Statins

[Armitage.Shanks]

DS129 said:

Interesting, why no grapefruit ?

I think it's something in the fruit that inteferes with any medication related to CHD and blood disorders.

[matchmaker]

Armitage.Shanks said:

DS129 said:

Interesting, why no grapefruit ?

I think it's something in the fruit that inteferes with any medication related to CHD and blood disorders.

It increases the amount of some statins that is absorbed by the body - increasing the doseage by a possibly dangerous amount.

[Kermit power]

We're pretty certain that my father's constant pain from neuropathy in his legs was caused by Statins.

My wife's GP keeps telling her she should be on them because she's diabetic - even though she's slim, otherwise healthy and very fit. She asked the GP for some empirical evidence to support the recommendation and was met with tumbleweeds...

[mikyman]

I had bad side effects with regular statins and refused to take them.
However my GP was aware that statins were not for everyone.He advised that there is a relativly new drug on the market that is better at reducing cholesterol, with fewer side effects.
The usual dose is 180mg of bempedoic acid combined with 10mg of ezetimibe.Brand name Nustendi.
GP's are reluctant to prescribe them as the cost significantly more than basic statins.
I have been on them for 6 months without any side effects and recent blood tests show my cholesterol levels have significally reduced.
If you have side effects from statins persuade your GP to prescribe them.

[Evoluzione]

All of the facts can be found on the slip contained in the box. I would suggest reading that before taking them.

[Kermit power]

Evoluzione said:

All of the facts can be found on the slip contained in the box. I would suggest reading that before taking them.

Some facts can certainly be found there but in my experience at least three key facts tend to be missing.

1. How does the outcome of this treatment compare to other possible treatments?

2. Of the potential side effects, which are permanent and which reversible simply by stopping taking the medication.

3. Where I can see independent evidence confirming the efficacy of the treatment both when it was first passed for use and also within, say, the past 24 months.

With the first one, there have been documented cases of pharma companies doing all sorts to sell drugs via doctors, but even when that's not the case, it must be near impossible for a GP to keep track of all the possible new and existing treatment options for thousands of medical conditions to make sure what they're prescribing is optimal.

With the second, had my father properly understood that the pain he now suffers constantly would've been irreversible, I doubt he would've ever taken the risk of using Statins.

For the third, there was a time when doctors swore by leaches for almost everything! Then enlightenment happened, and those doctors were viewed as quacks. Today, though, leaches are once again used very successfully for various conditions. Medicine doesn't stand still, and it's perfectly possible for causal links to be disproven, potential side effects to be under or overestimated when a drug is first approved or a whole host of other factors to change over time.

Let's also not forget that there's a vast amount of money in Pharma, and the manufacturers aren't going to rush to tell people there's a better way, are they?

[anonymous-user]

Armitage.Shanks said:

I'm not prepared to give up on the food and drink I enjoy so won't be altering my diet any time soon. If my QRISK score changed or my fitness declined AND I was given medical advice then I'd think about it.

I'd rather enjoy eating the above with some risk than cutting it all out for a 'potential' reduced risk and being miserable. Today everything is a risk and long life and good health is no guarantee.

Or another way of looking at it go on statins and you can keep eating all the stuff you shouldn't as your high Cholesterol is offset by the medication.

This post has actually made me question statins a whole lot more. I don't believe you get something for nothing, and I don't believe there is an easy shortcut over hard work.

Are people honestly thinking it is OK to eat unhealthily as they are taking a statin which lowers their cholesterol anyway? Much as I want to believe this is a wonder drug to allow you to stay heathy whilst living an unhealthy lifestyle I am just not buying it.

It just seems that the Drs are putting everyone on these things as they "might" help and there are seen to be no downsides. I am sure the pharmaceutical companies would love for all adults to be on statins their whole life.

On a positive side the exercise and cutting out all junk food is clearly having a positive effect as I have lost just under 2KG in 2 weeks. I am actually finding it quite easy now, I don't actually crave or want to eat any fried of sugary foods as I feel I will ruin it.

