statin

The Real Reason to Take a Statin

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“Why should I take a cholesterol medication if my cholesterol isn’t high?”

This is a question I heard recently from a new patient, Greg (not his real name, of course). Greg’s seeing me because he had a heart attack a year ago, and he wants to make sure he’s doing everything he can to prevent another one.

Overall, Greg’s doing quite well. He’s active, he quit smoking. and he’s taking his blood pressure medications as directed. However, he stopped the cholesterol medication because he didn’t think he needed it. As far back as he can remember, his doctors have told him his cholesterol numbers are good. Why would he need a cholesterol med if his cholesterol was OK?

He was surprised when I recommended that he start taking his cholesterol medication again.

What are Statins?

The medication that Greg had stopped was a statin. Statins are commonly referred to as “cholesterol medications” and are one of the most prescribed medications in the world. They are also one of the most controversial. There is a lot of debate about who should be taking a statin medication. While there are passionate people on both sides, often the “right” answer is mostly dependent on the goals of the patient. It’s my role to explain the risks and benefits of taking a statin. And, while I don’t tell the patient what to do, I do emphasize that countless studies have proven that statins do decrease the risk of heart attack, stroke, and death in those who are at high risk for heart disease.

They’re Not Just for Cholesterol

Why did I recommend that Greg restart his cholesterol med if his numbers were good?

There are 3 reasons:

1)    What is defined as “good” cholesterol numbers depend on the patient’s risk.  Cholesterol numbers that are perfectly acceptable in a young person with no risk factors, might not be acceptable in someone with a high risk of heart disease.  Greg had a heart attack in the past, which puts him in a high-risk group.

2)    It’s not just about lowering cholesterol numbers, but HOW the cholesterol is lowered. Although we call statins “cholesterol meds”, what we primarily use them for is to lower the risk for future heart attack and stroke. This is an important point because not all cholesterol medications are the same. Some (such as some niacin-based medications), make cholesterol numbers look better, but don’t change risk and are rarely used.

3)    Statins have been shown to lower risk even in those with normal or low cholesterol numbers. Rather than “cholesterol meds”, statins would be more appropriately called “risk meds”.

Once Greg understood why he was prescribed a statin (not just to lower his cholesterol, but more to lower his risk for future heart attack and stroke), he was glad to start taking it again.

Statins myth: thousands are dying because of warnings over non-existent side effects

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False claims about the risks of statins may have cost the lives of tens of thousands of Britons, researchers have said, after a Lancet study found the drugs do not cause side-effects which have deterred many.

The research on 10,000 people found that if they did not know what drugs they were given, they were no more likely than those given sugar pills to report symptoms such as muscle pain, sleep disturbance and cognitive impairment.

Yet when participants in a second part of the trial were told the drugs were statins, rates of some reported side-effects shot up – with muscle pain appearing up to 41 per cent more common.

Last night the study’s lead author accused British medicines regulators of “jumping the gun” in ever listing such side-effects on drug packaging.

Prof Peter Sever, from Imperial College London, urged the Medicines and Healthcare Products Regulatory Agency (MHRA) to now strip packets of such warnings, in order to save “tens if not hundreds of thousands of lives”.

There are people out there who are dying because they’re not taking statins, and the numbers are large, the numbers are tens of thousands, if not hundreds of thousandsProf Peter Sever, Imperial College London

He said it was a “tragedy” akin to the MMR scandal that high risk patients had been deterred from taking drugs which could save their lives. Urging patients not to “gamble” with the risk of heart attacks and strokes, he said “bad science” had misled the public, deterring many from taking life-saving medication.

The study of patients at risk of heart disease, found that those told that their daily drug was a statin were far more likely to think they were suffering side-effects.

Researchers said it illustrated a “nocebo effect” which meant patients were more likely to think they were experiencing side-effects if they expected them.

As a result, daily aches and pains were more likely to be attributed to statins.

The phenomenon is the opposite to the well-known placebo effect, the beneficial response sometimes experienced by those given “dummy” drugs as part of trials.

