More commentary on statin drugs…

I was delighted when my friend, Dr Kevin Pho, accepted my recent post on statin drugs.

As a ‘student’ writer, I was also happy to read more than a couple ‘robust’ comments. No worries here, bike racers and heart docs have thick skin.

I penned six responses on the KevinMD post. The gist of the comment is in bold. (I know; it’s weak using responses to comments as a post.)

Do you have industry sponsorships?

I have no industry relationships. I am just a clinician–a regular doctor. I see patients in the office, ablate arrhythmias and implant (evidenced-based) devices. That’s it. My blog has never made a dime. On the contrary, I pay for its costs myself. Like you would spend for any enjoyable hobby.

Did you know many of the trials of statin drugs are sponsored by pharmaceutical companies?

It is true that most of the statin trials are supported by statin makers. Such relationships are important to consider because of possible bias. But…randomized placebo-controlled clinical trials that look at hard endpoints like death, stroke and heart attack are tough to rig. You would have to posit overt dishonesty of the investigators. Though I think researchers may occasionally exaggerate positive results in lieu of adverse effects, I do not believe industry funding leads to widespread fraud. I believe most in medicine and science are right-minded–human yes, but still right-minded.

Many patients get put on statins instead of counsel on the benefits of living a healthy lifestyle.

It’s ironic that some of the criticisms of my piece stem from my perceived advocacy of statin drugs. In fact, it is the opposite: I don’t like prescribing pills. I consider myself a crusader for healthy living. I believe the best way to prevent and treat heart disease is by consistently making good choices. That said, “we” have yet to find the best means to get people on what I call the ‘program.’ (A side bar here is that I believe Ms Obama is on the right track–start with the new generation.)

The purpose of my piece was to offer my take on recent evidence for statin efficacy and safety.

Many patients are put on statin drugs for high cholesterol without clear evidence of benefit.

I concur with the notion that the debate on statins for low-risk patients continues. Most experts believe the reason statins show mixed results in low-risk patients stems from low event rates in this cohort. It’s hard to statistically lower an already low event rate.

Statins have been shown to lower CoQ10 levels.

I have read about the CoQ10 depletion idea. Ideas like this are important. Ideas are always good. But thus far, I know of no trial looking at hard outcomes (death, heart attack, stroke) that shows a benefit to adding CoQ10. The danger of promoting ideas as sound medicine is that things that are theoretical, studied only in rats or observed in a chem lab, don’t always prove true when studied in real people. Examples abound here. Think anti-oxidant vitamins.

Though some data exist suggesting that CoQ10 supplements may help relieve statin-induced muscle soreness, the MayoClinic and others say “more studies are needed.”

Statins may cause significant muscle soreness or other adverse effects?

Finally, If your doctor dismisses a potential drug-related side effect, the solution is easy. Get another doc. One who listens; who discusses the evidence base; who partners with you and then allows you to choose your course. This is called ‘patient-centered care.’ It makes for longer office visits.

Wait a minute, are you saying running behind schedule in the office might signify a good doctor?

Grin!

JMM