[Armitage.Shanks]

I'm not advocating statins gives you a free pass. It does however allow those who cant/wont diet or alter what they eat to reduce their own risk. I picked up on a well know supercar driver chap on IG the other day who mentioned he has a BMI over 50 yet goes out fine dining several times a week supplemented by fast foods in the day. Diets don't work for him and he enjoys life. I'll be surprised if he's not on statins and no doubt they are helping him subconciously or otherwise.

I'm not overweight, I exercise regularly and I suppose some would say in good shape. I therefore eat anything I want and casually track my weight which has remained constant for over 25yrs. What I eat (without looking at labels) in calories is undoubtedly offset by exercise and when it's not, given I'm getting older, and my mainly cardio routine will reduce then I'll have to temper my intake and presumably make some eating choices v going on statins. My only compromise so far is full skimmed milk but more from convenience than lifestyle choice.

[anonymous-user]

Armitage.Shanks said:

I'm not advocating statins gives you a free pass. It does however allow those who cant/wont diet or alter what they eat to reduce their own risk. I picked up on a well know supercar driver chap on IG the other day who mentioned he has a BMI over 50 yet goes out fine dining several times a week supplemented by fast foods in the day. Diets don't work for him and he enjoys life. I'll be surprised if he's not on statins and no doubt they are helping him subconciously or otherwise.

A BMI of 50 is morbidly obese, meaning he will eventually suffer obesity related health conditions. I get that he enjoys life YOLO, but I am sure he would enjoy life a lot more if he wasn't morbidly obese. If he has enough money to buy supercars I am amazed he doesn't want to live as long as he can to enjoy the life his money would provide.

As for diets not working for him, I have no words if that is his diet!

My BMI was 25 and I was getting to that awkward stage between a medium and a large, a medium being a bit tight and a large hanging off me. I can't imagine being able to buy any clothes that look half decent with a BMI of 50!

Oh well his life even if he is significantly shortening it and potentially suffering health issues!

[QJumper]

Joey Deacon said:

A BMI of 50 is morbidly obese, meaning he will eventually suffer obesity related health conditions. I get that he enjoys life YOLO, but I am sure he would enjoy life a lot more if he wasn't morbidly obese. If he has enough money to buy supercars I am amazed he doesn't want to live as long as he can to enjoy the life his money would provide.

As for diets not working for him, I have no words if that is his diet!

My BMI was 25 and I was getting to that awkward stage between a medium and a large, a medium being a bit tight and a large hanging off me. I can't imagine being able to buy any clothes that look half decent with a BMI of 50!

Oh well his life even if he is significantly shortening it and potentially suffering health issues!

Just another example of how we're becoming a society that not only mitigates, but encourages and enables people's poor choices. Maybe people find it hard to tell someone that they're doing soomething wrong, or maybe there's just more money in letting them do it and then monetising the solutions.

[Evoluzione]

Kermit power said:

Evoluzione said:

All of the facts can be found on the slip contained in the box. I would suggest reading that before taking them.

Some facts can certainly be found there but in my experience at least three key facts tend to be missing.

1. How does the outcome of this treatment compare to other possible treatments?

2. Of the potential side effects, which are permanent and which reversible simply by stopping taking the medication.

3. Where I can see independent evidence confirming the efficacy of the treatment both when it was first passed for use and also within, say, the past 24 months.

With the first one, there have been documented cases of pharma companies doing all sorts to sell drugs via doctors, but even when that's not the case, it must be near impossible for a GP to keep track of all the possible new and existing treatment options for thousands of medical conditions to make sure what they're prescribing is optimal.

With the second, had my father properly understood that the pain he now suffers constantly would've been irreversible, I doubt he would've ever taken the risk of using Statins.

For the third, there was a time when doctors swore by leaches for almost everything! Then enlightenment happened, and those doctors were viewed as quacks. Today, though, leaches are once again used very successfully for various conditions. Medicine doesn't stand still, and it's perfectly possible for causal links to be disproven, potential side effects to be under or overestimated when a drug is first approved or a whole host of other factors to change over time.

