Statins - side effects

Jdsk
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Re: Statins - side effects

Post by Jdsk »

Tangled Metal wrote:There's a family history of high cholesterol but after the NHS started checking levels of different cholesterol types my family history became low dangerous type and high good type. Seems a high good type helps keep the bad type down or so we all got told. Before the ratio was measured my mum nearly got put on statins because cholesterol was high. Not after ratio tested.

HDL cholesterol:
https://www.nhs.uk/conditions/high-chol ... ol-levels/
https://en.wikipedia.org/wiki/High-density_lipoprotein

Tangled Metal wrote:I just know it's likely to not become a real issue until I'm a lot later in life, say late 60s or early 70s.

I don't think about it that way. The underlying disease process is atherosclerosis. That's ticking away in most of us from at least our 20s. It causes most coronary artery disease, many strokes, and a whole lot of nasty other conditions. Those may present much more commonly in later life but the time to intervene and stop progression is as early as possible. And that's regardless of plasma cholesterol concentration.
https://en.wikipedia.org/wiki/Atherosclerosis

Jonathan
Jdsk
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Re: Statins - side effects

Post by Jdsk »

NB date.

New study.

"Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials"
https://www.bmj.com/content/372/bmj.n135

Conclusions
No overall effect of atorvastatin 20 mg on muscle symptoms compared with placebo was found in participants who had previously reported severe muscle symptoms when taking statins. Most people completing the trial intended to restart treatment with statins. N-of-1 trials can assess drug effects at the group level and guide individual treatment.


Jonathan
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simonineaston
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Re: Statins - side effects

Post by simonineaston »

Good News! I must surely be getting to the stage where statins might be prescribed...
S
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nez
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Re: Statins - side effects

Post by nez »

Jdsk wrote:Plasma total cholesterol typically has a within-individual coefficient of variation of about 5 to 10%. That's considerably larger than the effect of mild dehydration. Unidentified variation in hydration is included in the first figure.

It would probably be statistically impossible to distinguish between the two from only two analyses.

(Of course this variation is a major problem when the guidelines have strict thresholds for classification, risk assessment or offering treatment.)

Jonathan

PS: Anyone who could invent a convenient spot test for dehydration would be doing a great clinical service, and might make a fortune if they were so inclined.

As a sailor it’s pretty obvious - your pee goes dark
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mjr
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Re: Statins - side effects

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Jdsk wrote:New study.

"Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials"
https://www.bmj.com/content/372/bmj.n135

"Participants were recruited from general practices" — so none of the more serious cases, who would be under hospital clinic care.

"excluded participants with previously raised levels of serum alanine aminotransferase (≥3 times the upper limit of normal), with persistent, generalised, unexplained muscle pain (whether or not associated with the use of statins) and levels of creatine kinase five times or more the upper limit of normal" — so this study excludes some people who stopped or were stopping statins because of unexplained muscle pain, or because of two possible explanations for muscle pain?

"A common criticism of large placebo controlled trials of statins is that patients most likely to experience side effects are not included" — and yet, despite stating that, they do not directly address the above exclusions.

I would probably not have been recruited in the first place (due to being under hospital care not GP) but would have been excluded anyway by the report of unexplained muscle pain and one of my CK test results.

There also seems to be no attempt to measure and control for physical activity. My problems manifested themselves more when I tried to do more (at least my two worst episodes came while cycling uphill) and my reading suggests that this isn't unusual. It's a pretty powerful discourager, too, so if you are fearing muscle pain, maybe you do less?

Due to the above limitations, I'm not sure this tells us much useful about people who report severe muscle pain while taking statins. It is disappointing that the above design choices were not challenged before deployment.

The linked opinion is pretty insulting IMO, implying many reports are due to the "nocebo effect". It certainly wasn't for me. I expected statins to work. My father took Zocor for years without much obvious trouble. My doctors expected statins to work and I think most of them disregarded the side-effects, so it took years for my deteriorating mind and body to be linked to statins. Even then, I was very sceptical and kept a notebook of statin usage and muscle pain attacks primarily hoping to show the well-established statins were not the cause and I could continue taking them! Because since then, I've been on a treatment rollercoaster...