NHS guidance recommends the cholesterol-busting drugs for around 40 per cent of adults.

But a number of doctors have argued against “mass medicalisation” saying too many pills are being doled out instead of efforts to improve lifestyles.

The new study suggests millions of patients could benefit from high doses of statins

Prof Sever said many of those arguing against statins had exagerrated risks such as muscle pain, which were not backed by the new study, the largest ever research into their side-effects.

In 2009, the MHRA listed such side-effects on packaging for statins, after a series of observational studies suggested such links.

Prof Sever said the regulator should never have taken such action.

“There are people out there who are dying because they’re not taking statins, and the numbers are large, the numbers are tens of thousands, if not hundreds of thousands. And they are dying because of a nocebo effect, in my opinion,” he said.

“Many of us would say that the MHRA … did not make a profound value judgment based on the evidence,” the professor said.

“We would hope that the MHRA will withdraw that request that these side effects should be listed.”

He added: “These warnings should not be on the label … I would love to see these side effects removed.

A spokesman for the MHRA said: “The benefits of statins are well established and are considered to outweigh the risk of side-effects in the majority of patients.”

“Any new significant information on the efficacy or safety of statins will be carefully reviewed and action will be taken if required, including updates to product labelling.”

The study’s researchers said statins were not without any side-effects. Statins carry around a 9 per cent increased risk of diabetes, they said, with links to uncommon side effects such as myopathy, resulting in muscle weakness.

Even so, the benefits of the drugs in reducing risk of heart attacks and strokes “overwhelmed” the risk of side-effects, Prof Sever said.

Speaking of the nocebo effect, he said: “Just as the placebo effect can be very strong, so too can the nocebo effect.

“This is not a case of people making up symptoms, or that the symptoms are ‘all in their heads’. Patients can experience very real pain as a result of the nocebo effect and the expectation that drugs will cause harm.”

The study was funded by drug company Pfizer, which makes statins, but the authors said all data collection, analysis and interpretation of the results was carried out independently.

London cardiologist Dr Aseem Malhotra, who has argued against mass prescribing of statins, last night insisted the drugs had only “marginal” benefits for those with established heart disease, and did not save lives for lower risk patients.

Other research had found that more than half of patients put on statins abandoned them within a year, most commonly because of side-effects, he said.

He said the misrepresentation of the risks and benefits of statins would unfold to become “one of the biggest scandals in the history of medicine”.

 

7 Ways To Prevent and Even Reverse Heart Disease With Nutrition

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7 Ways To Prevent and Even Reverse Heart Disease With Nutrition

You can reverse heart disease with nutrition, according to a growing body of scientific research.

Considering that heart disease is the #1 cause of death in the developed world, anything that can prevent cardiac mortality, or slow or even reverse the cardiovascular disease process, should be of great interest to the general public.

Sadly, millions of folks are unaware of the extensive body of biomedical literature that exists supporting the use of natural compounds for preventing and even reversing heart disease.

Instead, they spend billions buying highly toxic cholesterol-lowering pharmaceuticals with known cardiotoxicity, among 300 other proven side effects, simply because their doctor told them to do so.

So, with this in mind, let’s look at the biomedical literature itself.

Three Natural Substances that Reduce the Risk of Heart-Related Death

Omega-3 Fatty Acids: There is a robust body of research indicating that the risk of sudden cardiac death is reduced when consuming higher levels of omega-3 fatty acids. Going all the way back to 2002, the New England Journal of Medicine published a study titled,  “Blood levels of long-chain n-3 fatty acids and the risk of sudden death,” which found  “The n-3 fatty acids found in fish are strongly associated with a reduced risk of sudden death among men without evidence of prior cardiovascular disease.” Another 2002 study, published in the journal Circulation, found that Omega-3 fatty acid supplementation reduces total mortality and sudden death in patients who have already had a heart attack.[i] For additional research, view our dataset on the topic of Omega-3 fatty acids and the reduction of cardiac mortality.

It should be noted that the best-selling cholesterol drug class known as statins may actually reduce the effectiveness of omega-3 fats at protecting the heart. This has been offered as an explanation as to why newer research seems to show that consuming omega-3 fats does not lower the risk of cardiac mortality.

