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Anti-cholesterol drugs may do more harm than good for older people

The side effects of Australia’s most commonly prescribed cholesterol-lowering drugs may outweigh the benefits in older people…

Elderly people, who often take a lot of different pills, may be at greater risk of side effects caused by statins interacting with other drugs. http://www.flickr.com/photos/nirbhao/

The side effects of Australia’s most commonly prescribed cholesterol-lowering drugs may outweigh the benefits in older people, a new clinical review has found.

More than 40% of Australians over 65 take cholesterol-lowering drugs called statins, which include atorvastatin (marketed as Lipitor), simvastatin (marketed as Zocor) and rosuvastatin (marketed as Crestor).

Common side effects from statins include abdominal pain, nausea, muscle pain and weakness and liver damage.

University of Sydney and Royal North Shore Hospital researchers Associate Professor Sarah Hilmer and Dr Danijela Gnjidic reviewed randomised trials that included older people, as well as published observational studies.

They found that the benefits of statins were unclear in older people who had never experienced heart attack or stroke, while the adverse effects may be more common and have greater impact in older people.

“If you have already had a heart attack, there is good evidence that statins can reduce risk of an early death even in the very old. But if you haven’t had a heart attack before, then we don’t have evidence that statins help older people,” Dr Hilmer said.

“Almost everyone would know someone who has had an adverse effect from a statin. Up to 10% of people in clinical trials get some sort of muscle pain, and if you are an older person without much reserve, that may stop you from walking and functioning independently.”

Dr Hilmer said there were also concerns about the association between statins and increased risk of diabetes and cognitive impairment.

“One trial looked at people with Alzheimer’s and found that those who stopped taking statins had an improvement in their cognitive function,” she said.

Patients with severe physical or cognitive impairments, or those in their last year of life, may want to consider reducing statin use, the authors said.

People with extreme fatigue, liver problems, myalgia (muscle pain) or those who take other drugs that interact with statins may consider discussing withdrawal of statins with their doctor, the researchers said.

People with more severe adverse effects such as rhabdomyolysis (skeletal muscle breakdown) should discuss immediate withdrawal of statins with their doctor.

Benefit-risk ratio

Dr Ken Harvey, Adjunct Associate Professor at LaTrobe University’s School of Public Health welcomed the study.

“It’s always useful to remind practitioners that the benefit-risk ratio of pharmacological interventions should be regularly reviewed, especially in the elderly where poly-pharmacy and drug interactions are more common,” said Dr Harvey, who was not involved in the study.

“It’s important to consider the possibility of adverse drug reactions (and report those suspected), especially in the elderly, because clinical trial experience in this age group is limited.”

Dr Harvey said reports of adverse drug reactions can be sent to the Therapeutic Goods Administration, which produces a searchable Database of Adverse Event Notifications.

“Important non-drug advice, such as encouraging people to stop smoking, eat a nutritious diet, moderate their alcohol composition, keep active and maintain an appropriate body weight should always be promoted, regardless of age,” he said.

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25 Comments sorted by

  1. Danny Hoardern

    Analyst Programmer

    This study will be of interest: http://healthland.time.com/2013/05/21/marijuana-the-next-diabetes-drug/

    Copy/paste:

    The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults
    Elizabeth A. Penner, BS, Hannah Buettner, BA, Murray A. Mittleman, MD, DrPH

    ABSTRACT
    BACKGROUND: There are limited data regarding the relationship between cannabinoids and metabolic processes. Epidemiologic studies have found lower prevalence rates of obesity and diabetes mellitus in…

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    1. Danny Hoardern

      Analyst Programmer

      In reply to Danny Hoardern

      More interesting reading from http://www.amjmed.com/article/S0002-9343%2813%2900200-3/fulltext

      The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults
      Elizabeth A. Penner, BS, Hannah Buettner, BA, Murray A. Mittleman, MD, DrPH

      Marijuana is the most commonly used illicit drug in the United States, and use is increasing. The 2010 National Survey on Drug Use and Health reported that between 2007 and 2010, the prevalence of marijuana use among persons aged 12 years…

      Read more
  2. John Newton

    Author Journalist

    I’m not a cardiologist, not even a scientist, and I don’t have a problem with cardiovascular disease. But when my father-in-law was told to switch from butter to margarine after his physician tested his cholesterol level and found it excessive – this after a holiday on the coast where he had been eating prawns every day – I began to take notice. A doctor prescribing margarine?

    Then I discovered a nest of cholesterol/CHD sceptics, foremost among them Dr Uffe Ravnskov, both of whose books The Cholesterol…

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    1. Olivia Hibbitt

      Medical Writer

      In reply to John Newton

      Hi John,

      I would view the opinions of your 'nest of skeptics' with extreme caution! They are not known for their unbiased approach to scientific method!

