Statin drugs

[gu99]

I have battled high cholesterol for most of my adult life and am now at 170 (total) with the aid of a statin drug.  I have seen some reports that say that even though statins reduce cholesterol numbers there isn't the expected correlation with reduced incidence of heart disease. Is that true?  And if so, why should I continue taking a statins and risk liver damage?

[twopack]

It looks to me like that last study erjon cited reported a decrease in RELATIVE RISK but no significant decrease in cardiovascular DEATHS with statin use.  Yet it reports a reduction in deaths WAS found for other diseases.  

This IS interesting!  There’s finally a study that makes sense to me.  The anti-inflammatory effect of statins (natural OR synthetic) is well known.  It makes sense they would be beneficial to many body systems, including the CV system.  After all, it is also widely accepted today that inflammation is a leading factor in the development of heart disease and sudden adverse cardiac events.  

Inflammation causes the body to lay plaque down to 'repair' vessels that aren't actually damaged.  The plaque can sit there or it can collapse/break off in the future.  We all know what happens then.  If we can reduce the inflammation that triggers this process we can reduce the amount of useless plaque lining our blood vessels.  Less plaque means more patent blood vessels (little matter the cholesterol level) and reduces the risk of sudden cardiac events from plaque collapse/emboli at the same time.

It has actually been proposed by some that the anti-inflammatory nature of statins may be more important in improving CV health than their ability to lower cholesterol levels.  In addition, the anti-inflammatory benefits of statins are achieved with low dose administration.  Higher doses have not been shown to further decreases inflammation.  For me, it’s important to know I can choose a low dose statin therapy and receive important benefits while avoiding the side effects higher doses are likely to cause.  (I’ve been there.  Can’t go again.)  

IMO, Gymdandee gave some excellent direction about lifestyle changes that absolutely work.  Anyone who can’t take statins, or prefers not to, should go back to his remarks and take notes.  I’ve seen those very things make a huge difference as I’m able to work them into my changing lifestyle.

The other stats in this thread seemed meaningless to me.  How can anyone assume results on a study that was never finished?  Initial results looked terrific?  That’s wonderful!  But it doesn't mean anyone can project initial findings into results that MIGHT have resulted further into the study.  It seems to me when you abandon your own study protocol you have abandoned the study.   Studies should be, and are, stopped immediately if it becomes clear participants are being significantly harmed.  Otherwise, I say take them to the intended conclusion.  To do otherwise raises suspicion.  After all, this wasn’t a drug targeted for a disease that had no present treatment or for patients who were desperate for it to come to market.  Clearly, the motives came from elsewhere.  Perhaps someday drug trials will be performed by people other than the manufacturers.  Those trials might be a bit easier for me to trust.  But that’s me.

[erijon]

Interesting story on the long term effects of statin use on all cause mortality numbers. An excerpt from the link below;

“The long-term benefit unexpectedly is not protection against heart disease and stroke, but against other illnesses that appear to be linked to infection,” said the lead author, Dr. Peter S. Sever, a professor of therapeutics at Imperial College London."

http://www.goupstate.com/article/20110905/znyt04/109053011

Also;

"The benefits of statins for preventing heart attacks and strokes are well-established, but after long-term follow-up the most significant effects seem to be on deaths from other causes. It's quite remarkable that there is still this difference between the two groups, eight years after the trial finished.

"Some studies have suggested that statins protect people against death from infectious diseases such as pneumonia. More research is needed to explain how these drugs might have unforeseen actions that prevent deaths from other illnesses."

http://www.sciencedaily.com/releases/2011/08/110828101912.htm

Very interesting!

Jon

[erijon]

"It looks like the in the years after four more people would be dying from Crestor then if they take nothing. And that why the study was stopped."

That is not correct and as you know if you read studies, All Cause Death Rates are not always linked back to the trial and they are not considered statistically significant unless they are tied to a direct cause which was not the case in JUPITER.

The statement approved by the FDA;

"A press statement on the company's website said that the trial's Steering Committee and also the Independent Data Monitoring Board recommended that JUPITER be stopped early because there was "unequivocal evidence of a reduction in cardiovascular morbidity and mortality amongst patients" who took Crestor compared to patients who took placebo."

This decision was approved by the FDA based on the opinion of the Independent Data Monitoring Board overseeing JUPITER.

Here is the statement from the National Institute of Health (NIH);

"AstraZeneca announced it has decided to stop the CRESTOR JUPITER clinical study early based on a recommendation from an Independent Data Monitoring Board and the JUPITER Steering Committee, which met on March 29, 2008. The study will be stopped early because there is unequivocal evidence of a reduction in cardiovascular morbidity and mortality amongst patients who received CRESTOR when compared to placebo."

[Occupant]

"You are quoting the NNT from JUPITER which was stopped early due to positive results and because of that, the NNT is grossly understated .."

My interpretation as to why the JUPITER Study was stopped early is a bit different. There is a graph as part of the study that shows "Death from any cause" Rosuvastatin versus Placebo. It looks like the in the years after four more people would be dying from Crestor then if they take nothing. And that why the study was stopped.

[erijon]

Your analysis of the NNT is a bit misleading. You are quoting the NNT from JUPITER which was stopped early due to positive results and because of that, the NNT is grossly understated. Had the Jupiter study run it's intended length, the NNT would have been 25. Also, every statin has a different NNT, they are not all the same. Here is one example from the AHA;

>>>Some LDL-C–lowering clinical end-point studies achieved a low NNT per year such as the Scandinavian Simvastatin Survival Study (SSSS), which achieved an NNT of 11.7 and an NNT per year of 2.2.<<>>However, the 6 clinical end-point LDL-C–lowering statin studies (Table 2) achieved an average NNT of 41.0 and an average NNT per year of 8.5, reflecting an overall less efficient therapeutic approach. Three recent trials have compared 1 statin brand or dose against another.18,24,25 In these “statin versus statin” trials, the average NNT was 64.6, and the average NNT per year was 19.1. Arteriographic LDL-C–lowering statin studies achieved an average NNT of 64.3 and an average NNT per year of 28.7. <<<


Here's the link, it has all the NNT's listed;

http://circ.ahajournals.org/content/117/4/560.full

Also, these are the actual numbers from JUPITER;

http://circoutcomes.ahajournals.org/content/2/3/279.full

[gymdandee]

Ubiquinol should be taken!