and Assessment of Lescol in Renal Transplantation (ALERT). The available data suggest that CHD risk reduction by statins is a class effect and that the LDL-C reduction is the key event driving the change in risk.[/b]

What makes these studies and their results impressive is that they are "end point" studies. That is to say, they base the results on endpoints, such as heart attack or death, not simply a hypothesis about the potentials based on assumed relationships.

There is no panacea, and there are money interests, to say the least. However, these studies cover several different statins on thousands and thousands of patients with many hundreds of academic researchers involved. The data are impressive.

ARIZONA73 12-26-2003 08:23 PM

Re: Statins: Awfully compelling evidence...
 
Have you even bothered to read the article in Smart Money Magazine about the consequences of taking these drugs? It is by far, most compelling.

pcovers 12-27-2003 05:04 AM

Re: Statins: Awfully compelling evidence...
 
[QUOTE=ARIZONA73]Have you even bothered to read the article in Smart Money Magazine about the consequences of taking these drugs? It is by far, most compelling.[/QUOTE]
It is a good article. Much of the problems associated and written about concerning statins are CoQ10 related. Take CoQ10 and that problem is solved. Some do have muscle aches and muscle problems. For me, were I to experience such problems on statin and not while off statin...I would use my common sense and not take the statin.

However, when you have had a heart attack, or been diagnosed with CAD, the [b]most[/b] compelling consequence of concern is an "end point" event. I wish there were similar evidence associated with fish oil, policosanol, gugul, flax, vitamins (most all of which I take), but there is no similar evidence tied to "end points" for these substances. There is theory and hypothesis tied to these substances. There is clinical, double blind, controlled study, peer reviewed evidence that statins do in fact significantly reduce "end point" events, not just reduce cholesterol.

I wish it weren't so, but it is.

zip2play 12-27-2003 05:26 AM

Re: Statins: Awfully compelling evidence...
 
I too am worn out following all the leads to lower this that and the other risk factor in the hoipe that last month's news was pertinent (like margerine to unclog hard arteries).
I am doing Co-Q10, cod liver oil, lecithin, pantothenic acid, folic acid, a zillion blood pressure medications....judiciously working to control my weight, and walking everywhere (given up car.) and even planning angiography in the next month. I regularly test my blood lipids, homocysteine, C-Reactive protein, liver enzymes and creatine phosphokinase.

All this is nice and is certainly adding to my overall health but IMHO it is only the Lipitor that I am taking gives me some assurance that a lump of plaque might be discouraged from moving someplace untoward and killing me on the spot. If I get a sore knee....so be it! If a lifetime of plaque can be reduced one iota instead of increased, I raise my glass.

(I must be the only one on earth that CANNOT get that article out of SMART MONEY...even the November issue yields up only Esperion's new cholesterol drug!...ca va...THE LIPITOR DILEMMA search yields only THE MICROSOFT DILEMMA)...I swear I've read 2 dozen articles this morning!

ARIZONA73 12-27-2003 07:34 AM

Re: Statins: Awfully compelling evidence...
 
Zip2play,

You may want to inquire at your library about the November issue of Smart Money magazine. Many libraries have these magazines on hand. If they don't, they still may be able to get it for you.

Pcovers,

You are obviously familiar with coenzyme Q-10, and know what to look out for while taking statins. Unfortunately for many people, symptoms often will not surface until they have been taking these drugs for perhaps years. For many of these people, they simply do not make the connection, and attribute their symptoms to other causes, such as aging. Many doctors may also dismiss statins as being the probable cause. To make matters worse, many doctors don't even tell their patients about coenzyme Q-10 depletion, and the need to supplement. If they did, perhaps many problems can be avoided.

But even so, the next question would be how much coenzyme Q-10 should the patient take. This is a perplexing problem, especially since most coenzyme Q-10 supplements are not easily absorbed. The only way to determine the proper dosage for each patient would be to measure their levels of coenzyme Q-10, and supplement accordingly.