What I can't tell you is how common statin muscle problems are. Some of my relatives have suffered side-effects, even some who didn't know my troubles before, but I suspect that is understandable, as there are some genetic markers even flagged up as likely statin intolerance in some commercial DNA tests now.

I don't think a stream of selective-participant studies really help us work out the size of this problem, either!
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Jdsk
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Re: Statins - side effects

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mjr wrote:
Jdsk wrote:New study.

"Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials"
https://www.bmj.com/content/372/bmj.n135

"Participants were recruited from general practices" — so none of the more serious cases, who would be under hospital clinic care.

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.

The requirement for eligibility of having stopped or considering stopping the stain would be expected to include patients with more severe symptoms.

Jonathan
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Mick F
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Re: Statins - side effects

Post by Mick F »

I must state here and now, that being on 80mg of Atorvastatin for ten years gave me headaches like you wouldn't believe. Only "cure" was going to bed and taking co-codamol. I became like a zombie.
Muscle aches too.

I stopped taking the damned statins as an experiment. All symptoms went.
Went back on them, and all symptoms came back.
Statins?
Shove them! :shock:

I'm now on injections every fortnight.
No symptoms whatsoever.
Read all my posts on this subject.

Due my 119th injection on the 5th of March. I inject myself every other Friday.
Mick F. Cornwall
Oldjohnw
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Re: Statins - side effects

Post by Oldjohnw »

And I have had 40mg for 25 years. No problems. I ache a little sometimes. Always assumed it was the tablets and was so advised by GP. But perhaps not.

If, as seems the case, they have kept my otherwise high cholesterol level down, then hurrah for statins,
John
nez
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Re: Statins - side effects

Post by nez »



Thanks Jonathan. I'm sure there are all kinds of qualifications to the observation, but you know, Occam's razor.
Jdsk
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Re: Statins - side effects

Post by Jdsk »

I don't think that cuts here... more, please.

We've all observed the colour of our own urine. Most men do it most times they urinate.

It's the step from that observation to getting reliable information on dehydration where the evidence is missing. And I'd separate two situations: serial observations on the colour of your own urine, and use as a clinical test where the observer doesn't know what it looked like in the past. The second is probably more of a challenge.

Jonathan
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Re: Statins - side effects

Post by mjr »

Jdsk wrote:
mjr wrote:
Jdsk wrote:New study.

"Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials"
https://www.bmj.com/content/372/bmj.n135

"Participants were recruited from general practices" — so none of the more serious cases, who would be under hospital clinic care.

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.

The requirement for eligibility of having stopped or considering stopping the stain would be expected to include patients with more severe symptoms.

Freudian slip or autocorrect? "stain" :)

I would expect most of those with more severe symptoms would have been excluded by the "the general practitioner considered unsuitable to participate" exclusion, unless the GP really thought they were imagining it.
MJR, mostly pedalling 3-speed roadsters. KL+West Norfolk BUG incl social easy rides http://www.klwnbug.co.uk
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mjr
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Re: Statins - side effects

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Mick F wrote:I'm now on injections every fortnight.
No symptoms whatsoever.
Read all my posts on this subject.

Due my 119th injection on the 5th of March. I inject myself every other Friday.

I'm glad it's still working for you. Half my skin lost cohesion on the injections and I'm still trying to regrow it all.

And I'm glad if the statins work for some people too.

I just wish people would stop apparently trying to prove that they work for everyone.
MJR, mostly pedalling 3-speed roadsters. KL+West Norfolk BUG incl social easy rides http://www.klwnbug.co.uk
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Jdsk
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Re: Statins - side effects

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mjr wrote:
Jdsk wrote:
mjr wrote:"Participants were recruited from general practices" — so none of the more serious cases, who would be under hospital clinic care.

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".

Jonathan

PS: Thanks for pointing out my mistake.
Jdsk
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Re: Statins - side effects

Post by Jdsk »

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?

Thanks

Jonathan

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
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