Statins - side effects

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mjr
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Re: Statins - side effects

Post by mjr »

Jdsk wrote:
mjr wrote:
Jdsk wrote:That doesn't follow. Recruitment of patients from general practice could include those who were also under the care of or who had ever seen someone in secondary care.

It does follow because they were "recruited opportunistically when they complained of symptoms during a consultation". If you are under hospital care, you complain to the hospital clinician about symptoms arising from their medication, not your GP.

That's a selective quotation, the other inclusion criterion was "or had stopped taking a statin in the last three years because of muscle symptoms".

...which if you click through to the Appendix 3, you'll see that was identified by searching GP records, not hospital records. I do check this stuff, you know!

PS: Thanks for pointing out my mistake.

You did it again. :)

Jdsk wrote:
mjr wrote: I just wish people would stop apparently trying to prove that they work for everyone.


I'm not aware of anyone ever saying that. Do you have any examples?

Of course they don't say that, else the study would be criticised, but things like a study of muscle symptoms from statins that excludes loads of people who have had muscle symptoms from statins appears to be doing that.

PS: Primary prevention with stains is one of the textbook examples of how many people have to be treated to benefit one, eg:
https://en.wikipedia.org/wiki/Number_needed_to_treat

Yes, it makes nice neat textbook examples if you ignore loads of the disbenefits, such as non-cardio adverse events in that example.
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Jdsk
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Re: Statins - side effects

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mjr wrote:...which if you click through to the Appendix 3, you'll see that was identified by searching GP records, not hospital records. I do check this stuff, you know!

If a patient stopped taking statins because of symptoms attributed to them that would usually be recorded in the GP's records regardless of whose care they were under at the time.

Therefore that information could be used to assess eligibility for this study.

Jonathan
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Re: Statins - side effects

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mjr wrote:
Jdsk wrote:
mjr wrote:I just wish people would stop apparently trying to prove that they work for everyone.

I'm not aware of anyone ever saying that. Do you have any examples?

Of course they don't say that, else the study would be criticised, but things like a study of muscle symptoms from statins that excludes loads of people who have had muscle symptoms from statins appears to be doing that.

OK... so no-one has ever said that.

And this study wasn't about efficacy, it was about adverse effects. And it restricted itself to people who had symptoms without established myopathy. That's a lot of people. And it's a very clever study that helps to fill a gap in our knowledge.

Jonathan
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Re: Statins - side effects

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Jdsk wrote:
mjr wrote:...which if you click through to the Appendix 3, you'll see that was identified by searching GP records, not hospital records. I do check this stuff, you know!

If a patient stopped taking statins because of symptoms attributed to them that would usually be recorded in the GP's records regardless of whose care they were under at the time.

Therefore that information could be used to assess eligibility for this study.

I accessed my GP records and I don't see how any search is going to distinguish this discontinuation due to symptoms from one due to insufficient effect or replacement by more powerful medication: "Seen in other clinic (9N1y.) (Ongoing Episode) Pravastatin 20mg tablets - 28 tablet - take one at night for cholesterol Ended [DATE REDACTED] Clinical grounds by Dr [NAME REDACTED]"

If you want the detail, you have bring up a scan of a paper letter from the clinic to the GP, which is a graphic and not readily searchable. There's also no indication in Appendix 3 that the researchers did that level of drilling.

How do prescription discontinuations by specialist clinics appear in your GP records, then?
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Re: Statins - side effects

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mjr wrote:There's also no indication in Appendix 3 that the researchers did that level of drilling.

I suggest that you ask them directly.

Correspondence to: L Smeeth, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
statinwise@lshtm.ac.uk


Jonathan
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Re: Statins - side effects

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There seems little point asking them about a claim they never made. They have been quite clear how patients were selected and it is a method which will obviously exclude many people reporting real muscle side effects.

The patients included seem to be primarily those with unexplained mild or moderate symptoms who have not yet been referred to specialists in line with NICE Clinical Guideline 71 ("1.3.1.14 Adults with FH with intolerance or contraindications to statins or ezetimibe should be offered a referral to a specialist [...]") or the equivalent in CG181 — those not that far along this path, basically. As a result, the short-term outcomes are not surprising.
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Re: Statins - side effects

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Just had my 139th injection.
Once a fortnight, makes it nearly five and a half years. Still no side effects and when I've had a cholesterol blood-test, they don't even contact me with the results ....... so they must be fine.
Mick F. Cornwall
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Re: Statins - side effects

Post by joeegg »