In all fairness, I can't place total blame on the doctors for this failure to advise their patients. They are only relying on the information provided to them by the manufacturers of these drugs. It is their responsibility to notify the doctors, and the fact that they haven't places the blame squarely on their shoulders.

phja 12-27-2003 07:57 AM

Re: Statins: Awfully compelling evidence...
 
what about the AHA recommending all heart patients to switch to margarine and no butter and look at the research on that now....trans fat is the worst! i have a problem with what some studies and AHA says. what about the studies that cholesterol under 130 greatly increases your risk for cancer prematurely. i think in 10 years they will find all the drawbacks of theses drugs. theyt came out with a study that people with heart failure shouldn't have too low cholesterol....could it be that the low cholesterol from the statins contributed to the heart failure to begin with. i personally believe that things that damage the artery lining...such as stess,smoking in combination with very high cholesterol is what causes the blockages...not cholesterol alone. did most of you smoke before your heart problems? i know people with very high cholesterol(300's) and had angiogram with no blockages(didn't smoke) and people with low cholesterol(170) who had heart attack but smoked. i don't think the entire population should be on statins and prozac...its just what the drug companies(and doctors) have us brainwashed to believe. i'm not someone who always bashes the drug companies but i have a problem when they act like everyone should be on these drugs.i thought the framingham study said ratios are important but the doctors act like ldl is the only part that matters.

pcovers 12-27-2003 08:03 AM

Re: Statins: Awfully compelling evidence...
 
[QUOTE=ARIZONA73]In all fairness, I can't place total blame on the doctors for this failure to advise their patients. They are only relying on the information provided to them by the manufacturers of these drugs. It is their responsibility to notify the doctors, and the fact that they haven't places the blame squarely on their shoulders.[/QUOTE]
I am in complete agreement that the statin manufacturers should at least specifically recommend to the medical community that CoQ10 be supplemented with the statin. One possible reason that it is not overtly recommended is cost. The cost of CoQ10 is not insignificant and to recommend that a costly supplement be taken with the prescribed medication is not likely a good marketing measure. It is not a good reason, but it may be "the" reason.

I meant to inlcude the following info with my original post, but will include here:

Risk (End Point) Reduction per Study:

Primary Prevention
AFCAPS/TexCAPS -40%
WOSCOPS -31%

Secondary Prevention
4S -31%
CARE -24%
LIPID -24%

Ischemia
MIRACL -26%
AVERT -36%


What other route can be taken that demonstrates such convincing and dramatic results in end point reduction.

phja 12-27-2003 08:11 AM

Re: Statins: Awfully compelling evidence...
 
when they say large scale......how many people were in the study?

pcovers 12-27-2003 08:14 AM

Re: Statins: Awfully compelling evidence...
 
[b][i]what about the AHA recommending all heart patients to switch to margarine and no butter and look at the research on that now....trans fat is the worst![/b][/i]

There were no double blind studies that indicated moving to margarine would reduce heart attacks or death. There was recommendation based on speculation based on inferring meaning from studies.

[b][i]I personally believe that things that damage the artery lining...such as stess,smoking in combination with very high cholesterol is what causes the blockages...not cholesterol alone.[/i][/b]

I personally believe this as well. Double blind, clinical studies show this direct correlation, so it is good that we don't have to rely on what we feel or believe.

[b][i]did most of you smoke before your heart problems? i know people with very high cholesterol(300's) and had angiogram with no blockages(didn't smoke) and people with low cholesterol(170) who had heart attack but smoked.[/i][/b]

It has been proven that there is not an absolute correlation between high cholesterol and heart disease or low cholesterol and no heart disease. However, the studies referenced here on statins don't have to demonstrate any correlation between cholesterol and heart disease. They only demonstrate that in tens of thousands involved in the studies, there is [b]significant[/b] reduction in heart attack and death. It doesn't really matter if it is due to lowering cholesterol or not. Some would say that that is the reason…but it doesn’t matter. Maybe it will be found that statins actually are having a significant impact on the health of the artery lining even more than they are reducing cholesterol.

