Statins and Muscle Damage

[Tuesday]

For anyone who wants a summary of Taubes' book, he presented some of his research and arguments at Berkely last November. The video of the presentation is avalable here (RealPlayer required, click the little eye icon to start the video):
http://webcast.berkeley.edu/event_de...ebcastid=21216

It's about 2 hours long, and well worth the time.

[gman]

For those of you who would like to educate yourselves as to when statins should be prescribed, please see the link below.

http://www.nhlbi.nih.gov/guidelines/...l/atglance.pdf

One thing that may be of interest to you is that the goal is to decrease the LDL level, and the patients risk factors, in part, will determine how low this number should be.

The one important update to this is that if you have coronary heart disease (CHD), or a CHD risk equivalent, like diabetes, the LDL goal is now less than 70 (not <100).

The above reference is really the key to determining if someone has been appropriately placed on medication. If you understand this summary, congratulations! You now know more about lipid management than 99.9% of the rest of the population!

[Dan F.]

I am always amazed at the number of clients I get through my doors who are in their thrities, forties, and fifties that have been prescribed statins, blood pressure meds, anti -depressants, etc as a first step in the treatment process. It is very sad that a large part of the medical community has become nothing more than glorified drug peddlers.

The pharmaceuticals companies have to get their target profits... But it's not so simple: there's an intricate network of interests between industry, medical doctors and public expectations (patients). In some sense the situation resembles that of fitness industry where, like a beginner, you go in a gym for better shape and they put you in a program with machines and cables and a X times a week split routine. The problem is also what public expects: a shortcut to health, or what resembles "health": low cholesterol in blood in the first case and in the second case a pleasant ripped look (with 6 pack?) like models.

The keyword, I think, is "shortcut" that very often is not the better way but equally often is the most convenient for someone.

[Mark Rippetoe]

This from Dr. Bradford:

http://www.nhlbi.nih.gov/guidelines/...l/atglance.pdf

Standard treatment guidelines.

Not followed closely in actual practice as the bias is
strongly in favor of adding drugs due to CYA. Notice
how this is mostly when to start drugs. And that for
LDL (their main focus) the benefit is a 5.5 to 30%
reduction. What this means then is that 1.) goals
aren't reached and/or 2.) multiple drugs are used. And #2 means much better chances of adverse effects
and side effects. "Weight management" and "physical activity" for 3
months -- 3 MONTHS @!@#@!!???, of low-end ACSM-type
recommendations. Slapping on cholesterol-modifying
drugs intended for very long term use after 3 months
of minimal ineffective exercise is ridiculous. 3 months isn't a
good timeframe for dietary modification either, not in
the kind of population group you'd likely be having
this conversation with-- overweight, sedentary, lazy
and accustomed to doing whatever feels easy and good.
It takes a while for someone without any skills, who's
gone for a long time without giving a shit, to learn
to live in a better way. The first problem is that these guidelines suggest
that the underlying problem is lipids/LDL instead of
inappropriate exercise and diet and rest. None of
these drugs are magic pills that can make up for
neglect of physiologic realities. An obsession with
LDL or triglycerides or whatever marker you choose is
missing the big, giant (extremely giant in the case of
many health professionals) point.

So 3 months is as silly as
novice kids adding steroids after 3 months of a
foolish training program. Come to think of it, if
doctors were pushing strength/size this is probably
exactly how they'd add Dianabol. 3 years would be more appropriate than 3 months.

[gman]

Hey Rip,

A few points I wanted to address

"Not followed closely in actual practice as the bias is
strongly in favor of adding drugs due to CYA"

While I agree that medications are often overused, using such a broad generalized statement without any actual clinical experience is akin to saying
"All chiropractors are quacks", or "All physical therapists suck". There are bad apples in every field, but don't forget about all those good apples as well. Not all physicians want to simply CYA and throw pills at people. But it is very hard when a patient comes in demanding a mediation he say on TV for XXXXXX ailment. Most of these people have no interest in anything but taking a pill. Sad but true. Blame the Big Pharma companies for that one.

"Slapping on cholesterol-modifying
drugs intended for very long term use after 3 months
of minimal ineffective exercise is ridiculous."

Just because you start a medication, there is nothing that says you can't stop it if the patient continues to progress and improve with their diet, exercise and weight loss. Medications do not always have to be long term, but the hard truth is most people are lazy and not at all motivated to improve themselves, and would be much happier taking a pill a day than worrying about exercising every day and watching their diet. My clinical experience is that while the vast majority of people will be motivated in the short term to exercise and lose weight, less than 5-10% of people will last longer than 9-12 months. Also, keep in mind that most patients seen with elevated cholesterols who are treated are not the teens or 20 something year olds that show up on this board. They are older people, usually with other medical problems that place them at a higher risk for MI/CVA, etc. A LDL of 160 in a 22 year old is very different than one in a 55 year old with hypertension, diabetes and who smokes.

"The first problem is that these guidelines suggest
that the underlying problem is lipids/LDL instead of
inappropriate exercise and diet and rest."

This article is how to deal with elevated lipids, but I did not see anywhere where it stated they were the problem. They are the result of many things, including genetics, diet and lack of exercise, addressed (poorly in my opinion) in the article.

As far as missing the point, couldn't agree with you more, but this is only a guideline for lipid management. There are others out there that deal with obesity and poor nutrition.

The sad fact is that we used to have our high risk patients meet with a certified nutritionist and counselor on a regular basis for 45-60 minutes at a time, and at the end of the day...........suprisingly there was very little difference in improvement with folks who we saw every few months.

[Chucky]

Great post by Dr. Kilgore, wherein he mentions that in a "huge number of clinical laboratory tests, the results need to differ from 'normal' by two standard deviations in order to be considered a medical problem."

And speaking of statistics the following article in Slate written for the layperson is quite enlightening in how drug companies love to use relative risk in assessing medical studies rather than numbers needed to treat in order to slant the data to suit their own agendae.

http://www.slate.com/id/2150354/



"He uses statistics as a drunkard uses a lamppost, for support, not for illumination."

-Chesterton

[Mark1960]

I am someone who feels statins have been of benifit to me and were properly prescribed. Yes I agree with a lot that has been said ,however, there is a simple blood test to determine if muscle damage is occuring. While I had been somewhat controlling total chol with diet and exercise over many years. It became increaseing difficult as the years went by, also multiple risk factors -low HDL , high LDL,Tri,blood pressure etc became an inceasing concern. Presently I continue to exercise and watch my diet (though less stringently) and take Rosuvastatin, the specialist also prescribed fish oil for the trig. Had to beat the G.P. off with a stick over blood pressure meds. Blood pressure is fine since I got rid of the @#^% ex Mrs, lots of sex with the new girlfriend is also good for B.P. I find. Low Hdl still an issue despite my best efforts however total risk is now low. Life is good . Like your work long may it continue.

[juicysweet]

using such a broad generalized statement without any actual clinical experience

My comments are based on clinical experience. And a broad generalized statement was put in to sum it up. I stand by them and would point out that they are a very mild, cleaned up version of my thoughts on this subject.

Too many are conditioned to think of medicine as a field that encompasses and contains Health, when medicine is really a small, specialized practice area that rubs up against big, giant Health from time to time. It is unfortunate that medicine is deluded about itself, and has leveraged itself a controlling interest in so many things outside its actual purview.

Dr. Bradford