OT - Statins and You

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Jay Aitchsee
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Re: OT - Statins and You

Post by Jay Aitchsee » Thu May 10, 2012 11:56 am

dtsm wrote: PS - NEJM article that was just published: http://www.nejm.org/doi/full/10.1056/NE ... ?query=TOC
Here’s the problem with a lot of these reports. Many of the results are given in relative percentages which really don’t give us a clue to the absolute percentages involved.
One paragraph in this report allows us to compute the absolute percentages:
Their effect also appears to be dose-dependent: the odds ratio for new-onset diabetes is 12% higher with intensive-dose therapy than with moderate-dose therapy, although there's also a 16% greater reduction in the risk of cardiovascular events. This difference in risk translates into two additional cases of diabetes but 6.5 fewer cardiovascular events per 1000 patient-years with intensive-dose statin therapy
12% higher=2/1000=0.2% absolute increase
16% relative reduction =6.5/1000=.65% absolute reduction per 1000 patient-years
Now, without regard to the “meat” of the article. I’m not sure those absolute percentages are meaningful.

And here, without percentages on the benefits of statins:
but it must be considered in the context of the simultaneous prevention of 5.4 vascular events among those 255 patients
5.4/255 equals 2.1% Or, 2 out of every hundred treated. – Significant?

I don't know.
Jay

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dtsm
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Re: OT - Statins and You

Post by dtsm » Thu May 10, 2012 1:21 pm

Jay Aitchsee wrote:
dtsm wrote: PS - NEJM article that was just published: http://www.nejm.org/doi/full/10.1056/NE ... ?query=TOC
Here’s the problem with a lot of these reports. Many of the results are given in relative percentages which really don’t give us a clue to the absolute percentages involved.
I think one needs to read not just the article but also the references as well as the actual studies cited, eg The Jupiter Study, etc. I coincidentally had came across this article and posted it as an FYI for those interested in some of the more recent research.

On a personal note, I've been using a non-statin for over 15 years: most recent, Colesevelam - which is a class of medications called bile acid sequestrants. It works by binding bile acids in your intestines to form a product that is removed from the body. I cannot use the statins due to contra-indication with my liver. Decades ago, when diagnosed with high cholesterol, I stopped red meat for one year, ate bran muffic [remember those days?],was down to less than 8% body fat, worked out daily and still had to resort to medication.

My wife does use a statin, fortunately for her on a very low dosage. Again for her, diet and exercise didn't work. Must just be our genes

And having been involved in the marketing and sales of Merck's statins when they first came out more than two decades ago, I had to read a couple of loose-leaf binders of clinical trials, peer reviewed publications as well as the pharmaceutical company produced 'propoganda'....there is lots of information to digest. Back in those years, high cholesterol had just been identified as a major risk factor for cardiovascular diseases.

Janknitz
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Re: OT - Statins and You

Post by Janknitz » Thu May 10, 2012 6:01 pm

Janknitz wrote:
Prescribing statins to anyone with a total cholesterol of over 200 and/or an LDL of over 100 has become the "standard of care". Doctors fear getting sued if they don't prescribe statin drugs and a patient later has a cardiovascular event.
DTSM replied: This is absolutely false! If your total cholesterol exceeds 200, the standard practice is to recommend control through diet and exercise. The use of statins or any other medication is not the first line of treatment.
I did not pull those statements out of a hat. Listen to this podcast where Mary Vernon, MD, explains the pressure on physicians to prescribe statins: http://www.askthelowcarbexperts.com/201 ... ry-vernon/

At about 8:01 she says “Insurance companies actually pay physicians to prescribe certain medications.” She goes on to explain that insurers use the types and numbers of prescriptions a doctor prescribes as a measure of that physician’s quality of care. So if you have a diagnosis like diabetes, the insurance company expects to see statins prescribed, regardless of HDL/triglyceride levels (or lifestyle modifications). She explains that when a physician fails to prescribe the expected number of statins then his quality of care is deemed to be inferior (insurers may look at the number of boxes checked off on a quality-assessment questionnaire rather than looking at actual outcomes). Some doctors may be very successful at getting patients to make lifestyle changes and improve their diabetes and cholesterol that way, but if they don’t check off that statin box, they are not considered to be giving quality care.

