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Joined: 13 Apr 2006 Posts: 405 Location: Bournemouth England
Posted: Tue Sep 16, 2008 2:34 pm Post subject: The statin damaged rheumatologist
I found this letter in the BMJ website rapid responses today, I suspect he will be another voice in the wilderness, but he has a point to make
Reasons to be cautious about cholesterol lowering drugs
Struthers (3 September 2008) [Full text]
Reasons to be cautious about cholesterol lowering drugs
More reasons for caution with statins and other such 15 September 2008
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Andrew N Bamji,
Consultant rheumatologist
Queen Mary's Hospital, Sidcup, Kent DA14 6LT, UK
Send response to journal:
Re: More reasons for caution with statins and other such
There is little doubt about the statistical benefit of cholesterol- lowering drugs in regard to heart disease, but much of the argument (and advice) seems to have ignored the practical benefits and also the side- effects.
Many patients coming to my clinics are on statins even if their baseline cholesterol is only just above normal and with no account of any change in risk with age; it strikes me as absurd to be starting 84 year old patients on lipid-lowering agents, but the protocols for lipid management appear to have resulted in a completely uncritical prescribing phenomenon, largely driven by targets and without regard for common sense. The doses recommended get higher and higher; the likelihood of side- effects increases likewise.
As a patient who is disabled by the side-effects of statins (muscle weakness, cramps and early fatiguability) and by the effect of ezetimebe/fenofibrate (acute myolysis) I find it difficult to advise patients with similar symptoms that they should stop their treatment to see if life becomes bearable again. This is because they have mostly been programmed to believe that they will have an immediate heart attack if they follow my advice. But God forbid that statins get added to drinking water - and may He allow a statin-free polypill. Otherwise I am done for.
As a rheumatologist I welcome the influx of patients with myalgic symptoms as it maintains the departmental coffers through Payment by Results; however, it is frustrating to deal with iatrogenic disease especially if the patients prefer to suffer it than take a cardiac chance. Statin myalgia/myolysis is not uncommon. It is time for a full reassessment of risk of these drugs not least as the benefit does not appear to me to outweigh the risk especially round the edges of minimal change and great age.
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