Bottom line is that there are very significant differences in the number of those that die from coronary artery disease between those taking statins and those not taking statins. For those that died taking the placebo, which do you think they wished they had taken?

pcovers 12-27-2003 08:28 AM

Re: Statins: Awfully compelling evidence...
 
[QUOTE=phja]when they say large scale......how many people were in the study?[/QUOTE]
Examples:

4S 4444 participants
WOSCOPS 6595 participants
CARE 4159 participants
HPS 20,500 participants

All these statin trials have now randomized well over 50,000 patients. It may be unpalatable, however the numbers do not lie. This not recommendation based on some theoretical correlation between what someone thinks about fish oil or margarine. This is the result of [b]many[/b] independent, double blind, peer reviewed, clinical studies.

The bottom line is that there are fewer end points (heart attacks, death) with statins than without. This is not a feeling or a belief or a wish or a philosophy, it is a hard number reality. Some people cannot take statins. Some people have negative health problems by taking statins. Look up how many people have had horrible experiences with aspirin. I'm sure a small magazine could be filled with such horror stories and article. If you are one of those, then all the good in the world that aspirin does means nothing to you. However, for the millions of benefactors of aspirin, it would be a tragedy to remove it because of the few that can't take it.

Statins have at least as equal a safety record as aspirin with clinically documented significant reduction in death for those that take it as opposed to those that do not.

phja 12-27-2003 09:06 AM

Re: Statins: Awfully compelling evidence...
 
who sponsored all these studies?

ARIZONA73 12-27-2003 09:42 AM

Re: Statins: Awfully compelling evidence...
 
Probably the drug companies. Who else has that kind of money to spread around? The AFCAPS/TEXCAPS study for one, apparently was funded by a research grant from Merck & Company. Don't know about the other studies...yet.

JB 12-27-2003 09:50 AM

Re: Statins: Awfully compelling evidence...
 
Statins are a great drug but can cause muscle aches and pains according to the info given in most of these letter..

Well, I have tried nearly all of them and they do exactly that after I have taken them a certain length of time.

My question is this: Would taking Co-Q10 eliminate that problem? If so, how much should I take. I really want to continue on these statins for the benefits which are so evident, but I surely hate hurting each and every day.

I'm waiting eagerly for anyone's answer to this dilemna and possible solution.
Thanks
JB

ARIZONA73 12-27-2003 10:42 AM

Re: Statins: Awfully compelling evidence...
 
JB,

Well, if your muscle aches are in fact related to coenzyme Q-10 depletion caused by statins, supplementation may alleviate these symptoms.

As far as the proper dosage requirement, that certainly does present a problem. Dosage ranges can run anywhere from 100-600mg in order for it to have any kind of therapeutic effect. Your best bet would be to ask your doctor to measure your blood level of coenzyme Q-10. Laboratories are equipped to do this. A normal blood level is 0.8 to 1.2 micrograms per milliliter of blood. However, in order to obtain therapeutic effects, experts say this level must be driven up into the 2.5 to 3.5 range through sustained supplementation. By having your level measured as part of your routine blood test, eventually you should be able to arrive at your required dosage. For starters, considering you are currently taking a statin, you may want to begin with 100mg and work from there.

pcovers 12-27-2003 10:44 AM

Re: Statins: Awfully compelling evidence...
 
[QUOTE=phja]who sponsored all these studies?[/QUOTE]

A bit like asking, "When did you stop beating your wife". The mere asking of the question connotes guilt.

Most are sponsored by drug companies is conjunction with academic or research institutions.

Is the question suggesting that the outcomes are rigged? Do we suspect the ethics and competency of the many hundreds of various, non drug company employed researchers involved in vetting the data? What difference will it make to the outcomes showing significant reduction in end point events?


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