      The cholesterol and CHD 'theory' predates big pharma by a number of years, so it's not accurate to say that all the information has come from people with vested interests.

      What might be driving this skepticism is the fact that cholesterol is only one risk factor for CHD. Genetics, blood pressure and other life-style factors play a huge…

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    2. John Newton

      Author Journalist

      In reply to Olivia Hibbitt

      Olivia - Ravnskov and others date the cholesterol/CHD hypothesis to Ancel Keys, director of the laboratory of Physiological Hygiene at the University if minnesota, and later author of the famous Seven countries study.

      Ravnskov began his discussion of the problem thus: ‘Having followed the scientific literature about cholesterol and cardiovascular disease superficially, I could not recall anything in support of the idea that high cholesterol or saturated fat should be harmful to human health.’

      He then thoroughly interrogated all the studies. Nothing changed. I would urge to read his book.

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    3. Olivia Hibbitt

      Medical Writer

      In reply to John Newton

      No thanks! I prefer to get my information from credible, peer reviewed sources! I would 'urge' you to do the same!

      I would hazard that Ravnskov might have been confusing the literature with what was written on his cornflakes box!

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    4. John Newton

      Author Journalist

      In reply to Olivia Hibbitt

      Olivia - that is highly insulting to a reputable and well-respected European doctor. I strongly urge you to investigate further. As a medical writer, you might at leas have a look at some of the discussions on thincs.org - discussion between scientists more qualified than either of us.

      And here is a brief biography of the scientist who you accused of getting his information from a cereal box:

      He was born in Copenhagen, Denmark, and received his medical doctorate from the University of Copenhagen…

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    5. Olivia Hibbitt

      Medical Writer

      In reply to John Newton

      Thanks for that John, however I do think that I am qualified to discuss this topic. I have a 6 years research experience into familial hypercholesterolaemia and know just a teensy bit about cholesterol! I have personally performed experiments where I have actually seen with my own two eyes the results of increased plasma cholesterol. And no, there was not some pharma fairy sitting over my shoulder waving a magic profit wand in my face to make sure I saw what they wanted me to see!

      I've had a look at thincs.org and I stand by my assertion that this is not a credible source of information, regardless of the 'qualifications' bandied around on there.

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    6. John Newton

      Author Journalist

      In reply to Olivia Hibbitt

      Well, Olivia,I wish I was so sure about anything. Good luck, but do keep watching the debate

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    7. Barbara Webster

      Osteopath

      In reply to Olivia Hibbitt

      As the atovarstatin & simvastatin are metabolised by cytochrome P450, & P450 inhibitors such as macrolide antibiotics & amiodarone are prone to increasing the probability of adverse affects when in conjunction with statin usage, does anyone know the pharmacokinetics of the flu injections? Is it possible that the flu injections themselves, or the body's response to it could trigger known side effects of the statins when used in aged or otherwise medically compromised individuals?

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    8. John Wright

      Director

      In reply to Olivia Hibbitt

      Olivia how many of those credible sources have clear conflict of interest issues?
      Let's take NCEP for example, how many of that group would you trust not to have a conflict of interest? If you are a journalist turned medical writer, you will have learned to treat these groups with the sceptism they deserve. However if you are a researcher turned writer as many medical writers sadly are, perhaps this level of scrutiny escapes you.
      Your blind faith in the orthodoxy does you no credit, what have…

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    9. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to John Wright

      Don't forget to check the links in my earlier post below.
      The revised work on the Sydney Diet Heart Study is in the BMJ.
      While its not directly addressing cholesterol it does address the related saturated fat and heart disease link and shows it to need serious revision.

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  3. Jeremy Tager

    Extispicist

    I was diagnosed several years ago with hypercholesterolemia and my doctor recommended i go on statins immediately, despite having no other indicators of being at risk of heart attack. I refused, began to look at the literature on statins and became increasingly suspicious of statins for someone like me...My distrust of pharmaceutical companies also came into play as the evidence suggested the pharmaceutical sectors involvement in decisions to lower the recommended cholesterol thresholds at which statins would be prescribed. A new doctor and several years later, my cholesterol is ok and the evidence continues to mount that statins need to be treated with far more caution than big pharma would have us believe...

    Part of this story - like a number of others relating to medicine and pharmaceuticals - suggest the medical community is captured by pharmaceutical propaganda and perks ....It is way past time for the medical sector to get their house in order.

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    1. Olivia Hibbitt

      Medical Writer

      In reply to Jeremy Tager

      Hi Jeremy,

      several years ago people with high cholesterol would have been treated with statins as a matter of course. That is not the case now because we know more about absolute risk and what this means for the development of cardiovascular disease.