Note question after question on that podcast from people who have very good HDL, Triglycerides, and even heart scan scores, but physicians STILL want to put them on statins. I know so many people who are pressured by their physicians to go on statins because their total cholesterol is over 200 or LDL’s are over 100, regardless of any other factor. It’s a reality.

Other doctors have spoken about the pressure to prescribe statins and the potential liability they face if someone for whom they did not prescribe a statin has a cardiovascular event.

And it’s not just statins. Dr. William Davis has said that cardiologists who are successful at getting patients to adopt effective lifestyle changes may be denied financial bonuses by hospitals or their own group practices because their numbers of interventional procedures decline.

My sense (opinion here, not statement of fact) is that insurers, hospitals and others don’t really believe in “lifestyle changes”, and neither do many physicians. Why? Because they keep giving the same lifestyle advice (eat less—in particular a low calorie, low fat diet—and move more) and this advice doesn’t work in the long term for the vast majority of patients. Isn’t that the definition of insanity—doing the same thing over and over again and expecting different results?

For this reason, many physicians will give lip service to the lifestyle changes at the very same moment they are writing out the statin prescription. Physicians seem to either believe that most patients are too lazy and stupid to adopt these lifestyle changes, or—if they are willing to admit the standard lifestyle recommendations don’t work in the long term—are perplexed as to why not. Only a treasured few look beyond the conventional advice to find out why these standard lifestyle recommendations don’t work long term and to learn what does. Gary Taubes wrote an excellent piece in this week’s Newsweek magazine about this very topic.

We’ve all seen careless doctors and DME’s on this board in their approach to treating sleep apnea. Here we advocate that people educate themselves and monitor their own care. That should extend to other areas of healthcare as well. If you are a doctor you sound like a doctor who does much more than simply pulling out a prescription pad, and that’s a great thing. We can only wish that more doctors are like that.
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BlackSpinner
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Re: OT - Statins and You

Post by BlackSpinner » Thu May 10, 2012 6:31 pm

Janknitz wrote:
For this reason, many physicians will give lip service to the lifestyle changes at the very same moment they are writing out the statin prescription.
.
This is what my doctor did. I wasn't even told what my level was. I got the prescription filled and read the insert. Then I went on line and did some research. Not much, just the real websites. It didn't take much to find out that as an older woman the meds were a waste of money and could really cause problems.

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dtsm
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Re: OT - Statins and You

Post by dtsm » Fri May 11, 2012 9:58 am

Janknitz wrote:
DTSM replied: This is absolutely false! If your total cholesterol exceeds 200, the standard practice is to recommend control through diet and exercise. The use of statins or any other medication is not the first line of treatment.
I did not pull those statements out of a hat. Listen to this podcast where Mary Vernon, MD, explains the pressure on physicians to prescribe statins: http://www.askthelowcarbexperts.com/201 ... ry-vernon/
Nor did I This is the standard care recommendations from cdc.org: http://www.cdc.gov/cholesterol/what_you_can_do.htm. Medication is not the primary treatment regimen. They first recommend: diet, exercise, cessation of smoking....

What one needs to distinguish is that doctors first recommend the 'hard route', whereas patients often prefer to opt for the easy route - i.e. pop pills.

And while statins or other medications is not for everyone and should not be the first line of treatment, the clinical studies as well as the follow-up studies after more than 20 yrs of usage does clearly show the effectiveness of the various medications.

