What's the story with statins?

tallaght01

When I were a lad at medical school, statins were great.

The cardiology prof told us he thought they should be put in the tap water, and he was taking them every day, even though he had no real risk factors for heart disease.

Now, depsite there bing some real fat kiddies kicking about these days, I haven't prescribed a statin in years. But i get the feeling that the adult docs have, as of late, been less inmpressed with them on a population level.

I was hoping an oul atorvastatin would see my fat arse well into my 90s.

So, and I know it's a pretty open question, but does anyone know what the story is with statins? Why aren't we all taking them as soon as we hit 40?

Wonder drug or not?

Traumadoc

Yes but statins do have side effects, some serious, the less serious ( myalgias) seem to be very debilitating.

Also there is this

http://www.usatoday.com/news/health/2004-10-16-panel-conflict-of-interest_x.htm

2Scoops

There is hardly any question of their efficacy at a population level. However, there is minimal evidence that they could be used prophylactically (lack of data rather than lack of effect) so just try getting a doctor to prescribe you one if you don't have the 'standard' indications.

In addition, Joe Soap imagines he's better off if he's not taking any meds so he won't ask if the doc doesn't offer. So, only those people familiar with the evidence and with an open-minded doctor friend will be taking them.

The side effects are not a problem for most people. The cost would be another barrier for some.

tallaght01

2Scoops wrote: »

There is hardly any question of their efficacy at a population level. .

sorry, what I meant was would there be any effect by treating a population prophylactically.

So, presumably we should be seeing reduction in cardiovascular deaths since the advent of statins. I believe this has been borne out, but I'm not 100% sure. Have there been significant changes? And, out of curiosity, are we seeing changes in other illneses that are on the more vasuclar side of cadiovascular, such as stroke and peripheral arterial disease?

I know I should look this stuff up myself but this tiny hospital I'm in has a rubbish library (there's about 10 journals) and my institutional online access has just run out.

DrIndy

Statins have a good role for protecting from heart disease - not just from their HMG-CoA reductase effect of reducing LDL cholesterol - but also their anti-inflammatory function to decrease blood vessel inflammation that causes plaques.

Therefore people with normal cholesterol may still benefit from a statin from the anti-inflammatory viewpoint.

However - all medications have side effects - statins can cause myalgia and in extremis - rhabdomyolysis. They can also cause hepatitis. Although the incidence is low - to justify prophylaxing a population as fortifying breakfast cereals or in the USA - all flour - you need a clear risk/benefit ratio.

There are other advents out there though - diet and lifestyle in the western world is the chief progenitor of the genetic tendency for heart disease - curing that advantageously would have less side effects.

Population wide treatment can also be quite politically controversial - look at fluoridation or the MMR vaccine!

tallaght01

I would be opposed to putting them in the water but I wonder how many docs would prescribe them to a healthy 40 year old who knew the risks and wanted to take them.

On a related note, there's talk of statins benig useful in multiple sclerosis. We see a bit of MS in paeds (thought not huge amounts), so I might have to start learning the names of statins again :pac:

DrIndy

There is an interesting development in the mouse equivalent model of MS - but this is a mouse and the MS-related condition is virally induced - so we are a few years from human trials. Promising none the same!

I suppose with increased child obesity - metabolic syndrome is becoming more common in the younger population!