      Please don't confuse evolution of idea and treatment practice with the medical profession being brought out by big pharma. Ideas change, new evidence is added and practice changes. This does NOT mean that the previous practice was only driven by pharma paying GPs green fees!

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    2. Jeremy Tager

      Extispicist

      In reply to Olivia Hibbitt

      Hi Olivia
      I don't assume that all practice is driven by the interests of the pharmaceutical companies - but I do know that the pressures and influence used by big pharma is pervasive and insidious. It isn't just pharma paying green fees or samples or conference fees - as Sheldon Krimsky has written about, it is also about medical experts being paid as consultants by pharma, when they may have other roles (GP, member of advisory boards etc); encouraged to form companies that then work collaboratively…

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    3. Olivia Hibbitt

      Medical Writer

      In reply to Jeremy Tager

      That's fair enough...except that the recommendation you were given MIGHT have been correct based on the evidence available at the time.

      If you rocked up to a GP now with slightly elevated cholesterol and no other risk factors and they tried to stick you on a statin then you would be completely justified in telling them where to go.

      We also have to appreciate that we work within a system where the government relies on pharma to educate their customers about the use of their drugs. Yes this is a stupid system, but it's the one we work in. Why shouldn't clinicians be compensated for the time they spend education other clinicians about the use of medicines?

      I have to say, I used to work in this system and I never came across a single clinician who would just regurgitate the company message!

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    4. Jeremy Tager

      Extispicist

      In reply to Olivia Hibbitt

      Hi Olivia
      I had a doctor (who I liked in every other respect) who said he thought statins should be put in the water supply...He was linked to a university and his was a teaching clinic...An interesting study was reported recently (possibly on The Conversation) that indicated most doctors were aware of the possible influence that pharma could have over doctors and the medical community - but none of the doctors in the study would accept that they were subject to those same forces. I don't agree that the system is stupid - it's corrupt - and designed to increase the influence of pharmaceutical companies. That's why they do what they do - and why we (all of us) allow it. It is not a system that has to be and in my view it is the medical community that first and foremost needs to demand their profession back (yes, I would put it in such stark terms)

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    5. Olivia Hibbitt

      Medical Writer

      In reply to Jeremy Tager

      Yeah, I've heard that too....the same thing happened with aspirin... but people aren't recommending that now.

      I'm interested in what you think the solution is to this issue? Medics need to find out about new drugs and new therapeutic areas, and it seems that the only sector willing to pay for that is pharma....because it means their drug will get used. I think you should be directing your (completely valid) displeasure at the government and regulatory bodies that allow this to happen!

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  4. John R. Sabine

    Scholar-at-Large

    Really just one more example of Sabine's Universal Law of Nutrition (and as applicable to all drugs) -
    "A little will do you good, a lot will kill you".

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  5. John Doyle
    John Doyle is a Friend of The Conversation.

    architect

    Well, I'm certainly a sceptic about cholesterol lowering drugs.
    I've also seen statins recommended by doctors as a daily dose for anything.
    We know it works for patients who already have had a heart attack.
    But saying it's a good idea for everyone to take it for high cholesterol is a marketing ploy by pharmaceutical companies latching onto any straw which supports the idea whether soundly based in trials or not. And from what I can tell from my modest amount of reading these "straws" are not sound…

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    1. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to John Doyle

      Another lot of bad news for statin supporters is from DR Cate Shanahan MD <www.drcate.com>;

      Here you will see;
      *The only people who benefit from statins are men who have had a heart attack and are also smokers but refuse to quit
      *your total cholesterol score has nothing to do with your heart attack risk and triglycerides/hdl ratio is much better method of assessment..
      *Insurance companies pay HUGE bonus cheques to doctors who "help" keep their patients LDL levels down [to under 100 in the USA…

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  6. Geoff Syme

    Retired

    I will add something from personal experience. It relates to cognitive impairment. In 2009 I was found to have high cholesterol and artery problems, had a bypass op and was put on statins. My cholesterol remained high. My doctor tried various statins looking for one that might work. He put me one that had to taken just before going to bed. From the first night that I took it I slept for 2 hours then did not sleep properly for the remainder of the night. I am normally a good 8 hour sleeper. I tried…

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  7. ian cheong

    logged in via email @acm.org

    So we know all drugs have side effects. The problem is one can't effectively apply a blanket rule to individuals, because in amongst them, some will benefit and some will not.

    If people are aware of side effects, then clearly harm has been demonstrated and for them the harm may well outweigh the benefit.

    People are living longer in Australia at least partly because we are stopping people dying by using blood pressure and cholesterol lowering medications.

    A proper economic analysis of the…

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    1. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to ian cheong

      The cholesterol pills would have had nothing to do with his demise.
      We are not living longer in Oz because of cholesterol lowering medications.
      There is plenty about that if you read the conversation herein.

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