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Re: OT - Statins and You

Post by Janknitz » Fri May 11, 2012 11:04 am

And while statins or other medications is not for everyone and should not be the first line of treatment, the clinical studies as well as the follow-up studies after more than 20 yrs of usage does clearly show the effectiveness of the various medications.
Show me the studies please.
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dtsm
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Re: OT - Statins and You

Post by dtsm » Fri May 11, 2012 5:05 pm

Janknitz wrote:
And while statins or other medications is not for everyone and should not be the first line of treatment, the clinical studies as well as the follow-up studies after more than 20 yrs of usage does clearly show the effectiveness of the various medications.
Show me the studies please.
If you're seriously interested in reading the clinical literature, pm me your email address and I'll dig them up. It's been many years since I've gone through them but they can easily be found....And if you spend the time and effort to go through the cdc.gov site for their section on cholesterol, you will find plenty of reading [including the bibliography and reference sections].

Enough said on this thread...time to move on. Cheers

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Re: OT - Statins and You

Post by Janknitz » Fri May 11, 2012 7:21 pm

I am pm'ing you my email. I'll be happy to read them.
But why not post the links so others may do their own research?
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
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Re: OT - Statins and You

Post by dtsm » Fri May 11, 2012 7:41 pm

Disclaimer: I am not a medical practitioner and not dispensing advice. Please consult with your doctor.

1 General information site: http://www.cdc.gov/cholesterol/

2 Educational site for non-professionals [that's us ]: http://www.cdc.gov/cholesterol/material ... tients.htm

3 Educational site for medical professionals: http://www.cdc.gov/cholesterol/material ... ionals.htm

4 The heavy duty clinical studies [For your Mr. J, read and enjoy it,just under 300 pages] and one of the 'gold standards': ATP Guidelines. This is what doctors should follow: http://www.nhlbi.nih.gov/guidelines/cho ... /index.htm These are periodically updated.

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Re: OT - Statins and You

Post by Janknitz » Fri May 11, 2012 10:30 pm

Dtsm,

I think we got our wires crossed. You said:
And while statins or other medications is not for everyone and should not be the first line of treatment, the clinical studies as well as the follow-up studies[\b] after more than 20 yrs of usage does clearly show the effectiveness of the various medications.


I was asking for you to show me the studies, not the guidelines. People THINK the studies show the "effectiveness" of statins, but may be surprised to learn that while there are certainly a lot of studies, very few actually address Whether statins actually lower cardiovascular risk and death from cardiovascular causes (which is certainly what I think "effectiveness" of a statin should mean). You cannot make the assumption that the guidelines prove the existence of such studies because they do not. Case in point--the lack of scientific basis to support the my pyramid/my plate dietary recommendations.

You claim there are Studies that clearly show the "effectiveness" of statins, so back up your words. Show me.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

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Re: OT - Statins and You

Post by Janknitz » Sat May 12, 2012 12:16 am

BTW, with respect to the adult treatment protocol you rely on, you might find this interesting:
http://m.circoutcomes.ahajournals.org/c ... 5/1/2.full

Hayward RA, Krumholz HM. Three reasons to abandon low-density lipoprotein targets: an open letter to the Adult Treatment Panel IV of the National Institutes of Health. Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):2-5.

I'm pointing this out in particular because one of the primary reasons statins are thought to be "effective" is that they reduce LDL cholesterol. But, as this letter points out, evidence-based peer reviewed studies do not demonstrate that LDL levels are a good indicator of cardiovascular risk.

Without sufficient correlation between LDL and actual risk, are statins really "effective" at reducing cardiovascular risk???
Last edited by Janknitz on Sat May 12, 2012 12:52 am, edited 1 time in total.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

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Re: OT - Statins and You

Post by ozze_dollar » Sat May 12, 2012 12:35 am

chunkyfrog wrote:There has been some talk that taking Co-Q10 will help stave off some of the worst side effects.
Our doctor has recommended it for both of us, and periodic testing-which we do.
Since atorvastatin (Lipitor) is generic now, the Co-Q10 costs more than the RX drug.
Yep I take them. even my Cardiologist takes them. Must be good.

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Re: OT - Statins and You

Post by SleepyToo2 » Sat May 12, 2012 5:33 am

Janknitz wrote:BTW, with respect to the adult treatment protocol you rely on, you might find this interesting:
http://m.circoutcomes.ahajournals.org/c ... 5/1/2.full

Hayward RA, Krumholz HM. Three reasons to abandon low-density lipoprotein targets: an open letter to the Adult Treatment Panel IV of the National Institutes of Health. Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):2-5.

