Re: a primer on statins?


Leigh Melton wrote in message ...
Got a call from my endo. After all the poking, prodding, questioning
and lugging home a ton of junk, I've been rejected for the Liraglutide
study because of my cholesterol levels. I'm 18 points over their
maximum. He was sure he could get a waiver for me, but that didn't
happen.

So now he wants to put me on Lipitor. (Not for the study. Once I
start Byetta on Tuesday, that will make me ineligible.)

Since I've only been on a LC diet for about six weeks (and,
whaddayaknow, the elevated liver enzymes I had are now back in normal
range) I had thought I would try to get my chlolesterol ratios and
triglycerides in check by diet, exercise and taking fish oil caps,
etc.

I've seen references to statin use, good and bad, but don't know
enough to really know what to think.

Could someone point me to a statin primer? Its use in women
especially would be of interest to me. I've found plenty of partisan
sites, but would like something relatively balanced that a beginner to
the drug could grasp relatively quickly. He wants to start me on it
*tomorrow*, but I don't feel comfortable starting the drug until I've
read more.



Leigh

1. Should all T2 [try to ] take Statins?

http://www.medscape.com/viewarticle/496432_1

Apparently yes:

"In the Heart Protection Study (HPS) there were 5,963 diabetic subjects
within the overall study group of 20,536, of whom more than 90% had type 2
diabetes ( table 2 ).[9] Amongst the diabetic subgroup there was a similar
use of non-study statins and similar reduction in LDL cholesterol, of about
1 mmo/L, compared to the non-diabetic group.[10]

In the diabetic group on simvastatin there were highly significant
reductions in coronary deaths (20%), major coronary events (27%), strokes
(24%) and incidence of first revascularisation (17%). These figures are
similar to the reductions seen with simvastatin in the non-diabetic,
high-risk vascular patients.[9] There was also a significant reduction in
prespecified, peripheral macrovascular complications in the diabetic
subgroup including fewer amputations, leg ulcers, peripheral vascular
angioplasty and surgery. When considered together, the reduction in first
major vascular events in diabetic patients on simvastatin was 22%. An even
greater reduction was seen in the diabetic group without previous coronary
or occlusive vascular disease. Some 2,912 diabetic subjects had no
cardiovascular disease and simvastatin reduced the primary end point of a
first major vascular event from 13.5% to 9.3%, and of a first major coronary
event from 6.5% to 3.7%. This effect was still seen regardless of age, sex,
blood pressure, body mass index (BMI), HbA1C, initial LDL cholesterol or
type of diabetes, although there were very few patients with type 1 diabetes
in the study group.[10]. . ."

2. The ASCOT Study suggests that statins help even if you don't have bad
cholesterol,

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3090

"ASCOT Study Shows that Diabetes, Strokes and Heart Attacks Can be
Prevented"

". . .Results of the study showed that most strokes and heart attacks can be
abolished or reduced by 50% by simply combining modern blood pressure
lowering drugs as amlodipine and perindopril, plus effective lowering of
cholesterol, which also reduced new cases of diabetes by 30%. . . .

The final results of ASCOT, showed that the combination of newer blood
pressure lowering drugs reduced the risk of strokes by about 25%, coronaries
by 15%, cardiovascular deaths by 25% and new cases of diabetes by 30%
compared with the standard treatment.

The addition of the cholesterol lowering drug, atorvastatin, still further
reduced the remaining risk irrespective of the patient's original
cholesterol level. Indeed, the ASCOT patients only had average or below
average levels of cholesterol at the outset of the study. . ."

3. The CARDS Study agreed. (Am J Med. 2005 Dec;118 Suppl 12A:10-5.)
Also, the CARDS Study produced such favorable results that it had to be
terminated early to protect the placebo group

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3523

". . .Based on the evidence, patients with type 2 diabetes may be candidates
for statin therapy regardless of LDL cholesterol level and in the absence of
a previous CV event. . . ."

4. It seems to help with ". . .development of coronary collateral
circulation in patients with diabetes mellitus and advanced coronary artery
disease. . ."

http://www.medscape.com/viewarticle/530333?sssdmh=dm1.189954&src=nldne

and/or improve the walls of arteries

http://care.diabetesjournals.org/cgi/content/full/24/8/1499


5. They seem to have an anti-heart attack effect on the entire population:

http://cs.acc.org/cjrpicks/CJRPick.asp?cjrID=1901

". . .Statin therapy can safely reduce the five-year incidence of major
coronary events, coronary revascularization, and stroke by about 20% per
mmol/l reduction in LDL-C, largely irrespective of the initial lipid profile
or other presenting characteristics. The absolute benefit relates chiefly to
an individual?s absolute risk of such events and to the absolute reduction
in LDL-C achieved. These findings reinforce the need to consider prolonged
statin treatment with substantial LDL-C reductions in all patients at high
risk of any type of major vascular event.
Perspective: The reduction in major coronary events was seen as early as the
first year, while reduction in coronary revascularization and stroke was
evident after one year. . ."

6. Statins seem to delay the Type 2 Diabetes Progression:

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2025


7. 4225 references from medical journals, most of which point to improved
quality of life and/or longer life

http://search.medscape.com/uslclient/searchAll.do?queryText=statins

8. However, the side effects (for those few who suffer the side effects)
are very nasty. So memorize them.

http://medicine.ucsd.edu/SES/adverse_effects.htm

Regards
Old Al









.

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