Vitamin D: Levels of this essential compound have been found to be directly associated with the risk of dying from all causes. Being in the lowest 25% percent of vitamin D levels is associated with a 26% increased rate of all-cause mortality.[ii]  It has been proposed that doubling global vitamin D levels could significantly reduce mortality.[iii] Research published in the journal Clinical Endocrinology in 2009 confirmed that lower vitamin D levels are associated with increased all-cause mortality but also that the effect is even more pronounced with cardiovascular mortality.[iv] This finding was confirmed the same year in the Journal of the American Geriatric Society, [v]and again in 2010 in the American Journal of Clinical Nutrition.[vi]

Magnesium: In a world gone mad over taking inorganic calcium supplementation for invented diseases such as T-score defined “osteopenia” or “osteoporosis,” despite their well-known association with increased risk of cardiac mortality, magnesium’s role in protecting against heart disease cannot be overstressed. It is well-known that even the accelerated aging of the heart muscle experienced by those in long space flight is due to magnesium deficiency. In 2010, the Journal of Biomedical Sciences reported that cardiovascular risks are significantly lower in individuals who excrete higher levels of magnesium, indicating its protective role.[vii]  Another study published in the journal Atherosclerosis in 2011 found that low serum magnesium concentrations predict cardiovascular and all-cause mortality.[viii] Remember that when you are looking to ‘supplement’ your diet with magnesium go green. Chlorophyll is green because it has a magnesium atom at its center. Kale, for example, is far better a source of complex nutrition than magnesium supplements. But, failing the culinary approach, magnesium supplements can be highly effective at attaining a therapeutic and/or cardioprotective dose.

For an additional list of compounds that may reduce cardiac mortality, including cocoa, tea, wine and yes, even cholesterol itself, view our Reduce Cardiac Mortality page.

Pomegranate Heart Health Benefits

Four Natural Compounds Which May Unclog the Arteries

Pomegranate: this remarkable fruit has been found in a human clinical study to reverse the carotid artery thickness (i.e. blockage) by up to 29% within 1 year. [ix] There are a broad range of mechanisms that have been identified which may be responsible for this effect, including: 1) lowering blood pressure 2) fighting infection (plaque in arteries often contains bacteria and viruses) 3) preventing cholesterol oxidation 4) reducing inflammation.[x]

Arginine: Preclinical and clinical research indicates that this amino acid not only prevents the progression of atherosclerosis but also reverses pathologies associated with the process. (see also: Clogged Arteries and Arginine). One of the mechanisms in which it accomplishes this feat is by increasing the production of nitric oxide which is normally depressed in blood vessels where the inner lining has been damaged (endothelium) resulting in dysfunction.

Garlic: Not only has garlic been found to reduce a multitude of risk factors associated with arteriosclerosis, the thickening and hardening of the arteries, but it also significantly reduces the risk of heart attack and stroke.[xi]  In vitro research has confirmed that garlic inhibits arteriosclerotic plaque formation.[xii]  Aged garlic extract has also been studied to inhibit the progression of coronary artery calcification in patients receiving statin therapy.[xiii]

And let us not forget, garlic’s benefits are extremely broad. We have identified over 150 diseases that this remarkable culinary and medicinal herb has been confirmed to be of potential value in treating and preventing and which can be viewed here: Garlic Health Benefits.

B-Complex: One of the few vitamin categories that has been confirmed in human studies to not only reduce the progression of plaque buildup in the arteries but actually reverse it is B-complex. A 2009 study published in the journal Stroke found that high dose B-complex vitamin supplementation significantly reduces the progression of early-stage subclinical atherosclerosis in healthy individuals.[xiv] More remarkably, a 2005 study published in the journal Atherosclerosisfound a B-vitamin formula decreased the carotid artery thickness in patients at risk for cerebral ischemia.[xv] Another possible explanation for these positive effects is the role B-vitamins have in reducing the production of homocysteine, an artery and otherwise blood vessel scarring amino acid.[xvi]

Additional Heart Unfriendly Things To Avoid

No discussion of preventing cardiac mortality would be complete without discussing things that need to be removed in order to reduce risk, such as:

NSAIDs: Drugs like aspirin, ibuprofen, and Tylenol, have well-known association with increased cardiac mortality. Review six studies on the topic here: NSAID Cardiotoxicity.

