Statins

[harbottle]

I've never been recommended them.
My cholesterol is different on every test. Sometimes it's a bit over the limit, sometimes under. When it's over I just say I'll do it by diet, which is rubbish, as my diet doesn't change much at all, but it keeps them off my back for a year.

The day before my last blood test I had two massive full English breakfasts and cholesterol was fine.

Trigs are always very, very low.

 

[Jasmin2000]

Every cell in the human body can manufacture it's own cholesterol - too much of it in fact, which is why HDL particles are necessary to pick up waste cholesterol and bring it back to the liver.

The 'cholesterol has important functions in the body' bit is very true, though statins don't do much to get in the way of those important functions.

Indeed and the vast majority of our cholesterol is in the cell membrane, which is about 30-40% cholesterol. It regulates the fluidity of the membrane, which is important for signalling via receptors, such as insulin receptor. When I was in the lab it was a standard to treat cells with statins to deplete cholesterol and block signalling.

Now years later, I get insulin resistance on statins with BG spikes - exactly what happened in the lab. The GP and endo have never heard of this effect of statins. However, the vast majority of membrane receptors rely on cholesterol to function efficiently and I'm pretty sure we will see reports of all kinds of functional deficiencies in the future.

 

[Chris88]

The law of unintended consequences!

 

[snowball12]

I think it’s for type 1s

I think it’s for type 1s

Nope, I'm Type 2, I should have said earlier that my last cholesterol was 2.4!!!

 

[rebrascora]

Nope, I'm Type 2, I should have said earlier that my last cholesterol was 2.4!!!

Presumably that is because you are on statins though?

 

[Jasmin2000]

All patients with increased cardiovascular disease (CVD) risk, not just diabetics, can be offered statins. My mum is 85 and quite well, but age increases risk so in come the statins.

Healthcare costs relating to CVD are £10 billion/year in UK and cost the UK economy is £25 billion. Simple health economics. What's disturbing is that GPs just follow the NICE mantra and leave individual patients to ponder for themselves if they will benefit.

 

[PerSpinasAdAstra]

Now years later, I get insulin resistance on statins with BG spikes - exactly what happened in the lab. The GP and endo have never heard of this effect of statins. However, the vast majority of membrane receptors rely on cholesterol to function efficiently and I'm pretty sure we will see reports of all kinds of functional deficiencies in the future.

Statins do indeed have a significant effect on insulin resistance:

Atorvastatin Causes Insulin Resistance and Increases Ambient Glycemia in Hypercholesterolemic Patients

We investigated whether atorvastatin might decrease insulin sensitivity and increase ambient glycemia in hypercholesterolemic patients.Clinical trials suggest that some statin treatments might increase the incidence of diabetes despite reductions in low-density ...

www.ncbi.nlm.nih.gov

I'm not sure about 'all kinds' of functional deficiencies though. Statins have now been around since the late 1980s and so far the only hint of major problems beyond those listed as known side effects (that I'm aware of) is a possible link to Alzheimer's. Even then the statin clinical trials show a net improvement in rates of dementia, presumably because statins help prevent micro strokes. If the Alzheimer's thing is real, it's presumably gone unnoticed due to the net benefits - less dementia observed in the clinical trials, not more. If statins (at the doses people are prescribed) messed too heavily with every cell's ability to produce or use cholesterol I'd imagine we'd have people dropping dead all over the place. Instead the people paying closest attention are saying 'maybe Alzheimer's' 35+ years on from the approval of the first statin. I'd be surprised if there weren't some very rare side-effects that have yet to be identified, though I'd be shocked if there were widespread problems that haven't been identified by now.

*Edited to correct typo

 

[Tdm]

Statins do indeed have a significant effect on insulin resistance:

Atorvastatin Causes Insulin Resistance and Increases Ambient Glycemia in Hypercholesterolemic Patients

We investigated whether atorvastatin might decrease insulin sensitivity and increase ambient glycemia in hypercholesterolemic patients.Clinical trials suggest that some statin treatments might increase the incidence of diabetes despite reductions in low-density ...

www.ncbi.nlm.nih.gov

I'm not sure about 'all kinds' of functional deficiencies though. Statins have now been around since the late 1980s and so far the only hint of major problems beyond those listed as known side effects (that I'm aware of) is a possible link to Alzheimer's. Even then the statin clinical trials show a net improvement in rates of dementia, presumably because statins help prevent micro strokes. If the Alzheimer's thing is real, it's presumably gone unnoticed due to the net benefits - less dementia observed in the clinical trials, not more. If statins (at the doses people are prescribed) messed too heavily with every cell's ability to produce or use cholesterol I'd imagine we'd have people dropping dead all over the place. Instead the people paying closest attention are saying 'maybe Alzheimer's' 35+ years on from the approval of the first statin. I'd be surprised if there weren't some very rare side-effects that have yet to be identified, though I'd be shocked if there were widespread problems that haven't been identified by now.

