Statins for everyone over 50? Really?!

Here in the UK this week Professor Rory Collins has enjoyed a bit of a media blitz telling all who will listen that statins should really be considered for anyone over the age of 50, irrespective of their risk of cardiovascular disease and state of health. Here and here you can see how his ideas were reported in the Daily Mail and the Telegraph (two UK national newspapers).

One of the points Professor Collins often seems keen to get across is the ‘small risk’ from statins. However, Professor Collins often puts his focus on muscle damage, which in studies is sometimes only diagnosed if blood markers for damage are several times the upper limit of normal (sneaky, I know, but true). Also, many individuals prone to problems might have been screened out of the actual study before it even begins by employing a ‘run-in’ period where individuals are given the drugs to see how they react. If they react badly, they don’t get to make it into the study which leaves the more resilient individuals to give us a skewed idea of the hazards of medication. Also, we should be aware that statins can do more than damage muscles. They can weaken them, cause pain in them, and damage the liver and kidneys too. Cataract and diabetes are two other side effects.

I was thinking about the pros and cons of statins this week while being consulted by an elderly man with who came with a main diagnosis of Parkinson’s disease, and a past history of more than one ‘mini-strokes’ (known as transient ischaemic attacks). One of the medications he takes is the statin simvastatin. His daughter wondered whether this might be somehow compromising her father’s health, including his muscle and mental functioning. The only legitimate answer to her question is ‘yes’. But as I went on to explain, it is in my view highly unlikely that any problems here are likely to be entertained by her father’s regular doctor.

The problem is that most doctors will see sitting in front of them an elderly man with Parkinson’s disease and a history of mini-strokes, and imagine any compromise in his functioning will be related to these things, not a statin drug which was started several years ago. It might be, however, that the statin drug is genuinely compromising his functioning, and it’s certainly legitimate for this possibility to at least be entertained.

Purely by chance I came across a piece of research this week regarding the potential impact of statins on brain functioning. It’s not uncommon for people to report that taking statins led to them suffering memory or concentration issues. If statins affect the brain, then one might expect them to be particularly problematic in individuals who have compromised brain functioning to begin with, such as those with Alzheimer’s disease.

A group of US-based researchers decided to test this idea in a group of elderly individuals suffering from Alzheimer’s disease [1]. All of the individuals in this study were taking statins at the start of the study. The research involved taking these individuals off statins for 6 weeks, and then putting individuals back on their statin medication for another 6 weeks. During the study, individuals had their mental functioning assessed including with a tool known as the ‘mini mental state examination’ (MMSE). This test is designed to assess brain functions such as memory, the production and understanding of language, problem-solving and decision-making – what researchers and doctors often refer to as ‘cognition’.

This research revealed that withdrawal of statins led to a statistically significant improvement in cognition in the study subjects. Re-starting statin therapy led to cognition worsening again. The implication here is that for individuals with dementia, statin treatment might further compromise brain function and, along with it, quality of life and dependence of carers.

One gratifying thing is that there is hugely growing awareness of the very real downsides and potential for harm of statins. If you care to, you can look at the comments after the two articles I link to and read a steady stream of statin sceptics who often give first-hand tales of apparently being harmed by these drugs. And also encouraging is the fact that there are even murmurings from doctors who believe giving statins to everyone based on their age is just not good medicine (I’m in this camp too, of course).

One of the problems with Professor Collins is that he seems incapable of providing a truly balanced view of statins. He is particularly selective about his quoting of the supposed risks, I think. Plus, it seems he can’t quite bring himself to come clean about facts like statins don’t save lives in people with no prior history of cardiovascular disease (e.g. a previous heart attack or stroke) and the vast majority of people who take statins over several years will not benefit from them.

I reckon Professor Collins has a lot of his credibility invested in us believing his ‘hype’ about statins. He appears to have major blind spots about these drugs, and perhaps these two things are related. One other problem, I think, is that Professor Collins is not a clinician, and simply won’t have the experience of seeing the potential damage statins can cause in the real World. He’s a data man, and a very selective quoter of it, to boot.

