OT June Statins Thread

[polygonum]

Crops up regularly, always gets response, so here goes:

Statins and Musculoskeletal Conditions, Arthropathies, and Injuries ONLINE FIRST Ishak Mansi, MD; Christopher R. Frei, PharmD, MSc; Mary Jo Pugh, PhD; Una Makris, MD; Eric M. Mortensen, MD, MSc JAMA Intern Med. 2013;():1-9. doi:10.1001/jamainternmed.2013.6184

Importance Statin use may be associated with increased musculoskeletal adverse events, especially in physically active individuals.

Objective To determine whether statin use is associated with musculoskeletal conditions, including arthropathy and injury, in a military health care system.

Design A retrospective cohort study with propensity score matching.

Setting San Antonio Military Multi-Market.

Participants Tricare Prime/Plus beneficiaries evaluated from October 1,

2003, to March 1, 2010.

Interventions Statin use during fiscal year 2005. On the basis of medication fills, patients were divided into 2 groups: statin users (received a statin for at least 90 days) and nonusers (never received a statin throughout the study period).

Main Outcomes and Measures Using patients' baseline characteristics, we generated a propensity score that was used to match statin users and nonusers; odds ratios (ORs) were determined for each outcome measure. Secondary analyses determined adjusted ORs for all patients who met study criteria and a subgroup of patients with no comorbidities identified using the Charlson Comorbidity Index. Sensitivity analysis further determined adjusted ORs for a subgroup of patients with no musculoskeletal diseases at baseline and a subgroup of patients who continued statin therapy for 2 years or more. The occurrence of musculoskeletal conditions was determined using prespecified groups of International Classification of Diseases, Ninth Revision, ClinicalModification codes: Msk1, all musculoskeletal diseases; Msk1a, arthropathies and related diseases; Msk1b, injury-related diseases (dislocation, sprain, strain); and Msk2, drug-associated musculoskeletal pain.

Results A total of 46 249 individuals met study criteria (13 626 statin users and 32 623 nonusers). Of these, we propensity score?matched 6967 statin users with 6967 nonusers. Among matched pairs, statin users had a higher OR for Msk1 (OR, 1.19; 95% CI, 1.08-1.30), Msk1b (1.13;

1.05-1.21), and Msk2 (1.09; 1.02-1.18); the OR for Msk1a was 1.07 (0.99-1.16; P = .07). Secondary and sensitivity analyses revealed higher adjusted ORs for statin users in all outcome groups.

Conclusions and Relevance Musculoskeletal conditions, arthropathies, injuries, and pain are more common among statin users than among similar nonusers. The full spectrum of statins' musculoskeletal adverse events may not be fully explored, and further studies are warranted, especially in physically active individuals.

[Brian Gaff]

? Why here?

Brian

[polygonum]

Because in early May there was a long and involved thread about statins which seem to be of interest to many. The demographics of this group (from my perception) suggest that statins will have been offered to a large proportion of correspondents.

[John Williamson]

In the UK, as a matter of policy, *all* adult diabetics are pushed onto statins as early as possible unless they show contra-indictaing side effects.

The theory is that, as far as cardiac health is concerned, being diabetic is equivalent to having had your first heart attack.

[David.WE.Roberts]

Although they are now backtracking on this one last I heard (although I am struggling to remember why).

Something about the risks of a heart attack in diabetics not being caused by the same factors as the risks in one-attack non-diabetics.

Another fine example of correlation not implying causation.

However they are now suggesting statins for everyone because the reckon that the industry deserves the money - ...ummmm.. - the number and seriousness of heart attacks avoided is more than the number and seriousness of side effects.

Allegedly.

Oh, and what happened to a small dose of aspirin every day? IIRC that was a suggestion when I was first diagnosed.

Cheers

Dave R

[Andy Burns]

And a low dose of ACE inhibitor, or rolling all three into a "polypill"

[David.WE.Roberts]

Thanks - interesting stuff and uk.d-i-y is IMHO a good place to post OT stuff :-)

My brain fried early on with the big words.

Are they saying that they managed to select two matching groups with the same condition (presumably high cholesterol) where one group had statin therapy and the other didn't?

Does make me wonder how they treated the control group - or why they didn't.

Otherwise there would be the issue of underlying conditions linked to the requirement for statins.