Let's also not forget that there's a vast amount of money in Pharma, and the manufacturers aren't going to rush to tell people there's a better way, are they?

I can tell you've never read one because the opposite to the majority of what you have written is true. I don't know whether the condition your father suffers from is on there as you haven't given it a specific name.

If we were to prioritise where to get advice from then the NHS website, your GP and the medication advice note would be right at the top of the list.
Right at the bottom and in an act of desperation would be Dr PH.

Yet here we have yet another example of people doing things the wrong way round, again.

[Kermit power]

Evoluzione said:

Kermit power said:

Evoluzione said:

All of the facts can be found on the slip contained in the box. I would suggest reading that before taking them.

Some facts can certainly be found there but in my experience at least three key facts tend to be missing.

1. How does the outcome of this treatment compare to other possible treatments?

2. Of the potential side effects, which are permanent and which reversible simply by stopping taking the medication.

3. Where I can see independent evidence confirming the efficacy of the treatment both when it was first passed for use and also within, say, the past 24 months.

With the first one, there have been documented cases of pharma companies doing all sorts to sell drugs via doctors, but even when that's not the case, it must be near impossible for a GP to keep track of all the possible new and existing treatment options for thousands of medical conditions to make sure what they're prescribing is optimal.

With the second, had my father properly understood that the pain he now suffers constantly would've been irreversible, I doubt he would've ever taken the risk of using Statins.

For the third, there was a time when doctors swore by leaches for almost everything! Then enlightenment happened, and those doctors were viewed as quacks. Today, though, leaches are once again used very successfully for various conditions. Medicine doesn't stand still, and it's perfectly possible for causal links to be disproven, potential side effects to be under or overestimated when a drug is first approved or a whole host of other factors to change over time.

Let's also not forget that there's a vast amount of money in Pharma, and the manufacturers aren't going to rush to tell people there's a better way, are they?

I can tell you've never read one because the opposite to the majority of what you have written is true. I don't know whether the condition your father suffers from is on there as you haven't given it a specific name.

If we were to prioritise where to get advice from then the NHS website, your GP and the medication advice note would be right at the top of the list.
Right at the bottom and in an act of desperation would be Dr PH.

Yet here we have yet another example of people doing things the wrong way round, again.

I'm looking at one right now for Cocodamol.

Despite being one of many different painkillers - and an addictive one at that - there's nothing in there to say how it compares in efficacy to those other painkillers.

It also mentions that people may experience side effects, and lists some serious side effects which should cause you to stop taking them, but nothing about whether those side effects may last after treatment stops. It may well be that none of them will with Cocodamol, especially as by definition it's not a long term drug like Statins, but why not say so?

There are also no links in there to original trials or supporting data on efficacy. Why not? Again, the efficacy of paracetamol and codeine are both pretty much beyond question because they've been so widely used for so long, but there are plenty of other drugs where that's not the case, so why not share the info?

I'm not suggesting that anyone ask Dr PH for this information, btw. I'm merely pointing out that not all the facts you might want to know before deciding to take a medication are on the information sheet, so ask the doctor prescribing them.

This is what my wife did when our GPs (so far 3 different ones over about 8 years due to retirement and maternity leave) were trying to get her on Statins. She asked for further information about what results had been seen in trials for people like her - a T1 diabetic with no other major or moderate health concerns - and whether any of the potentially unpleasant side effects were irreversible.

You'd hope that a trained professional prescribing a drug that you're expected to take for the rest of your life would know that, but not one of them had the first clue. They were just prescribing them because that's the perceived wisdom that they'd accepted unquestioningly.

When my psychiatrist prescribed me Lisdexamfetamine, on the other hand, he was able to answer absolutely every question I had in detail.

The difference?

Not that my psychiatrist is in any way more intelligent than my GP necessarily. Just that he's a specialist who is only ever going to treat a small number of conditions with a small number of treatment options, so he can take the time to be an expert in all of them and keep up to date with new developments far, far more comprehensively than a GP who is essentially the corner shop of the medical world, treating literally thousands of conditions with greater or lesser frequency.

