Statins
Zoe Harcombe writes a good primer about statins and cholesterol
"If you are in the highest risk group possible (men of a certain age who have already had a heart attack), for every 100 of these men given statins for five years, 1.8 men will live, on average, an extra 6 months and 98.2 will gain no benefit. The intelligent thinking in the world of cholesterol is that any ‘benefit’ of statins for this small, very high risk group, results from anti-inflammatory properties of statins; the cholesterol reduction being a serious and unwelcome side effect.
To look at this another way, some September 2015 research showed that you can take statins for years and you might gain an extra 3 days. Again – likely an anti-inflammatory effect; the cholesterol lowering being a serious price to pay."
"If you are in the highest risk group possible (men of a certain age who have already had a heart attack), for every 100 of these men given statins for five years, 1.8 men will live, on average, an extra 6 months and 98.2 will gain no benefit. The intelligent thinking in the world of cholesterol is that any ‘benefit’ of statins for this small, very high risk group, results from anti-inflammatory properties of statins; the cholesterol reduction being a serious and unwelcome side effect.
To look at this another way, some September 2015 research showed that you can take statins for years and you might gain an extra 3 days. Again – likely an anti-inflammatory effect; the cholesterol lowering being a serious price to pay."
How LOW Cholesterol Can Harm Your Health
"You've heard for decades about the dangers of high cholesterol, but did you know that LOW cholesterol can lead to violence towards self and other, and has been linked to premature aging, death and other adverse health effects"
"You've heard for decades about the dangers of high cholesterol, but did you know that LOW cholesterol can lead to violence towards self and other, and has been linked to premature aging, death and other adverse health effects"
Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms.
Abstract
"In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and 'heme A', and thereby ATP generation. Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency. Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated."
Abstract
"In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and 'heme A', and thereby ATP generation. Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency. Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated."
Association of Statin Therapy Initiation With Diabetes Progression
Findings This large retrospective cohort study included 83 022 propensity-scored matched pairs of statin users and nonusers and found that the diabetes-progression composite outcome was significantly higher among patients with diabetes who used statins than among patients with diabetes who did not use statins. The study examined 12 years of data on patients covered by the Veterans Affairs health system and new-user and active-comparator designs to assess associations between statin initiation and diabetes progression from 2003 to 2015.
Meaning Statin use was associated with diabetes progression in patients with diabetes—statin users had a higher likelihood of insulin treatment initiation, developing significant hyperglycemia, experiencing acute glycemic complications, and being prescribed an increased number of glucose-lowering medication classes.
Findings This large retrospective cohort study included 83 022 propensity-scored matched pairs of statin users and nonusers and found that the diabetes-progression composite outcome was significantly higher among patients with diabetes who used statins than among patients with diabetes who did not use statins. The study examined 12 years of data on patients covered by the Veterans Affairs health system and new-user and active-comparator designs to assess associations between statin initiation and diabetes progression from 2003 to 2015.
Meaning Statin use was associated with diabetes progression in patients with diabetes—statin users had a higher likelihood of insulin treatment initiation, developing significant hyperglycemia, experiencing acute glycemic complications, and being prescribed an increased number of glucose-lowering medication classes.
Statin induced diabetes and its clinical implications
"Although a number of questions remain unanswered, the available evidence supports that statins do increase the chances of NOD. In this regard some statins appear to be more strongly related (e.g., simvastatin, rosuvastatin and atorvastatin) than others (e.g., pravastatin). Although causality of this association has not been proved, there are evidences from experimental studies that make this association plausible. It is difficult to weigh benefit; in terms of prevention of adverse cardiovascular events, versus risk of NOD although benefits appear to outweigh risks in moderate to high CVD risk population. Their use in low CVD risk population for primary prevention is controversial. Some clinical trials are underway to make the current picture more clear. Until that time, clinicians using statins should be more cautious and vigilant regarding their use and carefully balance benefits with risks."
"Although a number of questions remain unanswered, the available evidence supports that statins do increase the chances of NOD. In this regard some statins appear to be more strongly related (e.g., simvastatin, rosuvastatin and atorvastatin) than others (e.g., pravastatin). Although causality of this association has not been proved, there are evidences from experimental studies that make this association plausible. It is difficult to weigh benefit; in terms of prevention of adverse cardiovascular events, versus risk of NOD although benefits appear to outweigh risks in moderate to high CVD risk population. Their use in low CVD risk population for primary prevention is controversial. Some clinical trials are underway to make the current picture more clear. Until that time, clinicians using statins should be more cautious and vigilant regarding their use and carefully balance benefits with risks."