Statin Drugs: It is the height of irony that the very category of drugs promoted to millions globally as the standard of care for primary and secondary prevention of cardiovascular disease and cardiac mortality are actually cardiotoxic agents, linked to no less than 300 adverse health effects. Statin drugs have devastating health effects. Explore the research here: Statin Drug Health Effects.

Wheat: while this connection is rarely discussed, even by those who promote grain-free and wheat free diets, wheat has profound cardiotoxic potential, along with over 200 documented adverse health effects: Wheat Toxicity. And why wouldn’t it, when the very countries that eat the most of it have the highest rate of cardiovascular disease and heart-related deaths? For an in-depth explanation read our article: Wheat’s Cardiotoxicity: As Serious As A Heart Attack.

Finally, for additional research on the topic of heart health promoting strategies visit our Health

Reduced statin benefits observed as CKD worsens

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In patients with advanced chronic kidney disease, the benefits of statin therapy on cardiovascular outcomes decreased with declining estimated glomerular filtration rate, according to a recent meta-analysis.

“Our results show that, even after allowing for somewhat smaller reductions in LDL cholesterol as GFR declines, there is a trend towards smaller relative risk reductions for major coronary events and strokes,” researchers from the Cholesterol Treatment Trialists’ (CTT) Collaboration wrote. “In particular, there was little evidence that statin-based therapy was effective in patients starting treatment after dialysis had been initiated.”

Researchers from the CTT analyzed patient data from 28 randomized controlled trials assessing the effects of statin therapy on LDL cholesterol reduction according to baseline renal function (n = 183,419; mean age, 62 years; 73% men; 58% with vascular disease; 20% with diabetes). In 23 trials, a statin-based regimen was compared with control (n = 143,807; mean baseline LDL cholesterol, 3.64 mmol/L; mean difference in LDL cholesterol at 1 year, –1.08 mmol/L; median follow-up, 4.8 years). In the remaining five trials, researchers assessed the effects of an intensive statin regimen vs. standard statin regimen (n = 39,612; mean baseline LDL cholesterol, 2.53 mmol/L; mean difference in LDL cholesterol at 1 year, –0.51 mmol/L; median follow-up, 5.1 years).

Baseline renal function data were available for 99% of patients; 68% had an eGFR of at least 60 mL/min/1.73 m²; 19% had an eGFR between 45 and 60 mL/min/1.73 m²; 6% had an eGFR between 30 to 45 mL/min/1.73 m²; 3% had an eGFR 30 mL/min/1.73 m² or less and were not on dialysis; 4% were on dialysis.

Statin therapy treatment effects were estimated with rate ratio (RR) per mmol/L reduction in LDL cholesterol.

Researchers found that statin-based treatment reduced the risk for a first major vascular event by 21% per mmol/L reduction in LDL cholesterol (RR = 0.79; 95% CI, 0.77-0.81), including reduced risks for major coronary events (RR = 0.76; 95% CI, 0.73-0.79) and stroke (RR = 0.84; 95% CI, 0.8-0.89).

“There was a significant trend towards smaller proportional effects on major vascular events with lower eGFR at randomization (P = .008 for trend),” the researchers wrote. “Within each baseline renal function category, the proportional reduction in major vascular events was similar, irrespective of estimated cardiovascular risk level.”

Researchers also found that, overall, statin therapy reduced the need for coronary revascularization procedures by 25% per mmol/L LDL cholesterol reduction (RR = 0.75; 95% CI, 0.73-0.78); however, there was no trend observed for this outcome by baseline renal function.

Statin therapy also reduced the risk for vascular death overall by 12% per mmol/L reduction in LDL cholesterol (RR = 0.88; 95% CI, 0.85-0.91), and researchers found a trend toward smaller proportional effects on vascular mortality with declining baseline renal function (P = .03 for trend).