I take the 80mg Atorvastatin every day following a triple bypass about 6 months ago.
I do get muscle ache,normally in my back,but because of the other tablets i take i can't pin it down to one medication.
I also suffer from mild breathlessness and can't get a heart rate above 130.
My cholesterol level at the time of the operation was 6, so not severely high,however there is a family history of strokes and heart attacks. My lifestyle definitely did not contribute to my blocked arteries.
I expect to be on statins for the rest of my life,more as a precaution.
A friend,who is a medical professor,believes statins should be given automatically to people with a family history of heart disease and by doing so could prevent severe illness further down the line.
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Re: Statins - side effects

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joeegg wrote: 26 Dec 2021, 6:30pm A friend,who is a medical professor,believes statins should be given automatically to people with a family history of heart disease and by doing so could prevent severe illness further down the line.
Until we can reliably predict the people who will suffer adverse effects, that would be causing harm to many, so surely must be against medical ethics principle of doing no harm.
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Re: Statins - side effects

Post by joeegg »

If you broadened the principal of medical ethics with regard to do no harm then that would exclude chemotherapy treatment. And hundreds of other treatments that have side effects.
If cholesterol can be reduced naturally all well and good. But family history plays a part where high cholesterol is inherited. In these cases statins may be appropriate and the benefits could substantially outweigh any mild side effects.
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Re: Statins - side effects

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joeegg wrote: 28 Dec 2021, 7:51am If you broadened the principal of medical ethics with regard to do no harm then that would exclude chemotherapy treatment. And hundreds of other treatments that have side effects.
Nobody is suggesting chemotherapy for everyone automatically, are they?
If cholesterol can be reduced naturally all well and good. But family history plays a part where high cholesterol is inherited. In these cases statins may be appropriate and the benefits could substantially outweigh any mild side effects.
And what about the severe side effects? Memory loss and muscle spasms, to name just two I suffered.

Keep them for the people who show high cholesterol test reading even after lifestyle and diet changes, plus show genetic test results suggesting statins should work and even then, be cautious and keep monitoring. No more prescribing them almost blind and unmonitored!
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Re: Statins - side effects

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joeegg wrote: 28 Dec 2021, 7:51am .......... statins may be appropriate and the benefits could substantially outweigh any mild side effects.
Mild side effects?

I'm the OP.
Read the first seven or eight pages.

Statins?
As far as I'm concerned, I don't want them anywhere near me ever again.
Mick F. Cornwall
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Re: Statins - side effects

Post by joeegg »

Are you saying that statins are prescribed routinely for people who have no cholesterol problems. If so,thats ridiculous. You had bad side effects and stopped taking them . Lots of other people probably have limited side effects which don't interrupt their daily life. Should they stop taking them because of your side effects ?
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Re: Statins - side effects

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joeegg wrote: 5 Jan 2022, 4:46pm Are you saying that statins are prescribed routinely for people who have no cholesterol problems. If so,thats ridiculous. You had bad side effects and stopped taking them . Lots of other people probably have limited side effects which don't interrupt their daily life. Should they stop taking them because of your side effects ?
I'd add "or no" to "limited".

Jonathan

PS: But it isn't really "cholesterol problems". Current practice is based on the evidence for reduction of cardiovascular disease and events.
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Re: Statins - side effects

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joeegg wrote: 5 Jan 2022, 4:46pm Are you saying that statins are prescribed routinely for people who have no cholesterol problems. If so,thats ridiculous.
Ridiculous but that's what happening. Based on what I've experienced and been told by many friends and family that I trust, many GPs are disobeying NICE Clinical Guideline 181 and prescribing what they call "high intensity" statins after a single high cholesterol reading, with no ramping-up, without even attempting diet and lifestyle modifications and often without even taking a full lipid profile, with the only risk assessment being the QRISK2 calculator.

Oh and thanks to recommendation 1.1.14 of that Guideline, people who doctors consider working class (like most of my family) are more likely to be given statins than toffs!
You had bad side effects and stopped taking them . Lots of other people probably have limited side effects which don't interrupt their daily life. Should they stop taking them because of your side effects ?
Not if they need them after improving their diet and lifestyle — but even then, their blood should be retested every 3 months at first and annually once it settles down, as stated by recommendations 1.3.28 onwards and frequently not done. Then far more side-effects will be diagnosed before they ruin people's lives.

Also, I didn't simply stop taking them. I consulted experts, stopped, restarted, was tested extensively (including genetic tests eventually) and tried pretty much every dosage of every statin still used. Eventually, even the lowest dose of the lowest-intensity statin had me stopping the bike in tears at the deep sickening pain in my knees. Of course, I could just have given up cycling and other physical activity instead, kept taking the statins and professed to "have limited side effects which don't interrupt [my] daily life", but I don't believe that would end well!
Jdsk wrote: 5 Jan 2022, 4:49pm PS: But it isn't really "cholesterol problems". Current practice is based on the evidence for reduction of cardiovascular disease and events.
Current guidance may be based on that, but current practice is not following it!
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