Association of Statin Use With Risk of Back Disorder Diagnoses
"Back pain results in tremendous disability and cost; therefore, understanding predisposing or protective factors deserves attention. Statins are widely used, but there is no consensus on whether statins are protective 1 of or deleterious 2-4 to musculoskeletal conditions. A previously published propensity score (PS)–matched study of statin users and nonusers found an association between statin use and increased risk of use-related injury and arthropathies. 2
Scarce data exist on the association of statins with back pain. 3,4
Because statins may increase vulnerability to myalgias and contribute to the myopathic component often experienced with back pain, the objective of this study was to examine the association of statin use with the risk of back disorder diagnoses. Our a priori hypothesis was that statin use would be associated with back disorders, including spondylosis and intervertebral disc disorders"
"Back pain results in tremendous disability and cost; therefore, understanding predisposing or protective factors deserves attention. Statins are widely used, but there is no consensus on whether statins are protective 1 of or deleterious 2-4 to musculoskeletal conditions. A previously published propensity score (PS)–matched study of statin users and nonusers found an association between statin use and increased risk of use-related injury and arthropathies. 2
Scarce data exist on the association of statins with back pain. 3,4
Because statins may increase vulnerability to myalgias and contribute to the myopathic component often experienced with back pain, the objective of this study was to examine the association of statin use with the risk of back disorder diagnoses. Our a priori hypothesis was that statin use would be associated with back disorders, including spondylosis and intervertebral disc disorders"
Statins and Amyotrophic Lateral Sclerosis
Malcolm Kendrick
"On the other hand, in a population of fifty million people taking statins (atorvastatin and simvastatin) we can expect that figure to be multiplied by around twenty. Now instead of 1,250 people developing ALS, we can expect to see 20 x 1,250 = 25,000.
Or, to put this another way. Each year, in the US and the UK, we can expect to see an extra 23,750 people developing Amyotrophic Lateral Sclerosis due to taking statins."
Malcolm Kendrick
"On the other hand, in a population of fifty million people taking statins (atorvastatin and simvastatin) we can expect that figure to be multiplied by around twenty. Now instead of 1,250 people developing ALS, we can expect to see 20 x 1,250 = 25,000.
Or, to put this another way. Each year, in the US and the UK, we can expect to see an extra 23,750 people developing Amyotrophic Lateral Sclerosis due to taking statins."
British Medical Journal Says Statins Provide No Benefit for Healthy Elderly
Justin Smith September 5, 2018
"A new study published today in the British Medical Journal has found statins do not provide any benefit for elderly people, unless they have type 2 diabetes. In order to understand the significance of this study it is useful to first discuss some background and some key important concepts."
Justin Smith September 5, 2018
"A new study published today in the British Medical Journal has found statins do not provide any benefit for elderly people, unless they have type 2 diabetes. In order to understand the significance of this study it is useful to first discuss some background and some key important concepts."
MIT scientist Raymond Francis discusses the ineffectiveness of Statin drugs.
New Research Confirms We Got Cholesterol All Wrong
by Paul Mabry MD | Sep 23, 2018
by Paul Mabry MD | Sep 23, 2018
Researching this post I found this study on statins and C-Reactive Protein. Here’s a quote: “Extensive clinical trial data have shown that the degree of LDL-C reduction obtained depends on the particular statin used and that intensive LDL-C lowering reduces the incidence of cardiovascular events compared with more moderate LDL-C lowering. More recent data suggest that effects independent of LDL-C lowering may also play a part in the reduction in cardiovascular events. C-reactive protein (CRP), a marker of inflammation, is a potential predictor of CVD risk, and statins reduce CRP levels by up to 60%. CRP reduction is independent of LDL-C lowering, and variation between statins in CRP reduction may play some role in CVD event reduction rates. At present, however, there are few outcome data relating to the cardiovascular benefits of reducing CRP.” Here’s a quote from the actual study mentioned in the Daily Mail article noted above that triggered me to write this post: “If LDL-C is atherogenic, people with high LDL-C should have more atherosclerosis than those with low LDL-C. At least four studies have shown a lack of an association between LDL-C and degree of atherosclerosis [5], and in a study of 304 women, no association was found between LDL-C and coronary calcification [16]. One exception is a study of 1779 healthy individuals without conventional risk factors for CVD [17]. Here the authors found that LDL-C was significantly higher among those with subclinical atherosclerosis (125.7 vs.117.4 mg/dl). However, association does not prove causation. Mental stress for instance is able to raise cholesterol by 10-50% in the course of half an hour [18,19], and mental stress may cause atherosclerosis by mechanisms other than an increase in LDL-C; for instance, via hypertension and increased platelet aggregation.”