I wouldn't take the word of Dr PH, but nor would I just take the word of a patient information leaflet alone, or that of a doctor who can't answer fairly fundamental questions.

[Grumps.]

Lots of valid points raised here and I certainly wasn’t asking specifically for absolute answers as I would indeed read the leaflets etc.

It was more a general kinda ‘how you getting on with statins’ and if anyone has seen any real benefits, which it appears that many have.

My health isn’t great and I do like to think I have a reasonably healthy diet so as far as that goes, I can’t really do any more!

Regardless, thanks to all for both sides opinions and experiences etc.

[pavarotti1980]

Kermit power said:

Some facts can certainly be found there but in my experience at least three key facts tend to be missing.

1. How does the outcome of this treatment compare to other possible treatments?

2. Of the potential side effects, which are permanent and which reversible simply by stopping taking the medication.

3. Where I can see independent evidence confirming the efficacy of the treatment both when it was first passed for use and also within, say, the past 24 months.

With the first one, there have been documented cases of pharma companies doing all sorts to sell drugs via doctors, but even when that's not the case, it must be near impossible for a GP to keep track of all the possible new and existing treatment options for thousands of medical conditions to make sure what they're prescribing is optimal.

With the second, had my father properly understood that the pain he now suffers constantly would've been irreversible, I doubt he would've ever taken the risk of using Statins.

For the third, there was a time when doctors swore by leaches for almost everything! Then enlightenment happened, and those doctors were viewed as quacks. Today, though, leaches are once again used very successfully for various conditions. Medicine doesn't stand still, and it's perfectly possible for causal links to be disproven, potential side effects to be under or overestimated when a drug is first approved or a whole host of other factors to change over time.

Let's also not forget that there's a vast amount of money in Pharma, and the manufacturers aren't going to rush to tell people there's a better way, are they?

1. The "little slip" is a patient information leaflet for the drug in the box not the results of a non-inferiority study.
You are not correct in pharma companies do anything to sell drugs. They are bound by ABPI rules and can't even dish out a pen or post-it note nowadays never mind sweeten a deal. In addition GP's are not going to be able to determine what brand of generic drug a patient will get. That will be down to the pharmacy and who they have a contract with and they will be going for cheapest acquisition cost. GPs will not be fully aware of new drugs but google the term Horizon Scanning which tells you new drugs being released in the next few years. As well as this each CCG (now ICB) have medicine optimisation teams who do this work for GP practices and on a more regional level Area Prescribing Committee's, Guideline groups, regional formularies which dictate what can and cannot be prescribed

2. Side effects are listed based on their seriousness. There is no way of listing whether an adverse event is short term, long term or permanent as this will not be the case for everyone who experiences them. Talk to pharmacist about this

3. Look online. The SPC for the drug or reference sources such as Cochrane Library, Medline, EMC, CKS etc etc. Look for the study data to give you some information. May not be useful as it will not be in layman's terms and its worth having an understanding of what efficacy actually is. Again ask your pharmacist.

In relation to your point of medicine not standing still. Look up phase IV of a clinical study. Post marketing phase. There is huge amount of work done to look at reported adverse events post marketing of a drug and this will lead to changes in the literature. All SPCs will have version controls so this is all visible

You last post is correct, there is a vast amount of money for big pharma, but there is also a vast amount of money screwing big pharma for the best prices possible. The UK obtains some of the best prices for drugs because the likes of NHSE, NICE, CMU and locally teams are set up up to do this

[Kermit power]

pavarotti1980 said:

Kermit power said:

Some facts can certainly be found there but in my experience at least three key facts tend to be missing.

1. How does the outcome of this treatment compare to other possible treatments?

2. Of the potential side effects, which are permanent and which reversible simply by stopping taking the medication.

3. Where I can see independent evidence confirming the efficacy of the treatment both when it was first passed for use and also within, say, the past 24 months.

