[Home] [Headlines] [Latest Articles] [Latest Comments] [Post] [Sign-in] [Mail] [Setup] [Help]
Status: Not Logged In; Sign In
|
Health See other Health Articles Title: The Statin Dilemma: a Primer for Patients Yahoo Statins have redefined the treatment of heart disease. Statins work by halting or reducing the buildup of fatty plaque inside blood vessels, a condition known as atherosclerosis, chiefly fueled by abnormally high cholesterol and the leading cause of heart attacks and strokes. A true game changer in our fight against these mass killers, statins have prevented the recurrence of heart attacks and strokes in countless patients afflicted by cardiovascular illness. Yet using them in those with elevated cholesterol but no history of heart attack or stroke -- the so-called primary prevention -- still causes trepidation in many patients and some physicians. This shouldn't be the case. Here's what you should know to make the right choice. The Statin Score Card: Prevention vs. Treatment Statins get high marks in both categories. Study after study has shown they not only prevent first and subsequent heart attacks and strokes, but also reduce the number of deaths from both first and subsequent cardiovascular events. In fact, among people with high cholesterol with no history of heart attack or stroke, statins slash deaths over five years by as much as 20 percent, research shows. And while mortality has been traditionally used as the most critical gauge for a drug's efficacy, it is by no means always the most important one, especially in light of the fact that 85 percent of heart attacks and strokes are nonfatal. Preventing the nonfatal yet devastating aftereffects of heart attacks and strokes is an equally important yardstick of therapeutic success. People who survive a heart attack can suffer a range of consequences -- some of them serious and some downright catastrophic -- including loss of cardiac muscle function that severely limits a patient's quality of life and can precipitate heart failure. Preventing nonfatal heart attacks and strokes is an essential goal of statin therapy. Research involving more than 100,000 participants shows that statins can greatly reduce nonfatal heart attacks and strokes, repeat hospitalizations and invasive procedures such asballoon angioplasties, stent placement and open-heart surgery, among others. Atherosclerosis -- the main culprit behind cardiovascular illness -- is a slow process that occurs over many years, giving clinicians ample opportunity to halt or slow its progression and ward off its most devastating consequences. Starting a statin after a heart attack or a stroke in many cases signals an opportunity missed. Here are some of the most common questions we get in our clinic. Q: I have high cholesterol, but I am healthy otherwise. Should I take a statin? A: Not necessarily. First and foremost, know your cardiac risk score, a complex formula that, in addition to cholesterol, factors a patient's age, weight, gender, smoking and medical conditions such as diabetes and high blood pressure, which are known to fuel cardiovascular damage. While the latest guidelines of the American College of Cardiology and the American Heart Association call for statin use in people who have an estimated 10-year risk of heart attack or stroke of 7.5 percent or higher, we caution our patients that there is no magic number that perfectly predicts their risk. Instead, their score should be a conversation starter. Clinicians should consider additional variables, including family history, fitness level, lifestyle and patient preference. Some patients have borderline risk that makes decisions tricky, so it is essential to further individualize risk via additional testing. A new test that non-invasively measures the amount of calcified plaque inside the heart's arteries can be an excellent risk predictor, often foretelling the likelihood of heart attacks with comparable or greater accuracy than other standard tests. Another valuable, cheap and simple approach can be using an ultrasound to measure the thickness of the carotid arteries in the neck, critical supply routes that deliver blood to the brain. Above all, people with borderline scores or those who hesitate to take statins greatly benefit from ongoing conversations -- that, we feel, should carry over multiple clinic visits to help them make the best decision. Given that cardiovascular disease kills more people than any other illness, we deem this one of the most critical discussions to have with our patients. Q: What about all the terrible side effects of statins I keep hearing about? A: Most patients tolerate statins remarkably well so the bad rap these drugs get is more often than not inflated or downright undeserved. Serious side effects, if and when they do occur, should prompt rapid dose adjustment or treatment cessation. The most important thing you can do is swiftly report any new or worsening symptoms to your physician. -- Statins and diabetes. While some reports show higher risk of diabetes among statin users, the totality of current evidence tells us that statins do not cause but rather tend to unmask preexisting diabetes. Statins can also accelerate the development of disease in those already on their way to develop it. It is true that statins can cause small spikes in blood sugar in predisposed people, but regular exercise and even minimal weight loss can help keep pre-diabetes in check. If you have been diagnosed with glucose intolerance -- a condition that often heralds the onset of diabetes -- your physicians can help you balance the risk and benefits of statin treatment. -- Statins and memory. There is scarce evidence that statins fuel dementia. The opposite may be true. Emerging evidence indicates that statins can preserve cognitive function by preventing the brain damage that often accompanies strokes. -- Statins and muscles. Muscle damage is a genuine concern but, fortunately, is truly rare and often reversible. Mild muscle pain is relatively common and typically harmless. In the absence of symptoms, your physician should check your muscle function within three months of starting a statin. If you develop new or worsening muscle ache, talk to your doctor promptly. Q: I already take a statin so it's OK for me to indulge a bit and not worry too much about exercise, right? A: Wrong. Statins are important weapons in our armamentarium against cardiovascular disease, but alas, they are no silver bullets. No pill, no matter how effective, can replace diet and exercise, which, along with smoking cessation, remain the foundation of heart disease prevention. These