*Edited to correct typo

I've recently started statins, no problems as yet

 

[Jasmin2000]

I'm not sure about 'all kinds' of functional deficiencies though. Statins have now been around since the late 1980s and so far the only hint of major problems beyond those listed as known side effects (that I'm aware of) is a possible link to Alzheimer's. Even then the statin clinical trials show a net improvement in rates of dementia, presumably because statins help prevent micro strokes. If the Alzheimer's thing is real, it's presumably gone unnoticed due to the net benefits - less dementia observed in the clinical trials, not more. If statins (at the doses people are prescribed) messed too heavily with every cell's ability to produce or use cholesterol I'd imagine we'd have people dropping dead all over the place. Instead the people paying closest attention are saying 'maybe Alzheimer's' 35+ years on from the approval of the first statin. I'd be surprised if there weren't some very rare side-effects that have yet to be identified, though I'd be shocked if there were widespread problems that haven't been identified by now.

*Edited to correct typo

As you say, functional deficiencies have not been seen to cause widespread serious side-effects, and from a health costs perspective - benefits outweigh risks. However, within the massive cohort of statin users, there will be some subpopulations that are greatly affected, e.g. 40% increase in Type 2 incidence in men over 60 given statins.

This must then also be true of any purported improvements in dementia - not relevant on a larger scale and affecting only a subpopulation. ApoE is involved in cholesterol transport and is a risk factor for Alzheimer's. Hence, in the subpopulation expressing this gene, statins would have a more beneficial effect than in the overall population of Alzheimer's sufferers.

 

[PerSpinasAdAstra]

As you say, functional deficiencies have not been seen to cause widespread serious side-effects, and from a health costs perspective - benefits outweigh risks. However, within the massive cohort of statin users, there will be some subpopulations that are greatly affected, e.g. 40% increase in Type 2 incidence in men over 60 given statins.

Just to clarify the 40% figure for anyone who read that wrong (like I did, and had to do a lot of googling) - that's a 40% increase in the risk of Type 2, in a population who were prescribed a statin - a population thus more likely to already have high BMI, high waist-to-hip ratio, pre-existing insulin resistance, high triglycerides, high blood pressure. And that's a 40% increase in the risk - it's not as if 40% of men over 60 who are prescribed a statin will become diabetic (which is how I first read it, and I knew it had to be wrong, because it is wrong, but I had to learn why it was wrong 😉 )

 

[Jasmin2000]

...a population thus more likely to already have high BMI, high waist-to-hip ratio, pre-existing insulin resistance, high triglycerides, high blood pressure.

That's a huge oversimplification. Clearly, statin trials focus on those with risk of, or actual, cardiovascular disease (CVD), which is often related to high BMI etc., but by no means always. In fact in most statin trials high BMI and insulin resistance were exclusion criteria.

What would be nice is to see whether statins cause type 2 in normal "healthy" folk. In the analyses of the statin trials, such individuals exist and a meta-analysis of healthy statin users showed 87% higher odds of new-onset diabetes compared to non-statin users, as well as higher diabetes with complications and obesity.

 

[PerSpinasAdAstra]

That's a huge oversimplification. Clearly, statin trials focus on those with risk of, or actual, cardiovascular disease (CVD), which is often related to high BMI etc., but by no means always. In fact in most statin trials high BMI and insulin resistance were exclusion criteria.

What would be nice is to see whether statins cause type 2 in normal "healthy" folk. In the analyses of the statin trials, such individuals exist and a meta-analysis of healthy statin users showed 87% higher odds of new-onset diabetes compared to non-statin users, as well as higher diabetes with complications and obesity.

Please excuse me - I assumed you were getting the 40% figure from large population studies rather than clinical trials (with exclusion criteria). My assumption was based on this article, which put the increased diabetes risk observed in clinical trials at 9% to 12%, with the higher figures observed outside of clinical trials - Link

 

[Merluza]

I have a long and odd history with statins. When I was first prescribed them I had no problem for over a year, then the particular type of statin was changed for cost reasons. A month or so after taking the new type of statin I had a lot of problems. These were extreme enough for me to stop taking them and refusing to do so; the problems vanished.

I then had at least a decade of being badgered by different doctors to take them again and was even sacked by one specialist because of my resistance. About 5 years ago my partner developed a heart problem and was naturally prescribed statins. She didn't, and still doesn't, have any noticeable problems with them so I thought I'd give them another try. I did, with the ones that I had previously tolerated and the same problems came back. I am now taking a very low dose of a statin that is considered less good but I can at least tolerate with the only side effect being occasional pins and needles.

