Referring to the comments expressing skepticism that statins reduce all-cause mortality (in contrast to Dr Mandrola): I wholly agree that evidence supports the view that a grounded skeptic will be reluctant to prescribe statins widely. I'll make a point not yet mentioned: Massive studies enrolling tens of thousands of subjects over several years that supposedly demonstrate the benefit of statin vs placebo should raise -- yes, raise -- your skepticism alarm.
Here's why: if a study needs to have tens of thousands of subjects to demonstrate a clinical effect, you can be certain the effect is very very small. Furthermore, the putative benefit can be easily overcome by harms, even very rare ones. Naturally, study authors find ways to obfuscate this point, or don't bother to track all side effects. One standard trick is to report the benefit as a reduction of relative risk, but the harms as an increase of absolute risk. Studies also focus on disease-specific benefits, but don't track all-cause mortality, the only one that really counts when prescribing for a healthy patient.
Though I typically agree with Dr Mandrola, I must respectfully disagree on the supposed benefits of statins especially when prescribed as primary prevention.
I was always thinking that statin drugs make you bulletproof from future cardiac outcomes. The 25% stat is a new learning for me. Thank you. I should stop using statins as a license to eat all the processed crap I want 😳.
Why risk serious muscle injury? Doesn't it make sense to first give patients the SmartStatin test for variants in the SLCO1B1 gene? About 2% of people have 2 variant copies that put them at high risk, because they may be unable to metabolize the drug, which could result in dangerously high blood levels even when taking small doses. This can cause mitochondrial damage, with muscle cell death and symptoms of exercise intolerance and severe pain, even without CK > 3 times upper-normal.
Thank you Dr. Mandrola for sharing your analysis of statins and research on cardiology. I'm more interested in learning about statins, heart attacks and strokes as nothing scares me more in this world than MACE!
I’m surprised, frankly, that an article on statins on this Substack would mention relative risk reduction of statin therapy vs absolute risk reduction.
Thanks for this information and your balanced approach. I am 75 years old and take low dose rosuvastatin and cycle over 100 miles per week, 80 minutes 5 to 6 times per week. I always thought that muscle-associated symptoms were idiosyncratic in origin and neither inevitable or necessarily dose related. This study is reassuring.
I don't know about walking for four days, but I do know that I took a low dose of a statin for two days, as prescribed, and my legs gave out at the top of a staircase. The muscles suddenly just turned to jelly. That was over 20 years ago, in my late 40s. My numbers have gone down slightly with natural remedies, but regardless, breaking one's legs is a side affect not worth considering.
Thanks Matt. Good information you will not discover when meeting with your doc. Sometimes I think there's a real effort in the U.S. to rid society of its elders.
I think that medicine is politically controlled by giant corporations whose goal is to get older people (and younger too) to spend as much money as possible, and never to get better. Doctors are complicit when they are unquestioning and not sufficiently skeptical. It is very, very difficult for doctors because of the standard of care handcuffs on them.
I might agree, but prescribing more and more meds for elders will kill them sooner rather than later, the docs know this and the drug companies are aware of this. Dead customers are not helpful to profit margins. Like I always say, fentanyl makes no sense if you're trying to make money, unless dealers are receiving some incentive to rid society of addicts. Dead addicts are not financially advantageous to drug dealers, so why the fentanyl?
I’ve enjoyed reading this thread, and I have an answer to your question, Ruth. First of all, I appreciate this view about meds / I’ve been using exercise to wean off several of the meds I’ve been put on over the years - successfully.
Understanding the tobacco lobby helps us understand the pharmaceutical industry. Tobacco companies must continually recruit new customers because their product is the only product that, when used as directed, kills us. I’m sure you’re aware that’s why they had characters like Joe camel, etc. It fascinated children and they wanted to be cool like the ads. As for fentanyl, you must apply addict logic, in order to understand addict behavior. The denial mechanism is such that the addicted person truly believes, “it won’t happen to me...” and of course the addict wants to get as high as possible. So ultimately an overdose of a “brand” increases sales tremendously.
True, but as a dealer, you need live victims for as long as possible, and the fentanyl won't produce long term profit due to the dead. Your numbers won't replenish that quickly and you'd do better selling potent crack, meth or whatever, enabling the victims to live years longer. With cigarettes, it takes years to kill the victims, hence the great profits and recruitment efforts to effect a steady stream of newbies.
Statins do not reduce all-cause mortality. They increase it. Rhabomyolysis is well known. Dementia symptoms increase with statin use. Liver cancer. And diabetes. All correlate with statin use. Does this study prove that rhabomyolysis isn’t real? No it does not. It shows that some statin users can temporarily overcome. What about those who are staying at home with muscles wasting away? Dr. John, why don’t you look into the real statin data? it is out there, quite easy to parse if you really care to be skeptical.
Effects of Statins on Energy and Fatigue With Exertion: Results From a Randomized Controlled Trial
Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase
I will look forward to your write up on the SAMSON trial. Thanks a ton for explaining the research in a digestible format!
Referring to the comments expressing skepticism that statins reduce all-cause mortality (in contrast to Dr Mandrola): I wholly agree that evidence supports the view that a grounded skeptic will be reluctant to prescribe statins widely. I'll make a point not yet mentioned: Massive studies enrolling tens of thousands of subjects over several years that supposedly demonstrate the benefit of statin vs placebo should raise -- yes, raise -- your skepticism alarm.