I'm pointing this out in particular because one of the primary reasons statins are thought to be "effective" is that they reduce LDL cholesterol. But, as this letter points out, evidence-based peer reviewed studies do not demonstrate that LDL levels are a good indicator of cardiovascular risk.

Without sufficient correlation between LDL and actual risk, are statins really "effective" at reducing cardiovascular risk???
Thank you for posting this link, Janknitz. It is fascinating how the pharmaceutical industry and many (but not all) doctors focus on a single parameter as being the ONLY measure to be concerned with. Hayward & Krumholz point out that it is not the absolute value of LDL that we should be focused on. It is like saying that AHI is the only parameter to be looked at in sleep apnea. We know that it is only a crude marker - you can have a good AHI and feel terrible, or have a bad AHI and feel great. There are many other things that influence AHI, but what markers are best to be used for ALL patients is still a bit of a mystery. We have a lot of clues, but do we have studies (beyond a few small studies) to back up our belief that changing the humidity will help/not help our AHI? We need to read the research, but at the end of the day we have to make a decision in consultation with our docs that is based on our own experiences/lab results/Sleepyhead (or other software) print outs.

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Re: OT - Statins and You

Post by dtsm » Sat May 12, 2012 7:35 am

1 The two pioneering clinical trials include the Framingham Study [which by the way is also the underlying clinical study for hypertension and other diseases]; this has been on-going for decades and is the gold standard.
Two sites to help understand the conclusions [sorry, I have hard copies of some of the studies but not everything]
http://en.wikipedia.org/wiki/Framingham_Heart_Study
http://www.framinghamheartstudy.org/
Related abstracts:
http://www.ncbi.nlm.nih.gov/pubmed/20370913
http://www.ncbi.nlm.nih.gov/pubmed/1515981
http://www.ncbi.nlm.nih.gov/pubmed/15673620

Pfizer sponsored clinical related to above:http://clinicaltrial.gov/ct2/show/study ... rol&rank=1

2 The other significant and more recent clinical trial [yes, sponsored by a pharma company!!!] is Jupiter - abstract here: http://www.ncbi.nlm.nih.gov/pubmed/16442935. The actual study is available in pdf format from Astrazeneca: http://www.astrazenecaclinicaltrials.com [J: i will email you a personal pdf copy to read. I do hope you will take the time to actually read it]
Some peer review of Jupiter here: http://www.ncbi.nlm.nih.gov/pubmed/19491548,

Additional abstracts [full papers have to be paid for in electronic pdf format] on include:
http://www.ncbi.nlm.nih.gov/pubmed/15161326 [good one to start with]
http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/19891279
http://www.ncbi.nlm.nih.gov/pubmed/16449520
http://www.ncbi.nlm.nih.gov/pubmed/20409895
http://www.ncbi.nlm.nih.gov/pubmed/14692706
http://www.ncbi.nlm.nih.gov/pubmed/16449520
http://www.ncbi.nlm.nih.gov/pubmed/16574035
http://www.ncbi.nlm.nih.gov/pubmed/11464448

I really don't expect anyone to actually go through the above, it's not necessary. The ATP III Guidelines does the heavy lifting for you. Will you find respected medical researchers and practitioners that will find fault with the studies or guidelines. Yes of course you will; that's why peer review is always welcomed. But to imply that treatment of cholesterol [yes, that is what some of the folks are implying by questioning the proper usage of statins or non statins] is downright silly and short-sighted. No one likes to pop pills, especially if it means for an extended period of time. And there are those who will argue that aspirin doesn't work!

This is my last post on the subject....already TMI
Last edited by dtsm on Tue May 15, 2012 8:30 am, edited 1 time in total.

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Jay Aitchsee
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Re: OT - Statins and You

Post by Jay Aitchsee » Sat May 12, 2012 9:08 am

dtsm and Janknitz, thank you both for your thoughtful posts.

Jay

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