Most people have some side effects from statins but they are slight. If that's the case then they are worth it, I think. As with most things medical this is a personal thing. I depends upon your level of cholesterol and your tolerance of statins and you should decide but decide from a point of knowledge and experience not just resistance to the idea of taking more tablets. You can only know if statins affect to adversely if you take them.

If you refuse you will be challenged about this at every meeting with a doctor so you need to do your research and be ready to argue your case. The ones I take are Rosuvastatin which are considered old fashioned and not as good as the latest Flashy Floyd ones but they work sufficienly well for me and they keep the docs at bay. I don't personally approve of the way statins are prescribed like aspirin, and thereby hangs a tale, but that's a different thread.

 

[Chris88]

Rosuvastatin is one of the most potent statins on the market

 

[Merluza]

Maybe so, I may have been misinformed or I simply misunderstood. It doesn't really have any bearing on what I said. I take 5mg and to date only have pins and needles and an adequate reduction in my cholesterol. Even relatively small doses of other more commonly prescribed statins caused me problems.

 

[Robin]

Rosuvastatin is one of the most potent statins on the market

Maybe so, I may have been misinformed or I simply misunderstood. It doesn't really have any bearing on what I said. I take 5mg and to date only have pins and needles and an adequate reduction in my cholesterol. Even relatively small doses of other more commonly prescribed statins caused me problems.

I take Rosuvastatin without problems, a 5mg dose, after I’d had side effects with a couple of others. As I understand it, Rosuvastatin is one of a group that are thought not to cross the blood brain barrier.

 

[snowball12]

Presumably that is because you are on statins though?

Yes, it was only 4 to begin with, GP said it was for preventative reasons that I took statins. Same GP put hubby on Statins because he was 60???? crazy!!!!

 

[Jasmin2000]

Please excuse me - I assumed you were getting the 40% figure from large population studies rather than clinical trials (with exclusion criteria). My assumption was based on this article, which put the increased diabetes risk observed in clinical trials at 9% to 12%, with the higher figures observed outside of clinical trials - Link

Ah, I see where you're coming from - yes, population studies would be a bit different.

My sources are the meta-analyses of statin trials used by NICE to create the recommendations for statin therapy for CVD. These cover tens of thousands of patients and include many with comorbidities, different lifestyles, and ethnicities. Hence these meta-analyses are also used to pick out "on-paper" cohorts (old white guys, healthy individuals, those with cancer, diabetes, pregnancy, etc.) and have a look at the responses and side-effects to statins.

I do fear however, that these tertiary analyses will overlook any skewing in cohort selection, unrecorded patient conditions, badly set outcome measures, and so on, generating lies, damn lies, statistics, and meta analysis of meta-analysis!

 

[Merluza]

The problem with trials is that they have to be paid for, Trials that investigate negative effects somehow don’t get funded and so rarely get done. They become theories that are easily dismissed.

Trials are expensive, and a few hundred or thousand people who complain about side effects aren’t really worth it when you have something worth millions of dollars and doesn’t seem to bother most people.

In the final analysis it probably doesn’t matter and it’s up to the individual to make their own decision even if this can be hard when confronted by professionals, who often aren’t taking these drugs but have bought into the results.

 

[Maz2]

Just to clarify the 40% figure for anyone who read that wrong (like I did, and had to do a lot of googling) - that's a 40% increase in the risk of Type 2, in a population who were prescribed a statin - a population thus more likely to already have high BMI, high waist-to-hip ratio, pre-existing insulin resistance, high triglycerides, high blood pressure. And that's a 40% increase in the risk - it's not as if 40% of men over 60 who are prescribed a statin will become diabetic (which is how I first read it, and I knew it had to be wrong, because it is wrong, but I had to learn why it was wrong 😉 )

Always have to be careful with "headlines" as they rarely tell the whole story. I know someone who is on statins and was pre-diabetic. Now his hba1c is lower than mine (he is normal, mine has been normal but gone back pre-diabetic). I am not on statins.

As you say most of the people concerned probably had risk factors for Type 2 diabetes anyway, statin or not statin.

As everyone is different I suppose all one can do is try them if they are suggested or refuse them if they prefer to take the risks.

I know lots of people on statins who have no problems with their blood sugars.

One of my friends has very high cholesterol but, because she has no other medical problems and does not carry weight, she has not been offered statins. My GPs tend to work on the 10 percent rule which is the NHS guidance now and if you go above it they might suggest a statin. The trouble is one of my GPs told me that most of the percentage in my case comes from age!! so I am bound to go over soon. I think my GPs look at overall health first though.