For years we have been told that the horrible side effects that many of us have experienced from statin drugs is not real. That it is just in our head. But it turns out it is not only real but a new really expensive medication will work for those who cannot tolerate statins. A recent article in the Washington Post highlights this story.
In a study released Sunday researchers at the Cleveland Clinic showed that not only is statin intolerance is absolutely real but conveniently this new very expensive, possibly high dangerous drug (PCSK9) works.
I am both angry that for years we have been told that statin intolerance is not real. And then conveniently when a new potentially dangerous and very expensive cholesterol drug has been developed suddenly somebody bothers to actually look at statin intolerance as a justification for this new drug. What about all the patients harmed by statin intolerance? Why should we trust that this new medication won’t have even more terrible effects?
A cheaper cholesterol drug is Zetia. It’s not as cheap as generic atorvastatin, but it’s cheaper than the PCSK9 drug and any new drug is problematic. Bad side effects might emerge with time.
Let’s face it. Drug companies are in business to make money, and they have powerful PR reps, so I’m not surprised at this story. I once saw a cardiologist who had been a drug rep before he went to medical school, and he agreed that the drug-company-sponsored trials were biased.
I’ve never been told that statin side effects are not real. I corresponded with Beatrice Golumb at UCal San Diego some time ago. She’s published a lot about statin side effects. Example:
However a lot of GPs and even some cardiologists may not be familiar with her work.
Perhaps some of it is just my experience with a track record of four internists followed by a cardiologist who all told me my side effects were psychological (despite side effects being observable on actual diagnostic tests). My endo to this day minimizes side effects saying they are rare. I think you are right, drug trials are focused on showing efficacy and safety as defined by measurable mortality. I think these studies deliberately evade measuring side effects with techniques such as “run ins” where they give patients the drug before the study and eliminate patients who have bad reactions.
Hmm. I was never told the effects weren’t real. I was on two statins and they each had unpleasant side effects. When I switched from the first to the second, the side effects lessened. When I quit cold turkey, they stopped as though someone had thrown a switch. If anyone had told me the effects weren’t real, I would have told them to go home and sleep it off. Or words to that general effect.
The only person who would believe the effects were psychological is a person who has never taken the drugs. What utter nonsense.
I hope you fired the internists. One problem is that some people like my late mother would read the drug info and develop every side effect listed because she didn’t like taking drugs. But even if a side effect is rare, the occasional patient will be that rare exception and the docs should listen to the patient.
The statins are supposed to cause muscle weakness as well as muscle pain. But aging also causes muscle weakness. How is one to know which is which? I’m on a low-dose statin and I stopped taking it for a month and didn’t find myself any stronger or smarter.
There’s increasing evidence that cholesterol levels aren’t the critical factor. Some studies show that they do reduce CVD events but don’t affect mortality, and the latter is what most patients care about. Here’s a recent study that shows that one cholesterol drug doesn’t even reduce CVD events, but it slightly reduces mortality. And it’s in a specialized population:
Thank you Gretchen. I have tried two types of statin and can’t tolerate the side effects (which for me are real). I have been anguishing about not taking something that will reduce my risk of a stroke, but will allow myself to relax now.
My doctor asked me if I had any aches and pains when going through my list of scripts when he hit the “lipitor” and I was just about to ask him about then pain in shoulders. He immediately stopped them and we tried basically all the statins at different doses. All lowered my levels to normal levels but pain or weakness would move according to which and how much I was taking. Been off of them for almost a year, taking zeitia and though levels are elevated (220 total 130 ldl) I asked doc if I were not diabetic would he be concerned with those numbers and he said probably not. So unless I see a good jump up next test or so I’m waiting to see the testing on the new stuff and giving it some time before being the guinea pig. No family heart problems even with history of high cholesterol. Just cannot justify feeling like I’m 70 @ 50 just to gain a few years on the back end LOL.
While any one person may have side effects and not tolerate statins, we should not forget this from the diabetes association: people with diabetes are two to four times as likely as people without diabetes to have a heart attack or stroke. Cardiovascular disease is the NUMBER ONE KILLER of people with diabetes.
“Because people with diabetes are already at high risk for heart disease, the revised Standards of Medical Care call for all people older than 40 years of age with diabetes to take statins,” said Richard W. Grant, MD, MPH, Research Scientist, Kaiser Permanente Division of Research and Chair. They recommend people with diabetes who are between the ages of 40 and 75 with no additional cardiovascular disease risk factors take a moderate-intensity statin, while those of all ages who have cardiovascular disease, or those ages 40-75 who have additional cardiovascular risk factors, take a high-intensity statin.
"The big change here is to recommend starting either moderate or high-intensity statins based on the patient’s risk profile,” said Grant, “rather than on LDL level. Since all patients with diabetes are at increased risk, it is just a matter of deciding whom to start on moderate versus high-intensity statin doses.”
It is all about the ratio of ldl to hdl, vldl and triglycerides etc. I have found that eating prunes has lowered my ldl apparently but not my hdl which is very high. It’s either that or the levothyroxine. I tried one statin for a week had terrible pain which took a few weeks to go away and dopiness etc. and I won’t take them anymore. It seems that statins don’t help prevent damage to blood vessels that pwd get from high bg by lowering cholesterol but by an anti-inflammatory effect they have, so other anti-inflammatories such as aspirin, not the others, may be just as good.
They are also linked to causing cvd in some people.