“However, reducing LDL cholesterol with statin-based therapy had no significant effect on non-vascular mortality at any level of renal function,” the researchers wrote.

In sensitivity analyses excluding patients undergoing dialysis at randomization, researchers did not observe any trends for vascular outcomes or deaths across eGFR categories (P > .05 for all trend values).

In a commentary accompanying the study, Muh Geot Wong, MBBS, PhD, FRACP, and Vlado Perkovic, PhD, FASN, FRACP, both of The George Institute for Global Health, University of Sydney, Australia, noted the results raise further questions regarding the effects of lipid-lowering in advanced disease and highlight the importance of new trials with highly-effective agents.

“By defining what we still do not know, this analysis will hopefully encourage further studies that improve outcomes for this high-risk patient group,” they wrote. – by Regina Schaffer

Study on CT calcium testing redefines who needs statins

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CT calcium testing could significantly refine conventional wisdom regarding long-term statin therapy, as well as favorably influence cost containment and flexible treatment options, according to a study in the October 13 issue of the Journal of the American College of Cardiology.

The study, which involved CT calcium testing in a large patient population, found that nearly two-thirds of adults ages 45 to 75 are either recommended or considered for statins by current guidelines. Almost half of these candidates have no coronary artery calcium, and their actual risk is much lower than the threshold suggested by the guidelines to consider statin therapy. The greatest reclassification was noted in those at an intermediate level of estimated risk by traditional risk factors.

The results showed that a CT coronary artery calcium scan can efficiently guide cost containment and reduce the need for costly medical therapy, including limiting high out-of-pocket expenditures, according to the Society of Cardiovascular Computed Tomography (SCCT).

Coronary artery calcium (CAC) scoring has been used primarily to identify those at an increased risk of downstream events to guide appropriate medical therapy. However, the new data confirm that CAC also identifies those at a low risk of events, especially if they have a CAC score of 0.

The study could therefore significantly affect the physician-patient shared decision process regarding statin initiation for managing cardiovascular risk, added lead author Dr. Khurram Nasir from Baptist Health South Florida. Because the majority of patients are already candidates for statin therapy according to guidelines, the need to identify additional individuals for testing and preventive treatment becomes less compelling.

“We believe these risk-guided approaches can limit overtreatment at the population level,” he added.

 

Statin scam exposed: Cholesterol drugs cause rapid aging, brain damage and diabetes.

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Sadly, many people take statin drugs, which are commonly known by brand names including Lipitor, Crestor and Zocor. Prescription drug spending in the U.S. shot up to about $374 billion in 2014, representing the highest level of spending since 2001. Statins undoubtedly made up a significant portion of this spending, and now consumers who take such drugs have much more to worry about than the dent it’s making in their wallets.

The study, which was published in the American Journal of Physiology, states that statins’ “…impact on other biologic properties of stem cells provides a novel explanation for their adverse clinical effects.” Specifically, the study states that such adverse effects include advancing the “process of aging” and also notes that “…long-term use of statins has been associated with adverse effects including myopathy, neurological side effects and an increased risk of diabetes.” Myopathy refers to skeletal muscle weakness.

cholesterol-drugs-cause-rapid-aging

Statins make cells unable to repair properly, create nerve problems and destroy memory

Experts involved in the study suggest that the health problems associated with statins have likely been downplayed through the years. In reality, those taking such cholesterol-lowering drugs have been experiencing cataracts, fatigue, liver problems, muscle pain and memory loss. Simply put, the drugs have been found to tamper with cells in such a way that their primary purpose of reproducing and helping the body repair is thwarted. With that comes the onset of terrible health issues or the worsening of existing ones.

Professor Reza Izadpanah, a stem cell biologist and lead author of the published study, says, “Our study shows statins may speed up the ageing process. People who use statins as a preventative medicine for [health] should think again as our research shows they may have general unwanted effects on the body which could include muscle pain, nerve problems and joint problems.”