are cheap, readily available precautions that require no prescription -- and virtually free of any ill effects -- that all of us should take, regardless of risk profile. Q: I've heard news about cholesterol-lowering drugs called PCSK9 inhibitors. How do they fare against statins? A: PCSK9 inhibitors are quickly emerging as the new kid on the block of cholesterol-lowering drugs. These medications reduce bad cholesterol in a different way from statins. Recent clinical trials show a whopping 50 percent reduction in bad cholesterol. In addition, people taking these drugs were 50 percent less likely to have heart attacks and strokes than those taking placebo. And while we are watching these medications closely with a great deal of enthusiasm, we remain guarded in our optimism. For one, PCSK9 inhibitors are given via injection rather than a pill, and most patients will need to make periodic trips to the doctor's office. Second, they are considered experimental, and we have yet to glean the full scope of their therapeutic benefits and possible downsides through more and larger trails. Until then, we tell our patients to "stay tuned for more." Dr. Tolulope Adesiyun is a cardiologist and a research and clinical fellow at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Her research interests include heart failure and atherosclerotic heart disease. Poster Comment: The Captain There's always something more "natural" to take before you take chemical "statins". The poor pharmaceutical industry persuaded the FDA to take a stand against red yeast rice, which works much better than statins-without any side effects. Now, t's hard to find red yeast rice that still has the original medicinal properties, because the drug companies patented the compound! 16-2 A perspective from a doctor and drug developer: The comments here illustrate the central misunderstanding about the pharmaceutical industry and the FDA – and the essential PR problem that the industry has. The fact is, many of the drugs now developed and marketed by the Pharma industry (statins are a good example) are not designed to “treat” or “cure” illness – they are designed to prevent illness. And most of these drugs actually do “work” – that is, one can demonstrate statistically that the incidence of the prevented disease is lower in populations that take the drug compared with matched populations that don’t. The problem however, is that ALL drugs have side effects in at least a few people, some of which can be serious or even fatal. Moreover, no drug is ever 100% effective, sometimes in part because people don’t take it regularly, or as directed. This requires physicians (for their patients) and regulators (for the population as a whole) to make a risk/benefit judgment: Is the reduction in the risk or incidence of the disease in question worth the additional risk of the side effects? People seem to believe that a marketing approval from the FDA is some sort of guarantee that a drug is “safe” (as though “safety” – of drugs or anything else – were ever an absolute yes/no question). What it actually means however is that, based on all the available data from adequate and well-controlled clinical trials, the agency has concluded that the drug’s benefits to patients (ALL patients) substantially outweigh its risks. (In my professional opinion, this is not a judgment that most laymen are trained, knowledgeable or qualified to make – which is why, despite being a drug developer myself, I am opposed to direct-to-consumer advertising of prescription drugs. The US is virtually the only western country that permits this. For me, it is no coincidence that decline in the reputation of the Pharma industry dates to the onset of DTC ads). But from the lay consumer perspective, a drug that prevents an illness – even a serious illness – confers a nebulous benefit, while any adverse effects are very tangible. Consider a hypothetical drug that could help prevent cancer or some other very serious disease. Suppose this same drug also causes a slight increase in the risk of, say, heart attacks (assume for the moment that many more cancers are "prevented" than heart attacks “caused”). At the end of the day, if you DON’T get cancer while taking this drug, you can’t know if you might have been spared anyway, even without the drug. But if you DO get a heart attack, you will certainly “blame” the drug – even though people who are not on the drug also get heart attacks all the time. (“$$$! Have you or a loved one suffered a heart attack while taking NewDrug? You may be entitled to substantial cash compensation! Call the law firm of Ambulance Chasers-R-Us at 1-800-SUE-THEM and speak to an experienced attorney to protect your legal rights.”) This is the dilemma of all drugs designed to “prevent” illness. Unless they are squeaky clean (the drug with zero risk has yet to be invented – and that includes vitamins and “all natural” health food “supplements” with their nebulous or questionable efficacy), people just do not understand the risk/benefit equation – which is evident in the treated population as a whole, but not in any one individual. We pay lip service to “preventative medicine” but in the real world, it is extremely difficult – not for scientific, but for political and “human nature” reasons. Rockman the side effects of these are NOT overblown, contrary to whoever wrote this garbage. Every person I have ever known who took these including me had moderate to severe side effects. These wonder drugs caused permanent neuopathy in both feet as just one of about six different side effects I had from this poison. 30-5 MikeThe government doctors promotion of the low fat diet has been a 60 year farce. It's the inflammatories that cause the damage. All drugs have side effects. Your best bet is to get rid of all your drugs. Find a real doctor that knows about health maintenance and is not just a drug pusher. Doctors are not trained in medical school to do this so you have to look for a doctor that has learned body maintenance on his own.. BTW. I'm not suggesting to anyone to just drop their drugs. I'm suggesting that you find a doctor who knows how to allow your body to fix itself through nutrition/supplementation and the right exercise that can produce drug free longevity. Dementia, Alzheimer's diabetes heart disease cancer is rampant and drugs are not the answer. The longer you wait the more you must depend on drugs, not for health but just for survival and that's not living..36-1 Post Comment Private Reply Ignore Thread
|
||
|
[Home]
[Headlines]
[Latest Articles]
[Latest Comments]
[Post]
[Sign-in]
[Mail]
[Setup]
[Help]
|
||