We stirred up a hornets’ nest of controversy with our editorial column about prescribing the cholesterol-lowering drug Crestor for healthy people with normal cholesterol levels. What got people so excited was the idea of putting statin-type medications in salt shakers at steak houses or in the water supply. Some cardiologists have jokingly suggested to us that would be a good idea, although no one is seriously considering such a plan.
Here are some readers’ responses:
Putting Crestor in the water? Sounding Orwellian and not very likely, the very thought of it is scary. The side effects of Crestor can be severe.
My neurologist considered that the statins I was taking for a short period of time were the source of my peripheral neuropathy. A friend of mine went from daily running to walking with a walker, after taking statins. Another friend takes statins in spite of severe leg pains – when there are other and healthier ways to lower cholesterol.
I was appalled to read some time ago that statins are now prescribed for heart health as well as high cholesterol levels. The JUPITER trial should follow their research subjects for some years to determine if nerve damage is one of the side effects of statins. Since the results of the study were “so impressive that it was stopped after two years,” this is not very likely.
L.D., April 20, 2010
++++++++++
I know the comment about “putting it in the water” is not meant literally, but it raises the issue of all the stuff they ARE adding to foods. Case in point: they put iron in bread and cereal–some people don’t need additional iron, and in fact it can be harmful.
Seems like we’re seeing more and more products with added ingredients that one would normally take separately, like Vit D and Omega-3’s and calcium.
Not hard to see that a person could OD on some of these nutrients.
S.N.H., April 20, 2010
++++++++++
Crestor is associated with significant cardiovascular risk reduction in
adults age 70 and older, according to a subanalysis of the JUPITER trial
published April 20, 2010 in the Annals of Internal Medicine.
In JUPITER, adults with elevated high-sensitivity C-reactive protein levels
(an indicator of inflammation) and LDL cholesterol levels under 130 mg/dL
were randomized to receive either Crestor or placebo. This subanalysis
focused on 5700 adults 70 years and over.
After a median follow-up of 2 years, the Crestor group had a significant
reduction in the occurrence of a first cardiovascular event (stroke, heart
attack, unstable angina, bypass surgery or other revascularization, or
cardiovascular death), compared with placebo (1.22 vs. 1.99 events per 100
person-years). Those age 70 and over had a greater reduction in absolute
risk than their younger counterparts, and the benefit was observed soon
after treatment began.
In this study, the relative rate of any serious adverse event among these
older persons in the rosuvastatin group versus placebo group was 1.05 (with
the confidence interval actually 0.93 to 1.17).
So, once again, the benefit to risk ratio of statin therapy was
overwhelmingly favorable at the population level.
M.D.A., MD, April 20, 2010
++++++++++
There is no doubt that statins are an important and effective class
of medications. Reiterating the minutiae of the statistics is a nice exercise
but doesn’t address or respect the inescapable observation that this class
of drugs also has some concerning drawbacks. Why be afraid of reality?
Individuals need to be made aware of and counseled about the potential
side-effects of statins. Taking an ostrich-in-the-sand approach, cloaking
oneself in generalized statistics is not appropriate for a good physician who
claims to practice good medicine.
Who really cares about cholesterol numbers if, by taking a cholesterol lowering agent, a patient is rendered unable to walk independently and made subject to a calamitous fall?
As a neurologist, my goal is to help my patients make informed decisions and be aware and sensitive to potential side-effects. If the side-effects do occur then together we can make decisions how to employ the drugs optimally. If I sacrificed some of my patients to statistics, I’d be a lazy, inhuman doctor.
E.K., MD, April 21, 2010

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  1. Fred C., Phoenix AZ
    Reply

    Simvistatin and grapefruit: Mine is a strictly singular experience; I don’t presume to recommend this to others. 10 years ago I started on simvistatin 20mg and promptly saw both a 20-30 point drop in LDL and onset of muscle pain. Self-reduced to 10 mg and pain subsided while LDL stayed low. I have been dabbling ever since – dropping it altogether, trying aggressive alternate diets & supplements, etc. My personal best solution is good diet (not radical, just good), lots of supplements, grapefruit every few days and 5mg or less per day simvistatin (nip off the corner of a 20 mg pill).
    I have read the cautionary advice about how grapefruit tends to extend the ‘hang time’ of statins and other drugs. In my case, this hodgepodge all seems to work. Every few years I go off statins entirely for a month or so and yup – my LDL climbs back up 20-30 points. So the stuff does work, and maybe it does other wonderful things as well. I think the trick is to find the absolute minimum effective dose, and for some folks that dose may have to be ‘zero’. I’m 67 years old.