With the first one, there have been documented cases of pharma companies doing all sorts to sell drugs via doctors, but even when that's not the case, it must be near impossible for a GP to keep track of all the possible new and existing treatment options for thousands of medical conditions to make sure what they're prescribing is optimal.

With the second, had my father properly understood that the pain he now suffers constantly would've been irreversible, I doubt he would've ever taken the risk of using Statins.

For the third, there was a time when doctors swore by leaches for almost everything! Then enlightenment happened, and those doctors were viewed as quacks. Today, though, leaches are once again used very successfully for various conditions. Medicine doesn't stand still, and it's perfectly possible for causal links to be disproven, potential side effects to be under or overestimated when a drug is first approved or a whole host of other factors to change over time.

Let's also not forget that there's a vast amount of money in Pharma, and the manufacturers aren't going to rush to tell people there's a better way, are they?

1. The "little slip" is a patient information leaflet for the drug in the box not the results of a non-inferiority study.
You are not correct in pharma companies do anything to sell drugs. They are bound by ABPI rules and can't even dish out a pen or post-it note nowadays never mind sweeten a deal. In addition GP's are not going to be able to determine what brand of generic drug a patient will get. That will be down to the pharmacy and who they have a contract with and they will be going for cheapest acquisition cost. GPs will not be fully aware of new drugs but google the term Horizon Scanning which tells you new drugs being released in the next few years. As well as this each CCG (now ICB) have medicine optimisation teams who do this work for GP practices and on a more regional level Area Prescribing Committee's, Guideline groups, regional formularies which dictate what can and cannot be prescribed

2. Side effects are listed based on their seriousness. There is no way of listing whether an adverse event is short term, long term or permanent as this will not be the case for everyone who experiences them. Talk to pharmacist about this

3. Look online. The SPC for the drug or reference sources such as Cochrane Library, Medline, EMC, CKS etc etc. Look for the study data to give you some information. May not be useful as it will not be in layman's terms and its worth having an understanding of what efficacy actually is. Again ask your pharmacist.

In relation to your point of medicine not standing still. Look up phase IV of a clinical study. Post marketing phase. There is huge amount of work done to look at reported adverse events post marketing of a drug and this will lead to changes in the literature. All SPCs will have version controls so this is all visible

You last post is correct, there is a vast amount of money for big pharma, but there is also a vast amount of money screwing big pharma for the best prices possible. The UK obtains some of the best prices for drugs because the likes of NHSE, NICE, CMU and locally teams are set up up to do this

All good stuff, and I think it supports my view - especially for a drug you're expected to take for the rest of your life - that the little slip in the box contains some but not all of the information you might want.

[PT1984]

To quickly surmise they have worked for me. Without breaking it down my count was too high, now it’s well under the NHS threshold for concern. I’m having bloods every 2 months so hoping to drop the dose. No side effects at all.

Completely unrelated but I had mitral valve repair 09/22. It just failed but thankfully it was caught early. Full recovery. No cholesterol build up at all! But we knew that from pre surgery angiogram.

I have somewhat changed my lifestyle…..

[Evoluzione]

Grumps. said:

Lots of valid points raised here and I certainly wasn’t asking specifically for absolute answers as I would indeed read the leaflets etc.

It was more a general kinda ‘how you getting on with statins’ and if anyone has seen any real benefits, which it appears that many have.

My health isn’t great and I do like to think I have a reasonably healthy diet so as far as that goes, I can’t really do any more!

Regardless, thanks to all for both sides opinions and experiences etc.

It's pointless what other people think, it's what they do to you as an individual and what you think.
You are Person A, not Person B. Or C, D, E etc. Everyone reacts differently.

The correct mode is this:
Get the medication you have been prescribed.
Take out the advice leaflet, sit down and read it carefully.

Act accordingly on that.

[pavarotti1980]

Kermit power said:

All good stuff, and I think it supports my view - especially for a drug you're expected to take for the rest of your life - that the little slip in the box contains some but not all of the information you might want.