References:

1. Padala KP, et al. The Effect of HMG: CoA Reductase Inhibitors on Cognition in Patients With Alzheimer’s Dementia: A Prospective Withdrawal and Rechallenge Pilot Study. Am J Geriatr Pharmacother. 2012 Aug 22. [Epub ahead of print]

12 Responses to Statins for everyone over 50? Really?!

  1. Haarajot 31 August 2012 at 2:41 pm #

    Dr Briffa, isn’t there currently going on a large twenty years American study about a possible correlation between the use of statins and Parkinsonism?

  2. Lynn 31 August 2012 at 3:02 pm #

    Really pleased you addressed this John. Seeing this article by Professor Collins really annoyed me yesterday as you know. I have a hard enough job assuring my friends and family that I am not risking my health by my low carb, high fat way of life and then this article pops up and all their fears resurface. I lost my closest friend, who died as a result of a heart attack, after spending a thoroughly miserable few years with all the side effects of statins including a terribly itchy rash all over her legs and feet which drove her to distraction. None of her doctors connected it to the statins and one even suggested that she had bed bugs in her home!
    I will never support medication for the masses and certainly not making perfectly healthy people into ‘patients’. Rory Collins should be ashamed of himself.
    Lynn

  3. Megan 31 August 2012 at 4:48 pm #

    Does anyone know if Dr Collins is involved with, works for or is paid by the pharmaceutical industry. Why would he want to weigh in with his opinion on this subject unless it is worthwhile to him in a financials sense. maybe he has a book on the way?

  4. Lorna 31 August 2012 at 8:50 pm #

    Sorry, John, but where are the 2 articles we can link to so we can read comments? Really valuable to have your ‘watch’ on the pro-statin propaganda!

  5. Eddie Mitchell 31 August 2012 at 9:51 pm #

    “Does anyone know if Dr Collins is involved with, works for or is paid by the pharmaceutical industry. Why would he want to weigh in with his opinion on this subject unless it is worthwhile to him in a financials sense. maybe he has a book on the way?”

    From Dr. Malcolm Kendrick’s blog.

    Kendrick

    “This research comes from the Clinical Trials Service Unit at Oxford who run the Cholesterol Triallists Collaboration, and who run clinical studies – mainly funded by the likes of Merck and Schering Plough. This unit is exceedingly pro-statin and do post-hoc analysis of all the cholesterol trials again, and again. They point blank refuse to release the data they have on adverse effects of statins, claiming it is commercially sensitive. Not perhaps as sensitive as the muscles of those who take these damned things. He states that only one in ten thousand people suffer serious side-effects. This must make me a most amazing doctor as I have seen two cases of rhabdomyelosis, three severe liver failures and umpteen problems with mood swings, depression, impotence, cognitive problems and one case of possible motor neurone disease. These drugs create a vast range of side-effects, some very serious. Yet, still, there is no evidence of any significant effect on overall mortality.”
    http://drmalcolmkendrick.org/about/

  6. Eddie Mitchell 31 August 2012 at 10:30 pm #

    Hi John

    Could Professor Rory Collins have been pushing an advance damage limitation job ?

    Just after I posted the comments made by Dr. Kendrick, this information hot off the Pulse press landed in my email in tray.

    The study analysed all case reports of muscle-related adverse events with statins from the US Food and Drug Adminstration’s adverse event reporting system database over six years, including rhabdomyolysis, muscle atrophy and myalgia. Of the 57,000 case reports identified, rosuvastatin was found to have the highest risk of muscle-related adverse events compared with all other statins.With rosuvastatin designated a 100% relative risk to the other statins, the next highest risk was atorvastatin with a 55% risk of events, followed by simvastatin at 26%, pravastatin at 17% and lovastatin at 7.5%.These risks were found to approximately track with per milligram potency, meaning the relative potency of each statin appeared to be a predictor of muscle adverse effect reporting risk. The exception was fluvastatin, the least potent statin, but one that had a 74% risk of adverse events, compared with rosuvastatin.The study authors concluded: ‘This data offers important reference points regarding the selection of statins for cholesterol management. If statin reinitiation is considered following the muscle-related adverse events, statins of lower expected potency should be preferred.’