  2. K. Compary
    Reply

    Absolutely not! After my experience with Crestor I would caution anyone to be wary of it. Last Oct. I was in terrible shape & thought I was going to be in a wheelchair soon. My legs & hips hurt, could hardly walk & was totally fatigued. A friend had experienced the same symptoms with Lipitor so I thought maybe the Crestor was my enemy. Turned out to be so true. Even now, 8 months later, I still have pain with my legs & hips. After all this time I thought I would be ok, but am now thinking this pain will never go away. Am not on any statin at all & will take my chances. Niacin, fish oil, flax seed oil, vit C, D & B are what I am now taking & hoping will help with the cholesterol levels. Thanks for having his column available & also your column in the Dallas Morning News.

  3. PG
    Reply

    I get so tired of hearing about relative risks. What I want to know are the absolute risks! That is the important one to know. The pharmaceutical people use relative risk to make their drugs sounds more useful. If you knew the absolute risk, you most likely would not take their drugs.
    Also, to lower cholesterol, I used a low fat diet and ate homemade oat bran muffins 3 times a day for 6 weeks. In that time, my numbers went from almost 300 to 210. I now use Metamucil and eat Cheerios every morning. My numbers last time were 147 total. You do not need statins to lower your cholesterol if you don’t have the inherited kind of cholesterol. Diet alone really works!

  4. Ermestine
    Reply

    I have read a lot of reports on niacin for cholesterol, instead of statins. Does this require the doctors prescription? Thank you please keep the letters coming, and pray that the FDA will listen and take the statins off the market, so that patients will not be afraid to stop taking them.
    Ernestine
    PEOPLE’S PHARMACY RESPONSE: Niacin does not require a prescription, but its use for lowering cholesterol calls for medical supervision.

  5. B.D.
    Reply

    I’m grateful to all who posted on this site. After taking Lipitor (10 mg) for 6 months, my Internist switched me to Crestor (10 mg) after I complained of leg muscle weakness that I blamed for a nasty fall down porch steps/foot fracture. After 3 months on the Crestor, I began having back/core pain that resulted in severe sciatica. He dropped the dosage to 5 mg, yet I still developed muscle cramping/weakness (arms & legs, lower back) and still had the sciatica. I am now going against my MD’s wishes and will try natural sources for lowering my cholesterol and triglycerides. Need info on daily amounts to take of Niacin, Red Yeast Rice, Fish Oil, and Vitamin C, please.
    Thanks, all.

  6. Linda
    Reply

    I too am on statins. Vytorin and Crestor seemed to be the worst for me. I have muscle problems but while on these meds for a long period my muscles became so weak that I could not lift myself up without pulling my self up with the aid of a counter top.
    I can not make my doctors understand. They want me to stay on it but they are not the ones that are afraid to drop something for fear of having to get down and pick it up.
    Against their advice I stopped taking it and it took sometime but my muscles became stronger. I know we are not to doctor ourselves but when they won’t listen well I had to do it.

  7. Rx
    Reply

    A few years ago, during a lengthy illness, I consulted a Harvard/Yale educated doctor. My blood tests showed elevated cholesterol, glucose, CRP, homocysteine, but she pronounced me “in good health” overall. Hm. I was already taking some bad drugs. I could barely function due to pain and fatigue. She paid no attention to my many health concerns, only focused on putting me on Lipitor for the high cholesterol. Luckily, I said no. That aggravated her and she yelled at me.
    I took charge of my own health, stopped the nasty drugs, and went strictly gluten free. I also researched and began taking supplements, vitamins and minerals. My blood work 6 months ago showed everything was completely normal. However, during this time, one of my friends took a statin (Crestor, I believe), and now she has rhabdomyolysis. So glad I dodged that bullet!