Which is why you should speak to the pharmacist and to be honest they should be doing some counselling with first supply to answer questions. However it doesn't always happen. Normally some stroppy dispensing assistant checks address and chucks it at you

[PurplePangolin]

QJumper said:

Joey Deacon said:

A BMI of 50 is morbidly obese, meaning he will eventually suffer obesity related health conditions. I get that he enjoys life YOLO, but I am sure he would enjoy life a lot more if he wasn't morbidly obese. If he has enough money to buy supercars I am amazed he doesn't want to live as long as he can to enjoy the life his money would provide.

As for diets not working for him, I have no words if that is his diet!

My BMI was 25 and I was getting to that awkward stage between a medium and a large, a medium being a bit tight and a large hanging off me. I can't imagine being able to buy any clothes that look half decent with a BMI of 50!

Oh well his life even if he is significantly shortening it and potentially suffering health issues!

Just another example of how we're becoming a society that not only mitigates, but encourages and enables people's poor choices. Maybe people find it hard to tell someone that they're doing soomething wrong, or maybe there's just more money in letting them do it and then monetising the solutions.

I think you may be on to something there!

The whole thing is built on keeping people well enough but still “sick”. In fact the medical profession basically presides over chronic preventable disease aided by a corrupt government/health department and pharmaceutical/food conglomerates.

Of course they don’t want the population to be “cured” of diabetes,cvd,obesity etc - there is no repeat business in that.

Compare the funding for chronic disease prevention to the drug cost…..

The fact that anyone would rely on a “pill” to counter their gluttony and sloth is mind-boggling not to mention the ultimate cost to the health system - which then denies treatment to those with “proper” disease (eg hereditary)

[Kermit power]

PurplePangolin said:

I think you may be on to something there!

The whole thing is built on keeping people well enough but still “sick”. In fact the medical profession basically presides over chronic preventable disease aided by a corrupt government/health department and pharmaceutical/food conglomerates.

Of course they don’t want the population to be “cured” of diabetes,cvd,obesity etc - there is no repeat business in that.

Compare the funding for chronic disease prevention to the drug cost…..

The fact that anyone would rely on a “pill” to counter their gluttony and sloth is mind-boggling not to mention the ultimate cost to the health system - which then denies treatment to those with “proper” disease (eg hereditary)

In many cases, but not necessarily all.

I've had something of a revelation since being prescribed new meds for ADD. In addition to doing wonders to help me address all the things that come directly with ADD, they've also done a staggeringly good job of reducing my weight, almost without me noticing.

The psychiatrist's explanation for it was that the weight gain wasn't a result of sloth and gluttony, so much as of my brain subconsciously insisting on my finding something else to do when I gave up smoking to seek out some sort of reward sensation, and settling on sticking my snout in the fridge on a regular basis to deliver it.

In short, that one pill a day is helping my brain to work properly rather than constantly driving me off in search of the next dopamine hit.

Without it, I was always going to struggle immensely to control my weight unless I could find another outlet, and as I didn't want to take up smoking again, was highly unlikely to be able to suddenly become a competitive rally driver and couldn't persuade my beloved wife to make herself available 24/7 to provide the other obvious option as and when required for some unfathomable reason, I can't see where that would've come from.

With it, overnight I settled into what it doubtless my normal healthy appetite. I've got a fair amount of fuel stored up, so I'm typically eating a light lunch (sometimes as late as 3-4pm is I get caught up in something with work) and a family dinner. No snacks, no late night fridge browsing, nothing. If I'm not actually hungry - and properly hungry at that - my brain has stopped telling me to eat.

Of course, I'm just one person, and there's an exception to every rule of course, but it has made me think that the first line of diagnosis - especially when it comes to anything obesity related - is to understand why the patient is over-eating, as there is without a shadow of a doubt an absolute plethora of possible causes other than just being a slothful glutton!

If you don't treat the cause properly, then prevention is doomed to failure, so yes, you're going to end up prescribing lots of statins and other pills to combat the symptoms of having failed to treat the correct problem in the first place.