Broken record time: one-size-fits-all rules are too rigid and unblinking to make good therapy. When I dropped the statins and switched to a LCHF diet, my lipids dropped like a rock. (Trigs in the 40s, etc.). And they’re remained that way ever since. If I can have numbers that would do credit to a fit 25 year old, I’ll forego the side effect, thanks.
And we must remember that while CVD is a real risk for those of us with diabetes we have in fact been misled by the medical establishment. It is right there plain as day. Cholesterol does not pose as high as risk for patients with diabetes CVD as we have been led to believe. What appears to cause all this CVD? High blood sugars. Association studies have clearly shown that high blood sugars are associated with CVD at much much higher correlations than cholesterol. If you really want to lower your risks of CVD then get better control of your blood sugars.
ps. And I consider the “guidelines” generated by the pharmaceutical industry such as those from the ADA and the AHA as highly suspect.
pps. Nobody should “just take a statin,” particularly if it compromises their help.
I’m sorry that was rude. Let me try to have an open mind. I think we would all consider it unconscionable to prescribe a powerful drug like a statin to the nearly 90 million americans with pre-diabetes or diabetes without fully understanding that the benefits full outweigh the risks. My understanding is that the AHA and ADA guidelines were established with an evidence grade level of III (see Evidence Based Medicine). Basically a bunch of experts (and unfortunately highly conflicted experts) voting around their table. I think to have such a recommendation imposed on 1/3 of americans we should have “strong” evidence. Can you list some “key” trials which provide that evidence (like grade level I). These would be primary prevention trials that are randomized controlled intervention trials that show a reduction of CVD occurrence in diabetes patients independent of glycemic control (the independence of glycemic control is important since we know glycemic control is strongly correlated with CVD).
Not according to my doctor, but I refuse to put up with the side effects any longer. I know I am an old lady, but I refuse to be forced to hobble along like one and battle extreme e4xhaustion every day.
I think we can all agree that DM increases one’s risk of cardiovascular disease including death. Understanding what tools we have to prevent such complications is important. So we have to intelligently analyze the best current data we have at the time. Sure, we should look at the source but I believe it is a disservice to confuse quality evidence with anecdotal reactions and vague conspiracy fears. I don’t see how “we have in fact been misled by the medical establishment” but I can say that we shouldn’t scare off other diabetics with this inflammatory rhetoric. Several commenters are correct: statins appear to have benefit independent of simply lowering cholesterol which is why they are recommended even with “normal” cholesterol. (And while aspirin is anti-inflammatory, it is dangerous to think that it is a safe or equal substitute.) Statins are generally low risk – there will always be some who have myopathy or other problems who clearly should not take them – but no one suggests they should. So it’s a risk assessment decision. How many risk factors for CVD do you have? The more risks, the more one should do to lower their risk. For example, if you have diabetes and atherosclerotic disease, then statins are strongly recommended. I tolerate statins so I use them in addition to everything else.
There are HIGH quality studies to support this and some are Grade A as noted below. Source: doi: 10.2337/dc16-S011 Diabetes Care January 2016 vol. 39 no. Supplement 1 S60-S71
•For patients with diabetes aged 40–75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin and lifestyle therapy. (Grade A)
For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be added to lifestyle therapy. (Grade: A)
•For patients with diabetes aged <40 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity or high-intensity statin and lifestyle therapy. C
•For patients with diabetes aged 40–75 years with additional atherosclerotic cardiovascular disease risk factors, consider using high-intensity statin and lifestyle therapy. B
•For patients with diabetes aged >75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin therapy and lifestyle therapy. B
•For patients with diabetes aged >75 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity or high-intensity statin therapy and lifestyle therapy. B
•The addition of ezetimibe to moderate-intensity statin therapy has been shown to provide additional cardiovascular benefit compared with moderate-intensity statin therapy alone and may be considered for patients with a recent acute coronary syndrome with LDL cholesterol ≥50 mg/dL (1.3 mmol/L) or for those patients who cannot tolerate high-intensity statin therapy. A
I am extremely reluctant to take statins, even though I have elevated LDL. My reluctance is due in part to the potential side effects discussed in the study for which @Brian_BSC started this thread, as well as the fact that cholesterol is vital to every single cell in my body. I’m lucky to have an endo who doesn’t push the issue, in large part because my HDL is also high and my triglycerides are low.
Ok, I guess I wasn’t clear. I have read this article and I am aware of what the ADA has done. Evidence based medicine is supposed to be about evidence. This is not about evidence. You cannot claim that:
For patients with diabetes aged 40–75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin and lifestyle therapy. (Grade A)
when there have been no controlled intervention trials. References 32 through 42 list the collected references used to support the lipid recommendations. Grade A is reserved for “Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered.” I asked you to tell me about “primary prevention trials that are randomized controlled intervention trials that show a reduction of CVD occurrence in diabetes patients independent of glycemic control.” That would be evidence of Grade A. None of these studies meet that standard. Since we know that the association of glycemic control with CVD is much stronger than the association of cholesterol with CVD any study that fails to control for such a known strongly confounding factor is highly suspect.
This is not the basis upon which to medicate millions of americans. If I am wrong about this I do hope you will correct me.
Aspirin is taken by many people with cvd and other disorders for preventative measures, it may not be safe for all, I can’t tolerate it, but imo I’m pretty sure based on what I have read it’s safer than statins or drugs like warfarin.
Actually many doctors do try to harass you take them if you have diabetes, even when you have good ldl/hdl ratio, low tricglycerides, low vldl and no cvd. Regardless of whether you have health conditions that suggest you shouldn’t take them. I also think the cholesterol levels guidelines are way too low now. Low cholesterol can also cause cvd and other health conditions.