  8. Luci
    Reply

    My cardiologist gave me a prescription for Simvastatin (Zocor) although I told her verbally and on the medical forms I filled out in her office that I was on Optipranol eye drops for pressure in my eyes and my ophthalmologist said it was “extremely important” that she know this. After taking simavastin for 4 months I developed severe pain in my left eye, and was diagnosed with “extreme dry eyes” and given a prescription for Restasis. I don’t believe these Simavastatin and Optimpranol should ever be taken together after seeing a “People’s Pharmacy” Q & A in my local newspaper on simvastatin and risk of cataracts.
    PEOPLE’S PHARMACY RESPONSE: WE HAVE SEARCHED IN VAIN FOR MENTION OF SUCH AN INTERACTION. THERE IS ONE ARTICLE SUGGESTING THAT SIMVASTATIN COULD BE HELPFUL IN CERTAIN TYPES OF GLAUCOMA:
    Ophthalmology. 2010 Mar;117(3):471-6. Epub 2010 Jan 4.
    Simvastatin and disease stabilization in normal tension glaucoma: a cohort study.
    Leung DY, Li FC, Kwong YY, Tham CC, Chi SC, Lam DS.
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong Special Administrative Region, The People’s Republic of China. dexleung@alumni.cuhk.net
    Abstract
    PURPOSE: To investigate whether simvastatin use is associated with visual field (VF) stabilization in patients with normal tension glaucoma (NTG). DESIGN: Prospective cohort study (ClinicalTrials.gov Identifier: NCT00321386). PARTICIPANTS: A total of 256 eyes from 256 Chinese subjects with NTG. METHODS: Patients were followed up at 4-month intervals for 36 months for VF progression per Anderson’s criteria. Clinical parameters were checked for association with progression in multivariate analysis. MAIN OUTCOME MEASURES: The primary outcome was the association between simvastatin use and VF progression. RESULTS: Thirty-one patients (12.1%) were taking simvastatin (statin+), and 225 patients (87.9%) were not taking simvastatin (statin-). Baseline age, gender, untreated intraocular pressure, VF indices, vertical cup-to-disc ratio, and central corneal thickness (CCT) were comparable between the 2 groups. There were significantly more patients with a history of hypercholesterolemia, systemic hypertension, and ischemic heart disease in the statin+ group. A total of 121 patients (47.3%) showed evidence of VF progression (mean rate of mean deviation loss was -0.30 decibel per year) during the 36 months of follow-up. Simvastatin use was among 8 of 121 patients (6.6%) who progressed compared with 23 of 135 patients (17.0%) who did not progress (P = 0.011). Logistic regression revealed that history of disc hemorrhage (relative risk [RR] 3.26; 95% confidence interval [CI], 1.21-8.76; P = 0.019), history of cerebrovascular accidents (RR 2.28; 95% CI, 1.03-5.06; P = 0.043), and baseline age (per 10 years older; RR 1.38; 95% CI, 1.08-1.76; P = 0.009) were significant risk factors for VF progression, whereas simvastatin use conferred a protective effect (RR 0.36; 95% CI, 0.14-0.91; P = 0.030). CONCLUSIONS: Simvastatin use may be associated with VF stabilization in patients with NTG. A larger scale randomized controlled trial and cost-effectiveness analyses seem warranted. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  9. max2tucker
    Reply

    I have been taking statins now for several years. I started on Crestor but when I experience substantial pain and a loss of muscle strength in my legs I stopped Crestor and asked my doctor to suggest a different brand. I switched to Pravastatin and while the pain did subside I have begun experiencing numbness in my feet and legs. I stopped taking Pravastatin late last month and am considering stopping statins altogether since I have begun to experience a restoration of my lower leg sensation. What is it about statins that cause this problem?
    PEOPLE’S PHARMACY RESPONSE: SOME PEOPLE TOLERATE STATINS WELL, BUT OTHERS DO NOT. THERE ARE OTHER WAYS TO GET YOUR CHOLESTEROL UNDER CONTROL. SEE OUR GUIDE.