Statin Doesn’t Reduce ICU Ventilation Delirium

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Rosuvastatin (Crestor) is not effective for reducing delirium and subsequent cognitive impairment in critically ill patients with sepsis-related acute respiratory distress who require mechanical ventilation, according to ancillary findings from a randomized controlled trial.

Participants in the multicenter, nationwide Patients in the Statins for Acutely Injured Lungs from Sepsis (SAILS) trial who were treated with rosuvastatin were no less likely to experience delirium while hospitalized in intensive care than patients in the placebo arm of the study, and the two groups had similar rates of cognitive impairment at 6- and 12-months follow-up.

The findings do not support those of previous preclinical and observational studies showing statins to be associated with reduced daily delirium in intensive care, researcher Dale Needham, MD, of Johns Hopkins University, and colleagues wrote in Lancet Respiratory Medicine, published online Jan. 28.
Delirium is very common in critically ill, mechanically ventilated patients, occurring in as many as 80%, in one study. Delirium is also strongly associated with cognitive impairment lasting for a year or more after discharge.
In an email exchange, Needham told MedPage Today that more than 70% of the patients in the SAILS study who required invasive mechanical ventilation due to sepsis-associated acute respiratory distress syndrome (ARDS) experienced delirium during their ICU stay.
“Approximately one-third of surviving study participants had cognitive impairment at 12-month follow-up, which prior studies have demonstrated is associated with duration of delirium in ICU,” Needham noted. “Despite encouraging preliminary studies, this trial showed no benefit of rosuvastatin in reducing delirium in intensive care or in reducing cognitive impairment during 12 months of follow-up.”
The double-blind study was conducted at 35 hospitals located throughout the U.S., and patients were randomly assigned in blocks of eight, stratified by hospital to receive either rosuvastatin (40 mg loading dose, followed by 20 mg daily until 3 days after discharged from ICU, study day 28, or death) or placebo.

The primary endpoint was daily delirium status in ICU up to 28 days in the intention-to-treat population and secondary endpoints were cognitive function at 6- and 12-months.
A total of 272 patients were assessed for delirium daily in intensive care, and the mean proportion of days with delirium was 34% (SD 30%) in the rosuvastatin group versus 31% (SD 29%) in the placebo group (hazard ratio 1.14, 95% CI 0.92-1.41; P=0.22).
Nineteen (36%) of 53 patients in the rosuvastatin group had cognitive impairment at 6 months versus 29 (38%) of 77 in the placebo group, with no significant difference seen between groups (treatment effect, 0.93, 95% CI 0.39–2.22; P=0.87).
At 12 months, 20 (30%) of 67 patients versus 23 (28%) of 81 patients had cognitive impairment, with no significant difference between groups (treatment effect 1.1, 95% CI 0.5–2.6; P=0.82).
“To our knowledge, this is the first ancillary study of a multicenter, randomized, double-blind, placebo-controlled trial evaluating the effect of rosuvastatin compared with placebo to evaluate effects on delirium in intensive care and subsequent cognitive function in patients with sepsis-associated acute respiratory distress syndrome,” the researchers wrote.
Researchers noted that incomplete data on delirium in the SAILS study was a potential limitation of the analysis, along with possible measurement error. They also noted that rosuvastatin has less antibacterial effects and tissue penetration than other widely used statins, including atorvastatin and simvastatin.
“Hence, we cannot conclude that a different statin would not be beneficial,” they wrote. “Some experts have suggested that randomized trials of delirium should assess statins with both high and low lipophilic properties given the uncertainty about the effects on neuroinflammation. However, both a lipophilic (ie. simvastatin) and nonlipophilic (ie. rosuvastatin) statin have been assessed in large randomized trials of patients with ARDS with similar findings of no beneficial effects on mortality and ventilator-free days.”
Based on findings from their observational study suggesting a benefit for keeping critically ill patients on pre-existing statin therapy, researchers in the U.K. are conducting a clinical trial aimed at determining if statins reduce the risk of delirium in this population.
Needham told MedPage Today that the lack of efficacy in the newly published post-hoc analysis highlights the importance of conducting studies on other potential strategies to reduce delirium in critically ill patients requiring mechanical ventilation.
“There is a need to continue evaluating interventions aimed at reducing delirium in the ICU and post-ICU cognitive impairments commonly observed in this population,” he noted.