Here's why: if a study needs to have tens of thousands of subjects to demonstrate a clinical effect, you can be certain the effect is very very small. Furthermore, the putative benefit can be easily overcome by harms, even very rare ones. Naturally, study authors find ways to obfuscate this point, or don't bother to track all side effects. One standard trick is to report the benefit as a reduction of relative risk, but the harms as an increase of absolute risk. Studies also focus on disease-specific benefits, but don't track all-cause mortality, the only one that really counts when prescribing for a healthy patient.
Though I typically agree with Dr Mandrola, I must respectfully disagree on the supposed benefits of statins especially when prescribed as primary prevention.
I was always thinking that statin drugs make you bulletproof from future cardiac outcomes. The 25% stat is a new learning for me. Thank you. I should stop using statins as a license to eat all the processed crap I want 😳.
Why risk serious muscle injury? Doesn't it make sense to first give patients the SmartStatin test for variants in the SLCO1B1 gene? About 2% of people have 2 variant copies that put them at high risk, because they may be unable to metabolize the drug, which could result in dangerously high blood levels even when taking small doses. This can cause mitochondrial damage, with muscle cell death and symptoms of exercise intolerance and severe pain, even without CK > 3 times upper-normal.
Thank you Dr. Mandrola for sharing your analysis of statins and research on cardiology. I'm more interested in learning about statins, heart attacks and strokes as nothing scares me more in this world than MACE!
I’m surprised, frankly, that an article on statins on this Substack would mention relative risk reduction of statin therapy vs absolute risk reduction.
Thanks for this information and your balanced approach. I am 75 years old and take low dose rosuvastatin and cycle over 100 miles per week, 80 minutes 5 to 6 times per week. I always thought that muscle-associated symptoms were idiosyncratic in origin and neither inevitable or necessarily dose related. This study is reassuring.
I don't know about walking for four days, but I do know that I took a low dose of a statin for two days, as prescribed, and my legs gave out at the top of a staircase. The muscles suddenly just turned to jelly. That was over 20 years ago, in my late 40s. My numbers have gone down slightly with natural remedies, but regardless, breaking one's legs is a side affect not worth considering.
Higher cholesterol, especially LDL, is protective as we age, and correlates with longevity.
Here is a nice chart:
https://www.dailymedicaldiscoveries.com/wp-content/uploads/2016-06-27_13-33-17.png
Thanks Matt. Good information you will not discover when meeting with your doc. Sometimes I think there's a real effort in the U.S. to rid society of its elders.
I think that medicine is politically controlled by giant corporations whose goal is to get older people (and younger too) to spend as much money as possible, and never to get better. Doctors are complicit when they are unquestioning and not sufficiently skeptical. It is very, very difficult for doctors because of the standard of care handcuffs on them.
I might agree, but prescribing more and more meds for elders will kill them sooner rather than later, the docs know this and the drug companies are aware of this. Dead customers are not helpful to profit margins. Like I always say, fentanyl makes no sense if you're trying to make money, unless dealers are receiving some incentive to rid society of addicts. Dead addicts are not financially advantageous to drug dealers, so why the fentanyl?
I’ve enjoyed reading this thread, and I have an answer to your question, Ruth. First of all, I appreciate this view about meds / I’ve been using exercise to wean off several of the meds I’ve been put on over the years - successfully.
Understanding the tobacco lobby helps us understand the pharmaceutical industry. Tobacco companies must continually recruit new customers because their product is the only product that, when used as directed, kills us. I’m sure you’re aware that’s why they had characters like Joe camel, etc. It fascinated children and they wanted to be cool like the ads. As for fentanyl, you must apply addict logic, in order to understand addict behavior. The denial mechanism is such that the addicted person truly believes, “it won’t happen to me...” and of course the addict wants to get as high as possible. So ultimately an overdose of a “brand” increases sales tremendously.
True, but as a dealer, you need live victims for as long as possible, and the fentanyl won't produce long term profit due to the dead. Your numbers won't replenish that quickly and you'd do better selling potent crack, meth or whatever, enabling the victims to live years longer. With cigarettes, it takes years to kill the victims, hence the great profits and recruitment efforts to effect a steady stream of newbies.
Statins do not reduce all-cause mortality. They increase it. Rhabomyolysis is well known. Dementia symptoms increase with statin use. Liver cancer. And diabetes. All correlate with statin use. Does this study prove that rhabomyolysis isn’t real? No it does not. It shows that some statin users can temporarily overcome. What about those who are staying at home with muscles wasting away? Dr. John, why don’t you look into the real statin data? it is out there, quite easy to parse if you really care to be skeptical.
Effects of Statins on Energy and Fatigue With Exertion: Results From a Randomized Controlled Trial
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1183454?tab=cme
Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase
https://www.ncbi.nlm.nih.gov/pubmed/17536877
Mild to Moderate Muscular Symptoms with High-Dosage Statin Therapy in Hyperlipidemic Patients —The PRIMO Study
http://link.springer.com/article/10.1007/s10557-005-5686-z
Well that sure muddied the waters. Another article might help. If you have been researching the topic perhaps a collaboration?
Damn, I hate acronyms. IHA!!!