  10. JM
    Reply

    Doctor MDA continues to refer to the JUPITER study on various threads on this site. A few points to keep in mind are: 1) JUPITER was sponsored by Astra-Zeneca. (unbiased?) 2) The study was ended 2 years early. This is often done by drug manufacturers to give a result that is most favorable to their big profit drug. 3) This study is being used by Big Pharma to promote statin use among even those with normal cholesterol levels! They now trumpet the anti-inflammation properties of statins. They ignored those who for years highlighted this major factor in heart disease. Now that they see a way to broaden the market in their huge profit making Crestor etc., suddenly they are highlighting the anti-inflammation properties of statins. 4) Keep in mind, as the big drug companies push the use of statins to lower CRP (c-reactive protein) levels to reduce inflammation, a factor in heart disease which they have long ignored while they put all their focus on lowering cholesterol (which is vital to your body in many many ways); they don’t want you to know that there are simple and safe (no side-effects) ways to lower inflammation. For example, 2-6 grams of Vitamin-C daily should do it for most people. But there is no profit for Big Pharma in this! (Years ago, two-time Nobel Prize winner Linus Pauling, was way ahead of todays big drug companies.) People, don’t swallow everything you hear today from the medical industry. While tremendous good things have been done, greed and profit are harming untold numbers of people. Do your research on any drug that is being recommended to you! (It can save you and your loved ones much heartache!)

  11. Dr. Penny
    Reply

    Thanks for your article explaining the misleading manner in which pharmaceutical companies report on the “beneficial” effects of their medications. The frequency and severity of side effects of statins are steadily mounting, and are far under-reported in the media. With any medication, it is important to weigh relative risks vs. benefits.
    As a holistic family physician, I have taken many of my patients off of statins due to side effects, concentrated on treating their elevated cholesterol with dietary changes, weight loss, exercise, omega-3 fatty acids, and found that most have LOWER cholesterol & LDL levels off statins than they did during treatment, and most of the side effects resolve within a few months.
    PEOPLE’S PHARMACY RESPONSE: WE ARE PLEASED TO HEAR THIS, AND HOPE MORE PEOPLE WILL BE ABLE TO FOLLOW THIS ROUTE.

  12. dk
    Reply

    Within five days of taking a statin drug for moderately high cholesterol, I was experiencing severe pain in my left arm as well as across my collar bones to the right shoulder. I immediately discontinued the drug, requested and was given a prescription for niacin, which has done the job with no ill effects. Meanwhile, 6 months later, I am still dealing with some pain in my left arm. The pain in my arm was diagnosed as a rotator cuff injury which occurred when the statin drug caused the ligaments to relax and allow things to slip out of place.

  13. Fred C
    Reply

    The remarks offered by doctors “M.D.A., MD” (April 20) and “E.K., MD” (April 21) are superb examples of the disconnect between the formulaic and diagnostic camps of the medical profession. One sees the same thing in teachers, lawyers, peace officers and bus drivers. I am grateful for the good ones, who see their work as a calling and who measure their success by the lives they have improved. Thank you, Dr. E.K.

  14. crandreww
    Reply

    Benefits versus risks? How can we truly assess this, when we are not even made aware of all of the true risks, such as Mitochondrial DNA mutations, such as a MELAS type disorder, and the potential for Neuronal Apoptosis both of what were seen on my brain biopsy, at 34 year of age, I was a Critical Care RN of 12 years practice and a former Statin User for 3.5 years, let alone the Cognitive effects/Neuropathy I have been dealing with for the past 8 years.
    The Diabetes risks are also worth assessing, 3 out 100? Sounds like something I would not want to risk. Statistics are so easily manipulated, as proven time and again, with just about every new drug.
    And consider the problems we have had with Ghostwriting for the Pharma Companies. http://www.plosmedicine.org/static/ghostwriting.action
    If a company stands to make a buck by selling something, that company will generally tell you anything you want to hear. Look at Wall street and the Banking industry these past few years. Why aren’t physicians trained in Nutritional approaches to treat disease? Why when we go to the doctor, we are thrown a Pill to take for our “Symptoms” and not actually treating any underlying disorders? As far as any STATINS, we have been sold a bill of goods… if you are lucky enough to survive taking the drug alone without any disabling effects, good for you, and how did Cholesterol get the bad rap anyway? What about all of the Chemicals we are putting in our bodies via processed foods, pesticides, genetically modified “foods”.

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