Statin Use Strongly Linked to Diabetes in Healthy Adults

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Even healthy adults taking statins are 87% more likely to develop diabetes.

A recent study published in the Journal of General Internal Medicine evaluated 3982 Tricare beneficiaries who were taking statins and 21,988 peers in the military health system who were not.

Using 42 baseline characteristics, the researchers matched 3351 statin users to 3351 nonusers and then examined the incidence of diabetes, diabetic complications, and obesity in both groups. At baseline, all study subjects had no cardiovascular disease, diabetes, or other life-limiting chronic disease.

In addition to seeing a strong association between new-onset diabetes and statin use, those taking statins also had a 250% greater likelihood of developing diabetes with complications than their counterparts, and they were 14% more likely to be overweight or obese. The researchers also determined that the higher the dose of the statin, the greater the risk of these conditions.

While previous studies have linked statin use to increased risk of diabetes and potential weight gain, the current authors noted they provided more evidence of the association among healthy adults, which is less frequently studied.

“The risk of diabetes with statins has been known, but up until now, it was thought that this might be due to the fact that people who were prescribed statins had greater medical risks to begin with,” said lead author Ishak Mansi, MD, a professor and physician-researcher with the Veterans Affairs North Texas Health System and the University of Texas Southwestern, in a press release.

The authors did not advise patients to stop taking statins based on their study results; rather, they recommended that patients and health care providers discuss potential benefits and risks with statin use. However, they also encouraged patients to pursue lifestyle changes to potentially avoid taking statins.

Study Questions Statin, Memory Loss Connection .

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Action Points

  • Note that this large observational study found that initiation of a statin, or any other kind of lipid-lowering medication, was associated with an increased risk of memory impairment within 30 days.
  • To the researchers’ credit, they identify that this association is likely driven by ascertainment bias.

Beginning treatment with a statin was associated with a nearly fourfold increased risk of developing acute memory loss within 30 days in a retrospective cohort study, but a similar increase in risk was seen in patients starting non-statin lipid-lowering drugs.

Compared with non-users, both statin and non-statin lipid-lowering drug (LLD) use was found to be associated with acute memory loss in the weeks following treatment initiation, but there was no difference in memory loss when statins and non-statins were compared with each other, researcher Brian L. Strom, MD, of Rutgers University in Newark, N.J., and colleagues wrote online June 8 in JAMA Internal Medicine.

 The observation that all LLDs were associated with memory loss suggests that either all drugs used to lower lipid levels cause acute memory loss or that the observed memory loss in the study was due to detection bias, Strom said.

In a telephone interview with MedPage Today, Strom said it makes sense that patients on a new drug would be more likely to notice symptoms and attribute them to the drug, and they are also more likely to report such symptoms to their physician.

“Patients might report a memory loss to me that they would otherwise pay little attention to because I am seeing them more often and I ask them about it,” he said.

Earlier Statin, Memory Studies Mixed

Several previous studies have shown acute memory loss associated with the use of statins, but others have not shown the association or have even shown improved memory in long-term statin users compared with non-users.

 Strom noted that without the non-statin LLD control group in his study, the findings would have shown a strong association between statin initiation and short-term memory loss.

“In the absence of this control group, the finding would have been completely misleading,” he said.

The study included data obtained between early 1987 through late 2013 from The Health Improvement Network (THIN), which is a comprehensive database of medical records from general practitioners in the U.K. Patients were excluded from the analysis if they had a diagnosis of Alzheimer’s disease or dementia, if they had received medications used for dementia, or if they had other conditions affecting cognition, such as Parkinson’s disease, Huntington’s disease, or vascular dementia.

The analysis compared 482,543 statin users with 482,543 matched non-users of any lipid-lowering drug (control group 1) and with 26,484 users of non-statin LLDs, such as cholestyramine, colestipol hydrochloride, colesevelam, clofibrate, gemfibrozil, and niacin (control group 2).

