Statins?

[KnottedYet]

People who actually have heart disease DO benefit from statins. There's no disputing that fact. So Crankin's DH is the perfect example of someone who should be on them.

A healthy person who has no signs of heart disease and whose only reason for taking statins is "numbers" is not going to benefit, as studies have shown repeatedly.

If someone comes in with heart palpitations, is the doctor immediately going to burn out her AV node and hook her up with a pacemaker? Or is the doctor going to look at her lifestyle and tell her to stop drinking her customary 3 pots of coffee a day? If she has a malfunctioning AV node, surgery and an implanted pacemaker would be appropriate. If someone has heart disease, statins are appropriate.

But just as the numbers of someone's heart rate don't tell the whole story, nor do the numbers of someone's cholesterol. We are told over and over again to treat the patient, not the test result. IMHO statins are over-prescribed because doctors know their patients aren't going to change their lifestyle and they are afraid of being sued when the patient gets ill if they haven't done SOMETHING to treat the "problem."

Irresponsible patients and terrified doctors in a profit-driven system are a bad combination.

[Jolt]

People who actually have heart disease DO benefit from statins. There's no disputing that fact. So Crankin's DH is the perfect example of someone who should be on them.

A healthy person who has no signs of heart disease and whose only reason for taking statins is "numbers" is not going to benefit, as studies have shown repeatedly.

If someone comes in with heart palpitations, is the doctor immediately going to burn out her AV node and hook her up with a pacemaker? Or is the doctor going to look at her lifestyle and tell her to stop drinking her customary 3 pots of coffee a day? If she has a malfunctioning AV node, surgery and an implanted pacemaker would be appropriate. If someone has heart disease, statins are appropriate.

But just as the numbers of someone's heart rate don't tell the whole story, nor do the numbers of someone's cholesterol. We are told over and over again to treat the patient, not the test result. IMHO statins are over-prescribed because doctors know their patients aren't going to change their lifestyle and they are afraid of being sued when the patient gets ill if they haven't done SOMETHING to treat the "problem."

Irresponsible patients and terrified doctors in a profit-driven system are a bad combination.

I would tend to agree with this. For people who already have heart disease, or who have a genetic problem with very high cholesterol levels, statins are helpful. For others, I would really prefer to see lifestyle changes tried first...but unfortunately too many patients aren't willing to cut down on the junk food, eat more fruits, veggies, whole grains, healthy fats and fish, exercise more, and stop smoking. Instead they would rather look for the "quick fix" and take a pill, even though that pill has side effects as do all medications whereas eating better and exercising will only have positive effects--not only on cardiovascular health but on other aspects of health as well. You're also right about the "cover your butt" aspect playing into it in some cases.

[Crankin]

I guess my cautionary tale is, how does the OP know she does NOT have heart disease, given her family hx? Up until my DH was on the table for the angioplasty, no one believed him (you ride 4,000 miles a year and you are thin). I am sure the blockages were there long before the symptoms. I am not advocating she get surgery, but if she wants to stop the drugs and try something like niacin or Metamucil, I would get a stress test with IV contrast dye, to rule out anything. I tend to want aggressive treatment for anything, and heart disease scares the crap out of me. Enough to keep me on the straight and narrow in terms of my eating and activity.
I totally agree that people want a pill to fix everything. It is difficult to believe the amount of non-compliance I see as a therapist, and not just with psychotropic drugs. I mean compliance with all medication.

[goldfinch]

For a discussion on using statins for primary prevention of cardiac events: http://www.sciencebasedmedicine.org/...chrane-review/

My read of this evidence is that there is solid evidence that statins have a real benefit for primary prevention. This benefit is small, which is exactly what I would predict for a preventive measure in a low-risk population. The data also show that statins are safe. The major risk is for the development of an inflammatory muscle disease, but that is very rare. For interventions that prevent death – that lower mortality – I think even small benefits are worthwhile. Further, having a heart attack or stroke, even if it is not a fatal event, has a very negative effect on quality of life. Taken together, one person per year out of several hundred taking statins for primary prevention will avoid a heart attack, stroke, or death. From a purely medical point of view, that sound pretty good to me.

What seems reasonable is to use statins for primary prevention in those who have some risk factors for vascular disease, in patients with genetically high cholesterol, and in those with high cholesterol or significant risk factors in whom lifestyle counseling has not yielded adequate results. Try diet and exercise first – and always in conjunction with medication, but statins are a reasonable choice in selected patients, even for primary prevention. We could use more studies to better delineate where to draw that line, but that will be difficult as any difference in outcome is likely to be slight and therefore massive trials will be needed to get statistically significant results.

[pll]

@goldfinch: That is very nicely written article you linked to. Very interesting site, altogether. Thank you!

[smittykitty]

Thanks ladies. Lots of good info pro and con for Statins. Tough to know what to do. Would love to not take them, but what if I'm the one who really needs them I will seriously continue to give it more thought. In the mean time I will put some real effort into more exercise and no ice cream Sure wish I could see into the future!

And yes, I think my MD tends to over prescribe, but then again, I've seen my numbers!!!

And yes, we did get in a nice ride! Rode yesterday too! Always a bonus this time of year. My FX is on loan (up near the wonderful Centennial Trail!) and Ruby is made of Sugar, so she can't get wet! (She's so Sweeeet!)

Thanks again for everyone's insight.

[OakLeaf]

Here's a review of a book talking about medical consumer decisionmaking in general. I haven't read the book yet, but it's a subject I take a great interest in both personally and intellectually. https://www.nytimes.com/2011/10/09/b...tml?ref=health I think it's always important not only to be fully informed before making important decisions, but also to understand what your ultimate goals are, and this is what the book is supposed to address.