A strong controversy has emerged about the reality of safety and efficacy of statins as stated by company-sponsored reports. However, physicians need credible data to make medical decisions, in particular about the benefit/harm balance of any prescription. This study aimed to test the validity of data on the company-sponsored statin trial by comparing them over time and then comparing statins with each other. Around the years 2005/2006, new stricter Regulations were introduced in the conduct and publication of randomized controlled trials (RCTs). This would imply that RCTs were less reliable before 2006 than they were later on. To evaluate this, we first reviewed RCTs testing the efficacy of statins versus placebo in preventing cardiovascular complications and published after 2006. Our systematic review thereby identified four major RCTs, all testing rosuvastatin. They unambiguously showed that rosuvastatin is not effective in secondary prevention, while the results are highly debatable in primary prevention. Because of the striking clinical heterogeneity and the inconsistency of the published data in certain RCTs, meta-analysis was not feasible. We then examined the most recent RCTs comparing statins to each other: all showed that no statin is more effective than any other, including rosuvastatin. Furthermore, recent RCTs clearly indicate that intense cholesterol-lowering (including those with statins) does not protect high-risk patients any better than less-intense statin regimens. As for specific patient subgroups, statins appear ineffective in chronic heart failure and chronic kidney failure patients. We also conducted a MEDLINE search to identify all the RCTs testing a statin against a placebo in diabetic patients, and we found that once secondary analyses and subgroup analyses are excluded, statins do not appear to protect diabetics. As for the safety of statin treatment – a major issue for medical doctors – it is quite worrisome to realize that it took 30 years to bring to light the triggering effect of statins on new-onset diabetes, manifestly reflecting a high level of bias in reporting harmful outcomes in commercial trials, as has been admitted by the recent confession of prominent experts in statin treatment. In conclusion, this review strongly suggests that statins are not effective for cardiovascular prevention. The studies published before 2005/2006 were probably flawed, and this concerned in particular the safety issue. A complete reassessment is mandatory. Until then, physicians should be aware that the present claims about the efficacy and safety of statins are not evidence based.
- GreenMedInfo site with abstracts on over 450 studies on adverse effects of statins
- Statins Given for 5 Years for Heart Disease Prevention (With Known Heart Disease)
Click the '%' button on the right hand side to see the percentage effectiveness of statins
Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomized controlled trials.
In which a number of people with respectable credentials and financial ties to the drug industry try to convince us that statins are good for us.
In which a number of people with respectable credentials and financial ties to the drug industry try to convince us that statins are good for us.
- Response by Malcolm Kendrick
"A number of people have asked for my views on the Lancet Paper ‘Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomized controlled trials.’ - Response by Zoe Harcombe
- A study was published in The Lancet, which was reported worldwide as “giving statins to people over the age of 75 could save thousands of lives.”
- This claim came from a press conference to launch the Lancet Paper, where a lead author, Colin Baigent, was quoted as saying: “Only a third of the 5.5 million over 75s in the UK take statins and up to 8000 deaths per year could be prevented if all took them.”
- This is false. It relies upon evidence in the over 75s for both deaths and primary prevention (people who do not already have heart disease) and neither was found.
- Figure 5 in The Lancet paper confirmed that the Rate Ratio (RR) for vascular deaths for over 75s was not statistically significant. Nor was it for those aged 70-75 for that matter. Even with the attempt to achieve a significant result, by excluding trials that failed to show benefit of statins, the RR for vascular deaths for over 75s was not statistically significant.
- Figure 4 in The Lancet paper confirmed that the RR for major vascular events for over 75s without vascular disease was not statistically significant. Nor was it for those aged 70-75 for that matter.
- This article was reported worldwide as ‘statins can save thousands of lives in the over 75s’. No statistical significance was achieved for deaths or primary prevention in this age group. The falsehoods need to be corrected.