Posted on 10/16/2006 9:15:45 PM PDT by neverdem
A provocative review paper published this month has raised questions about the aggressive cholesterol-lowering recommendations made two years ago by a government panel.
The panel, the National Cholesterol Education Program, urged patients at risk for heart disease to reduce sharply their harmful LDL cholesterol and to try to reach specific, very low levels.
Though the authors of the new paper, published in the Oct. 3 issue of Annals of Internal Medicine, endorse the use of cholesterol-lowering statins, they say there is not enough solid scientific evidence to support the target numbers for LDL cholesterol set forth by the government panel.
The authors’ argument challenges mainstream medical thinking and the consensus among most cardiologists that the lower the cholesterol is, the better.
Until 2004, an LDL cholesterol level of less than 130 milligrams a deciliter was considered low enough. But the updated guidelines recommend that high-risk patients reduce their level even more — to less than 100 — while patients at very high risk are given “the option” of reducing LDL cholesterol to less than 70. Patients often have to take more than one cholesterol-lowering drug to achieve those targets.
“This paper is not arguing that there is strong evidence against the LDL targets, but rather that there’s no evidence for them,” said Dr. Rodney A. Hayward, a study author, adding that this was largely because of the way clinical trials had been devised and carried out.
“If you’re going to say, ‘Take two or three drugs to get to these levels,’ you need to know you’re doing more benefit than harm,” said Dr. Hayward, who is director of the Veterans Affairs Center for Health Services Research and Development and a professor at the University of Michigan Medical School. He said he was particularly concerned because there was little long-term safety...
(Excerpt) Read more at nytimes.com ...
And just to add, I was on Lipitor (10 mg) for about six or seven years. Recently I changed to Zocor when it went off patent and my doctor says that 40 mg is roughly comparable to the 10 mg dose of Lipitor. The cost through my medical care plan is quite significant. I only pay $20 for three months supply of the new generic Zocor where it would have been several hundred dollars for Lipitor. I can't tell any real difference in the two. But I intend to raise this again with my doctor. He stays on top of this pretty well. I tend to trust his judgment and I haven't always trusted some of my doctors. I will argue with them if I don't agree with them. I have always believed that our medical care is up to us and that we are the "boss" when it comes to this subject.
So do you still have the weird dreams after switching to the generic Zocor? I have been on Zocor for a couple of years and just recently switched to the generic version. I have never had any weird dreams from either version...but then I rarely ever remember my dreams anyway.
I have noticed a bit of memory loss however...I just attributed it to menopause and hormone levels...but maybe the Zocor is the culprit. I'll be discussing this with my doctor at my next check up.
Some of those effects I see in my dad. We've been battling his lower back pain for some time now (along with fatigue etc.). Some we know is spine related, but after all the things they've done, including melting some of the nerves, he still has back pain. Now I'm wondering if Zocor is partly responsible.
Ya gotta keep up with meds these days. Docs see too many patients per day, and rely too much (I think) on the latest greatest drug to come down the pipe.
She was placed on a statin drug. Sometime after that, she could barely walk or sit up and had pain in her neck and shoulders.
She was, uncharacteristically, in bed the entire time that my brother next visited, and he and I discussed getting her a hospital bed so that she could sit upright. One of her doctors ordered scans and x-rays to rule out a fracture or some other damage but none was found.
One night I saw a commercial for a statin drug that mentioned "talking to the doctor" if muscle pains resulted from taking the drug.
I stopped giving my mother statins and she slowly regained her strength. The pains are gone.
Do you have any problems taking that much Niacin? Do you take it all at once....just wondering.
Since it's your thread, I can participate in the hi-jacking. :-)
I work for the Board of Elections in MD on their nursing home project. We go around to nursing homes to help the residents vote absentee ballots. Part of the reason that the project was started was because some people thought that the activity directors were just using voting as an "activity" and were pretty much controlling the votes. I don't know if that's true, but I do know that in some nursing homes, people who don't even know their own name vote. And, yes, they mostly vote Dem.
On the other hand, there are people there who are mentally sharp, but physically limited. They watch tv, go to speeches by candidates, and really know who they want to vote for. Those people deserve a vote.
I don't know how we sort them out.
I was on statins briefly, but they made me feel lousy. At the recommendation of my dad (who is also a FReeper), I switched to polycosanol, which is sold as a supplement, and combined with dietary modifications, managed to get my total cholesterol down from 215 to 167, and my LDL under 130, without the muscle aches and other statin side-effects.
I am fairly suspicious of the statin industry.
I recently talked to my doctor about taking CoQ10 (not related to statins), and he said that he often recommended it for patients who got muscle pains from statins. The CoQ10 eliminated the muscle pain, and allowed the patient to continue with statins.
It's worth a try, but I'm not sure I would bother trying with someone who has already managed to get to 90 without a lot of drugs.
Well, although I had heard of side-effects from large doses of statins, I figured I'd be fine at 10mg, but I didn't feel good at all each time I went back on them (I tried three times).
Addressing the Ethical, Legal, and Social Issues Raised by Voting by Persons With Dementia
This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and formulation of uniform and workable policies for voting in long-term care settings. In some instances, extrapolation from existing policies and research permits reasonable recommendations to guide policy and practice. However, in other instances, additional research is necessary.
Jason H. Karlawish, MD; Richard J. Bonnie, JD; Paul S. Appelbaum, MD; Constantine Lyketsos, MD; Bryan James, MBioethics; David Knopman, MD; Christopher Patusky, JD; Rosalie A. Kane, PhD; Pamela S. Karlan, JD
JAMA. 2004;292:1345-1350.
Not to mention Statins causing ALS, I read recently.
Yes, exactly. We are Board of Elections employees who mostly try to bring some measure of fairness to the process. But there are many questions about levels of dementia that none of us can answer.
For example, someone who wants to vote straight Dem, because they always have may or may not know anything about who they're voting for. How do you know?
On the other hand, someone who says I'll vote for Thomas, because that's my son's name, is not likely to have a clue.
Who gets to decide?
It's non-specific, and I'd rather treat a patient than a number.
Coming of Age of C-Reactive Protein
"Statins have been shown to reduce CRP levels by 25% to 50% in previous studies.19–21 Thus, this approach has the potential to lower the LDL cholesterol and CRP level simultaneously. A prospective, long-term study has been planned to test this hypothesis. Furthermore, CRP levels could be used to motivate patients to modify their lifestyles more aggressively. Recent studies have shown that losing weight and controlling diabetes also lower CRP levels.22,23 Thus, patients can use their CRP levels as an inflammation fitness score to monitor improvement in their cardiovascular health."
"The literature review found that reports of muscle problems during statin clinical trials are extremely rare. The FDA MEDWATCH Reporting System lists 3339 cases of statin-associated rhabdomyolysis reported between January 1, 1990, and March 31, 2002. Cerivastatin was the most commonly implicated statin. Few data are available regarding the frequency of less-serious events such as muscle pain and weakness, which may affect 1% to 5% of patients. The risk of rhabdomyolysis and other adverse effects with statin use can be exacerbated by several factors, including compromised hepatic and renal function, hypothyroidism, diabetes, and concomitant medications."(partial abstract)
That's the best citation for hard numbers that I've been able to find.
Where? Citation, please?
It's been there 2 years, we're its second class. The class size was and is going from 70-100-135-165 (4 yr expansion rate). :)
Unlike the state school in Reno, we don't cost the taxpayers a dime. :)
oh, well I dont have anything against Statins, but its just the government has been wrong on health on so many issues, which is where my comment was coming from.
If you think it's statin related, tell the doc to check CPK levels in his blood.
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