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