A secondary case-crossover analysis was performed that included 68,028 patients with incident acute memory loss whose exposure to statins was evaluated during the period immediately before the outcome versus three earlier periods (31 to 60 days prior, 150 to 180 days prior, and 270 to 300 days prior).

 Non-statin LLD Users Had 3.6-Fold Risk Increase

The analysis revealed that:

  • When compared with matched non-users of any LLDs, there was a strong association between first exposure to statins and acute memory loss within 30 days immediately following exposure (fully adjusted odds ratio 4.40, 95% CI 3.01-6.41).
  • The association was not seen in the comparison of statin versus non-statin LLDs (fully adjusted OR 1.03, 95% CI 0.63-1.66).
  • The association was seen in the first 30 days following exposure in non-statin LLD users compared with matched non-user controls (adjusted OR 3.60, 95% CI 1.34-9.70).
  • Both atorvastatin and simvastatin showed an increased OR within the first 30 days after exposure compared with non-users (adjusted OR 2.40, 95% CI 1.42-4.04 and 3.53, 95% CI 2.79 -4.48, respectively).
  • The case-crossover analysis showed a weak negative association, which was not found to be clinically meaningful.

A potential study limitation cited by the researchers involved a substantial difference in baseline characteristics between users of statins and users of non-statin LLDs, and differences among users of the various statin drugs.

“Bias from confounding by indication is the most serious potential problem in this study, even though we attempted to control for indication variables and a large number of other underlying conditions,” the researchers wrote.

The case-crossover analysis was conducted to address this issue because each patient served as his or her own control.

 Statin, Memory Issue ‘Tempest in Teapot’

The researchers also noted that potential confounding could exist for variables not recorded in the medical records database.

Strom said the study findings should reassure both patients and physicians who prescribe statins.

“This whole issue of short-term memory loss with statins is really a tempest in a teapot,” he said. “Statins are very effective drugs, and people should not veer away from them for fear of a short-term memory effect, especially given the data suggesting that long-term statin use improves memory.”

Does Preop Statin Help Survival in CABG?

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Study suggested simvastatin may help but other preop heart drugs weren’t useful

Going into coronary artery bypass surgery (CABG) on a statin might reduce mortality risk from the procedure, but other heart drugs might not make a difference, an observational study suggested.

The lipid-lowering drugs were associated with 65% to 74% relatively lower odds of perioperative death after adjusting for other factors, which was statistically significant across all five logistic regression models used in the study of 16,192 CABG patients ages 40 years and older in the U.K. Clinical Practice Research Datalink database.

Mortality risk out to 6 months also was significantly reduced among preoperative statin users, with a hazard ratio of 0.63 (95% CI 0.42 to 0.92),Robert Sanders, MD, of the University of Wisconsin in Madison, and colleagues reported at the European Society of Anaesthesiology’s Euroanaesthesia conference in Berlin.

The effect was only significant for the most commonly prescribed statin, simvastatin (adjusted OR 0.33, 95% CI 0.14-0.78), although it wasn’t clear whether this was the result of a statistical power issue or due to some real difference among statins because the study could not draw any causal conclusions.

“Further data are needed on whether all statins exert similar effects,” the researchers concluded.

They pointed to a prior meta-analysis of randomized, controlled trials and observational data that showed a 31% relative reduction in early death from any cause after cardiac surgery among people on a preoperative statin.

“In combination with previous studies, these data suggest that patients not taking statins should be considered for statin therapy based on their perioperative and chronic health risks,” Sanders’s group suggested in a press release.

Perhaps not surprisingly, statins were the most common of the heart medications the patients getting CABG were on in the study (85.1%).

The other medications considered ranged from 72.8% prevalence for beta-blockers to 60.5% for ACE inhibitors and 42.8% for calcium channel blockers all the way down to 1.2% for alpha-2 agonists.

None of them showed any consistent association between preoperative use and perioperative mortality across the propensity score-matched, Cox, and other regression analyses.