    http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/14525642/high-potency-statins-raise-risk-of-muscle-damage

  7. TerryJ 1 September 2012 at 4:09 pm #

    Lorna – the links are in the text. Where it says ‘Here and here’ the words are in purple which indicates there is a link associated with the word. Just hold your cursor over the word and it should change to a pointing finger, then click to go through to the linked site.

  8. TerryJ 1 September 2012 at 4:11 pm #

    Dr B., has anyone asked which statin Mr Collins is on ? He is over fifty !

  9. John Brooks 2 September 2012 at 5:04 am #

    Professor Rory Collins? Unless I’m mistaken he is a bedfellow of the pharmaceutical industry. Methinks the right honorable gentleman should have his finances examined.

  10. Greg Carlow 4 September 2012 at 1:09 pm #

    What about statins on renal failure and nerve damage? From looking at the statistics, some from your links, it is clear that the increase in renal problems is greater than the claimed reduction in heart problems and long term nerve damage is possible? Why are these never discussed?

  11. Christopher Palmer 8 September 2012 at 10:13 pm #

    Professor Peter Weissberg, medical director of the British Heart Foundation, said: ‘The issue is where do you set the threshold between low, normal and high risk.
    ‘The current arbitrary threshold was decided by cost but now statins are off patent (and much cheaper) it may be appropriate to see if there are benefits for more people – the threshold is a bit too high,’ he added.

    (From the report given in the Daily Mail)

    Ah-ha! So revenues from these darned pesky pills have declined and the profit margins have crashed. What better time to convert the former niche market into a future mass market, albeit each are founded upon a big fat lie.

    Side-effects of statins are almost inevitable irrespective of whether the patient or doctor becomes aware of them. Side-effects can be striking or subtle, and it’s easy to pass off and attribute the subtler indications to other causes.

    Apart from impeding synthesis of valuable cholesterol in the liver these drugs interfere with the synthesis of other valuable bodily biochemicals that also stem from the same mevalonate pathway, namely:
    Seleno-protein, Tau protein, Dolichol, CoQ10, and Nuclear Factor-Kappa B.

    According to Dr Duane Graveline suppression of the synthesis of these highly functional biochems accounts for the side-effects that are reported with their use, about which he has collected many accounts.

    ‘Prof Collins, 57, went to his GP a fortnight ago to ask about taking statins despite a relatively low cholesterol level, .. ..’

    (Mail)

    It’s not just that Rory Collins is a danger to others with his errant advice, he’s clearly a danger to himself also. Does the mental health act extend to such circumstances?

    .. ..’and was dismayed to learn she could not get high risk patients to take them because of fears about side effects.’

    (Mail)

    “Profits are privatised while the risks are socialised” (Sir Julain Rose) Scarcely a truer word spoken, save that in addition profits are privatised whilst actual harm is socialised. Perhaps the word is spreading, and not before time.

  12. Tony Avis 23 March 2014 at 10:45 am #

    I have been taking simvastatin’s now for some time because the doctor prescribed them to me after I hade been in hospital for kidney stones removal, the hospital took my blood pressure which was very high at the time, no other testes where done except blood pressure and blood tests which where sent away for analyses.
    Over period of time I have had an increasing problem with muscle pain and cramps in my legs, some times I get headaches only on the left-hand side of my head, the joints in my hands ache, and now I find it difficult to walk well because of the pain in the joints of my big toes, I also have difficulty getting out of bed in the mornings due to stiffness, I have had trouble with my gums and had to have some teeth removed because the gums got infected, I know from reading reports that this can be a result of taking statins, some people say that its your age but at 66 I don’t believe this I was quite fit and able to do lots of things but its getting worse.

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