Why don't doctors care to understand drugs from the cell biologist point of view?

[condoline]

Since cholesterol levels are uncorrelated with heart attack or stroke but inflammation is and statins are dangerous drugs (the cell biologists say they are cytotoxic, and with good reason), why do doctors persist in prescribing statins for people with no sign of coronary artery disease? Is it because statins are huge money makers, because doctors do not know how statins operate, because doctors like drug side effects because they keep bringing the patient back for an ever-increasing cascade of pharmaceuticals, or what? Why not a regimen of Mediterranean diet, exercise, stress-mitigation etc instead? Same thing with Fosamax etc: why not weight-lifting, good diet, etc instead of the potential for jaw osteonecrosis, fractures of the femur, etc? And why the bias against Q10? If the medical profession has never heard of the electron chain, then it's time to go back to school and learn something.

[condoline]

Actually, statins can cause arrythmias; I know from experience: I got hit by tachycardia big-time for the first time in my entire 79 years three weeks after abruptly quitting statins (moral of the story: never quit them cold turkey!), wild heart rhythms off and on constantly during the same week, extreme nocturnal leg pain and cramps for the same week which forced me out of bed, an extreme worsening of my peripheral neuropathy (I now stagger and weave because the soles of my feet no longer are in contact with my brain) and worsening of my pulmonary fibrosis to the point where I need supplemental oxygen almost all day every day. The arrythmias spaced farther and farther apart over about three-four months and finally disappeared; no sign of them for nearly two years now. I don't know for sure, but it could well be that my going on 1200 mg of CoQ10 about a week before the statin rebound started put my heart back together. The signs of rhythm problems which showed up on my ECG at the time of the rebound were completely gone a year later, according to the Mayo Clinic docs, which substantiates my subjective experience.

[Jerry_NJ]

I've been on a statin for about 15 years, Lipator then Simvastatin for the last 5 years (much lower cost, but that has changed as the Lipator patent has expired).  Both have moved me from a total cholesterol of about 240 to about 130/40.  I take 20 mg of the generic, I think Lipator was more like 10 mg.

For some reason my cardiologist's office contacted me and asked me to cut my simvastatin dose in half, cut the pills I had on hand.  She said there is some concern about the statin and my calcium channel blocker.  They wrote me a blood test prescription for a cholesterol check in 10 weeks, that is coming up in mid January.  I do recall reading about some concern of simvastatin in doses as at 40 mg.  I don't know what else I will be told, but this thread has stimulated my thinking to ask some questions.  I had already mentioned to them that I would like to go on generic lipator when it becomes available.  It may be that not all statins are created equal.  

This thread may not relate to my heart rhythm problem, but I found it interesting.  I can say a general distrust of medical doctors seems to be fairly widespread, especially among those of us older persons who have to see more doctors than we'd like.  My son is a medical doctor, so I try to remain open minded : )

Merry Christmas

[achillea]

What de Tocqueville said.  

[condoline]

The fact that doctors have degrees does not impress me at all. My first doc put me on benzedrine (which is highly addictive and now considered a recreational drug); I tossed it two days later. Next doc prescribed thyroxine: after sharp pain down my arm, I dumped it; third doc said (a) I did not need thyroid treatment and (b) even if I had, the amount prescribed could have killed me. Yet another doc was determined that I take Fosamax; I refused (and therefore avoided the possibility of jaw necrosis and femur fracture). And a Mayo cardiologist prescribed simvastatin, against my protests that Pravachol had caused my peripheral neuropathy: result is severe lung damage and supplemental oxygen (plus, belatedly, a diagnosis from him of statin intolerance). And somebody else I knew found it increasingly hard to swallow; when I heard that his doctor was insisting that this was stomach trouble and prescribing various drugs, I demanded that he cancel his doctor's appointment and see somebody else ASAP: result was an immediate operation for esophageal cancer and death three months later.

No, I am not a doctor. I am a dropout from the U of Minnesota PhD program in experimental psychology. I finished the written exams for the PhD one hour early, because at best I missed two questions. I dropped out before taking the orals. So I do know research methodology, and I tell you right now that much of it is pretty bad. The San Francisco study of what currently passes for research is interesting; look it up. And as for statins, Q10, etc: I have spent the last two years reading all the research available on both subjects. I seriously doubt that most doctors have even had the time to do as much as a fraction of that.

[condoline]

On Coenzyme Q10: cardiologists in Japan use it as adjunctive therapy in cases of heart failure and they've been doing this for years. Q10 is a prescription drug there.

Coenzyme Q10 is manufactured by the body. The switching back and forth between its two forms - ubiquinone and ubiquinole - results in the production of ATP (energy) at the end of the electron chain, which is in the mitochondria of cells. Without Q10, you and I would be dead. Statins deplete the body of Q10, and with older people this is a double whammy because a person at the age of 70 produces maybe half of the Q10 he or she produced when younger. Q10 should always be taken when statins are prescribed to avoid or mitigate at least some of the damage resulting from Q10 depletion.

No, Q10 is not a "miracle cure." It is just something ("just"??) essential for life, as is an adequate amount of cholesterol (for cell membrane integrity, etc).

My cardiologist takes Q10, by the way.

[condoline]

Statins are among the most incredibly effective inflammation fighters around. Just be sure you see your doctor frequently to be sure no side effects are showing up such as nocturnal leg cramps; if so, something else more serious may be going on as well and you may need to go to something else to fight the inflammation.