OTOH isn't it generally accepted that some statins (such as Symvastatin) do have adverse side effects for a number of users (myself included before I stopped using them)?

In which case this is just confirming what the brochure with the pills tells you.

The brochure for Pravastatin says that more than one in 1,000 people may suffer from side effects including muscle and joint pain, with more serious side effects for more than 1 in 10,000 people.

So is the research highlighting something more significant than that published by the drug manufacturer?

Cheers

Dave R

[polygonum]

There seem to be some extra things like dislocation, sprain and strain. Plus the specific association between amount of exercise and likelihood of one of the identified issues occurring. Obviously that is of particular significance to the military.

The current Patient Information Leaflets in the UK seem to be word-for-word identical except for things like maker's name, ingredients, etc.

[Tim Lamb]

My fault!

It seemed a fitting subject for our age group and I'd rather ask opinions of friends/aquaintances than strangers.

Currently I am reaching the end of a *two week off* followed by *two weeks on* to try and spot any side effects.

The next part of the plan is to halve the dose and then get another blood test.

I may try to get my insulin levels checked as there seems to be some linkage.

>

[Tim+]

A lot of medicine is driven by the desire of drug companies to get all of us on drugs for life. With that in mind, we all have a duty to be as critical as possible about the whole life benefits and risks of such treatment.

I feel well, consequently I do not participate in any "well man" clinics, nor do I allow anyone to even measure my BP without a dammed good clinical indication.

Tim

[Terry Fields]

AOL to that. I'm now on a small clutch of meds for high BP, that I can actually tolerate - and they might even be helping my BP!

Is he on amlodipine? I was given that about five years ago, in the search for BP meds that would work. After three months I had a distressing range of symptoms, from tingling arms and legs, a sore patch on the gum line, and loss of taste and smell. When I complained I was taken off it, and some of the symptoms disappeared right away (taste and smell), some took months to lessen, and I've still got the sore patch (although successive dentists can find nothing wrong).

The other thing I'd say, about statins, is that I found a lunch-time sandwich made using Flora margarine brought by cholesterol down from 7.4 to 5.2 units, low enough for me to argue that I didn't need statins - so this could be an easy route to try first.

[polygonum]

Am happy enough for them to satisfy themselves by measuring it. (Not a big enough issue to argue about.) But absolutely never would I allow a single reading in a surgery setting to dictate any treatment of me.

We have our own BP machine and I would at the very least use that repeatedly over hours, days, weeks. And might well ask for a 24-hour or longer monitor.

[greyridersalso]

Statins (allegedly) help in the prevention of heart attacks. I don't think they do b....r all for you once you've had one. The great cholesterol myth is just that and there seems as much valid, research results out to prove t he argument either way, too much of the stuff kills you/it occurs naturally , does no harm and we need it. I was one of the 1 in a 1000 and statins caused so much damage the neurolog ist thought I had rapid onset MS. We actually argued about the statins. I s topped taking them. One month later, no muscle pain, brain fog cleared, sho rt term memory improved, stutter vanished, and I was able to walk without a stick....etc. The neurologist was impressed but wouldn't accept it was any thing to do with the medication - "fairy dust then" I told him. I'm now on a non statin based medication, available from your GP, but you h ave to ask/demand/insist on it. I've heard of or know several folk who have had various issues clear up once they dropped the statins.

[polygonum]

You could be on a thyroid forum with that list! Have you ever been tested for thyroid hormones & TSH? (Not that the tests are that good for lots of reasons.)

[stuart noble]

I did that intensive self-monitoring for a few months (well, I love spreadsheets) and what became clear was that the evening readings were higher. Now I always have BP checked at the doc's first thing in the morning, which keeps them quiet. Currently on 5mg amlodipine with no side effects

[Tim+]

"No noticeable side effects YET" I think you mean. ;-)

Tim

[stuart noble]

Thanks for that :-)

[Tim+]

You're welcome. ;-)

The fact of the matter is that if these drugs really do make you live longer, you can look forward to dying of cancer or dementia instead.

Tim

[polygonum]

I think I remember reading something like an average of 14 days. Which didn't seem a lot when the adverse effects are taken into account. (There again, I might already have dementia and be mis-remembering what I read...)

[stuart noble]

Don't overlook dying of boredom, which I consider the most likely