[achillea]

Back in the mid-1830s, a Frenchman named Alexis de Tocqueville came to America and conducted an examination of this strange, new American Society.  In "Democracy in America,'  a book he wrote about this subject (even though his 'grant money' was for a somewhat different subject), he concluded that the fierce American belief in equality tended to make Americans disrespectful of ALL authority, as in, "Heck, my opinion is as good as that of any doctor, lawyer, whatever."

Since people with this turn of mind are totally unaware of their shortcomings (education being necessary for this kind of reflection), they feel no obligations whatsoever to study anything seriously.  After all, why do you need an education to state what you simply *know* to be true.

I think we might actually be witnessing this phenomenon, something like this in the popular assessment of science and medicine, for example.  People with zero background in cardiology, for example, really do feel that their opinions are completely on a par with researchers and practicing cardiologists whose whose IQs are above 130 and who have years of scientific or medical study under their belts.

[itdood]

My c-reactive was high (inflammation indicator).  I have significant family history of MI.  My cholesterol was normal.  I went on the lowest dose of simvastatin.  C-reactive protein went down to a "normal" level.  My doc didn't focus on lipids.  I'm not sure what point you're trying to make though.

you are saying Statins are dumb because lipids and MI don't correlate.
You say statins do lower inflammation
Inflammation is the root cause of lipid deposit and stenosis

SO with that logic, statins are effective

There are also studies that prove that statins can reverse established stenosis.  The evidence in favor of statins is large.

On Q10, now that stuff is snake oil.  no benefit, can't convince me otherwise.

[tom_h]

I failto see what this has to do with the heart rhythm forum, however I'll get off topic long enough to agree with achillea.  The evidence is there to show that statins reduce serum cholesterol thus reducing heart attack and stroke.  You are entitled to believe whatever theory you wish.  My last blood reported a total cholesterol level of of 130 mg/dL.  I plan to continue to take my daily 20mg. of Simvastatin.  This is down nearly 100 points from where it was prior to starting it.

[condoline]

I still find no correlation between cholesterol and heart attack or stroke: I am talking statistics here, with a large N (gives statistical power to the research) and with something much more concrete to point to than "high" cholesterol or "normal". Just what are "high" and "normal," anyhow. Actually, over 200 factors seem to play into heart disease probability. Statins have an extremely powerful inflammation fighting ability, plus they work against platelet clumping, etc. and this is what works, not the cholesterol fighting part. The cholesterol goes to the artery because the inflammation is there, and not vice versa, by the way; otherwise, the fact that cell membranes are largely cholesterol would suggest that our body cells are all badly inflamed - and what about the fact that the cerebral cortex is largely cholesterol? The docs have it all backward.

[achillea]

Well, for one thing, various types of cholesterol are in fact related to heart attack and stroke, but in ways that are more complicated and less stereotyped than once thought.  Here is more information on that:

http://www.sciencedaily.com/releases/2010/05/100518170034.

Yes, inflammation is a factor, and as one of the articles in the above links mentions, cholesterol crystals cause an inflammatory reaction in the blood vessels' lining, contributing  to cardiovascular disease.

Interestingly, study of the effects of statins increasingly shows that they are anti-inflammatory (not just in cardiac situations) and that their beneficial effects for some patients may be related to that:

http://www.medscape.org/viewarticle/743290_5

There is indeed growing evidence, however, that giving all patients with high blood fats is both non productive and possibly dangerous, and newer scientific papers like this one support re-thinking the whole approach.  Cause and effect are not so clear as they once seemed.  That said, if you read this article, you can see the historical reasons for this belief were rooted in the understanding of the physiology of the times:

http://blogs.scientificamerican.com/guest-blog/2011/11/15/cholesterol-confusion-and-why-we-should-rethink-our-approach-to-statin-therapy/

Doctos study biochem, cell biology and physiology in school, and a certain amount of pharmacology, too--lots more than most readers here will ever run into--and their acceptance of statins up to this point has been based on what they learned in serious academic classes. In the light of physiological understanding of the time, the approach made sense.

While any business likes to see a nice profit, the widespread use of statins has not been cynically based on greed or a conspiracy between Big Pharma and the medical profession, as the hysterical tabloid headlines would have us believe.  Cardiovascular disease remains a serious problem, and the majority of practicing physicians and researchers in the field are devoted to reducing its frequency.  Medications have been a solution for countless human illnesses over the ages (think foxglove for 'dropsy'), and it was and is logical to look into pharmaceuticals for help with cardiovascular disease.

The understanding of medical conditions is an evolving process, and we are at an intersection now where the 'feed 'em all statins" philosophy is changing dramatically.

Of course, changes in diet and lifestyle would be good for most humans.  Have you ever met a doctor who did NOT urge his patients to try for these things?  I have not met one in any field who even halfway avoided the subject..  And how many patients adopt these changes, switching to a lean diet and daily exercise?  You cannot compel sensible behavior, and in any case, a percentage of patients, especially the elderly and those dealt bad genes, will not get significant  benefit from behavioral changes alone.

Ultimately, the majority of those with cardiovascular diseases will wind up in doctors' offices, bringing immense pressure on physicians and researchers to find a pill that will work.  

And the cycle will continue, but probably with a trend in a slightly different direction.