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Super Advisor
cmkeyse
Total Posts: 459
Registered on: ‎03-17-2010

Statin Use

If you are thinking about getting off statins: don't. The statistics about cardiac events in type-2 diabetics are very high and unless you want to assure yourself of such an event, then continued use of statins makes sense. Lots of studies have shown that high LDL leads to CVD. However, LDL is necessary for life and if you have not had a heart attack or stroke then the ADA stated goal is below 100.  If your goal is way below 100, you should talk to your doctor about cutting back on the dose of your statin. The diabetes problems were noted with high dose statin use. You will also find that there is less benefit every time you double the statin dose, so a low dose may be okay for you but going off the medication may NOT. There is a long list of medications when taken in too high a dose is very unsafe and that list starts with insulin.  

 

Just my thoughts!

 

Chuck

alan_s
Total Posts: 13,751
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Registered on: ‎10-30-2009

Re: Statin Use

[ Edited ]


cmkeyse wrote:

If you are thinking about getting off statins: don't. The statistics about cardiac events in type-2 diabetics are very high and unless you want to assure yourself of such an event, then continued use of statins makes sense. Lots of studies have shown that high LDL leads to CVD. However, LDL is necessary for life and if you have not had a heart attack or stroke then the ADA stated goal is below 100.  If your goal is way below 100, you should talk to your doctor about cutting back on the dose of your statin. The diabetes problems were noted with high dose statin use. You will also find that there is less benefit every time you double the statin dose, so a low dose may be okay for you but going off the medication may NOT. There is a long list of medications when taken in too high a dose is very unsafe and that list starts with insulin.  

 

Just my thoughts!

 

Chuck


 

Chuck, I would love to go through every point you made to discuss this in detail. Unfortunately, I will be unable to do that properly until after I return from China in May.

 

In the meantime, it may help the discussion if you provide some checkable cites, preferably with urls, to support some of your claims. Note that I place any paper funded by the statin industry at the bottom of the credibility table when assessing the benefits of statin use. You will start tio ubderstand why I have that bias if you read these:

 

Money, Medications and Motives

Should Detectives, Not Just Academics, Review Drug Research?

To Medicate - Or Not? 

 

Please support:

 

  • The statistics about cardiac events in type-2 diabetics are very high and unless you want to assure yourself of such an event, then continued use of statins makes sense.

The statistics may be high, but I have yet to see a valid peer-reviewed paper funded by anyone other than the statin makers supporting the claim that use of statins will reduce the likelihood of those events. I have certainly never seen a paer that "assures" anyone, diabetic or not, of a cardiac problem if they fail to take a statin.

 

In my personal opinion I believe reducing BGs close to non-diabetic levels is a far more effective way for a diabetic to reduce the likelihood of a cardiac event.

 

  • Lots of studies have shown that high LDL leads to CVD.

Do they? My response is the same. I have yet to see a valid peer-reviewed paper funded by anyone other than the statin makers supporting the claim that high LDL leads to CVD.

 

PS If you have trouble finding cites, Morris is likely to be ready to assist you.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Must I test Before Meals Too?)
Born Under a Wandering Star (Latest: Lisbon: Food and Fado)
Advisor
ronaka
Total Posts: 950
Registered on: ‎12-24-2011

Re: Statin Use


cmkeyse wrote:

If you are thinking about getting off statins: don't. The statistics about cardiac events in type-2 diabetics are very high and unless you want to assure yourself of such an event, then continued use of statins makes sense. Lots of studies have shown that high LDL leads to CVD. However, LDL is necessary for life and if you have not had a heart attack or stroke then the ADA stated goal is below 100.  If your goal is way below 100, you should talk to your doctor about cutting back on the dose of your statin. The diabetes problems were noted with high dose statin use. You will also find that there is less benefit every time you double the statin dose, so a low dose may be okay for you but going off the medication may NOT. There is a long list of medications when taken in too high a dose is very unsafe and that list starts with insulin.  


I agree with your thoughts on statins. They have been proven beyond any doubt to significantly cut the risk of CVD and stroke. As far as too much insulin being a problem, that kind of depends on what you mean by too much. For sure if you take so much that you suffer a hypoglycemic event, then that is too much and it can be threatening to life depending on how low you do go.

 

But, if your BG is controlled with insulin and your BG is good, then there is no such thing as too much insulin. When your BG is good then you are taking just the right amount of insulin. It is a very serious mistake to cut back on insulin just to suffer high BG values.

Ron

Not a doctor, only another T2 diabetic with, unfortunately 11 year experience. Be cautious about accepting advice, including mine, on medical conditions from the internet. It can be a good place to get ideas, but validate them with your doctor and other medical professionals first.
alan_s
Total Posts: 13,751
Topics: 189
High Fives: 1,227
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Registered on: ‎10-30-2009

Re: Statin Use


ronaka wrote:

I agree with your thoughts on statins. They have been proven beyond any doubt to significantly cut the risk of CVD and stroke.

 

I invite you to provide disinterested cites for that, in the same way as I requested cites from Chuck.

 

Saying it is so does not make it so.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Must I test Before Meals Too?)
Born Under a Wandering Star (Latest: Lisbon: Food and Fado)
Super Advisor
cmkeyse
Total Posts: 459
Registered on: ‎03-17-2010

Re: Statin Use

Alan,

 

The National Diabetes Fact Sheet, 2011 published by the Center for Disease Contorl USA can be found at : 

 

http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf 

 

It contains the following statements about prevention of complications:

 

"Glucose control


• Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or
type 2 diabetes. In general, every percentage point drop in A1c blood test results (e.g., from 8.0% to 7.0%) can reduce the risk
of microvascular complications (eye, kidney, and nerve diseases) by 40%. The absolute difference in risk may vary for certain
subgroups of people.
• In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease."

 

Control of blood lipids


• Improved control of LDL cholesterol can reduce cardiovascular complications by 20% to 50%."

 

I strongly agree with your comments that control of diabetes is about prevention of complications and also agree that there are problems with funding of research by companies that benefit from that research like those that manufacture the drugs we take. That being said, I have not heard a great arguement for not using Statins. Could provide research or organizations that support your point of view.

 

The American Diabetic Association's

Standards of Medical Care in Diabetes—2012

can be found at:

 

http://care.diabetesjournals.org/content/35/Supplement_1/S11.full#sec-63

 

and this paper references the following documents among others on cholesterol recommendations:

 

(263) http://circ.ahajournals.org/content/110/2/227.abstract?ijkey=e416519c635c3e53c6973d694a222c399cfbbd0...

(262)  http://jama.ama-assn.org/content/291/9/1071.abstract?ijkey=71d1a6b7a8b8b6f8f2a05a8f896d92924cb7e787&...

 

There are many more refferences than these that are published in recognosed journals and/or endorced by professional organizations such as the AMA, ADA, National Heart, Lung, and Blood Institute, American College of Cardiology Foundation etc.

 

Chuck

 

 

 

 

Advisor
ronaka
Total Posts: 950
Registered on: ‎12-24-2011

Re: Statin Use


alan_s wrote:
I invite you to provide disinterested cites for that, in the same way as I requested cites from Chuck.

 Saying it is so does not make it so.


Check out the JUPITER study results. It is only one of many that have found the same thing. Yes, I know it is done by a drug company. That's who does all the studies. If you want to learn some facts you will have to give on the conspiracy theories. If we threw away all the drug company studies we would have no approved drugs to use. I guess that is what you want?

Ron

Not a doctor, only another T2 diabetic with, unfortunately 11 year experience. Be cautious about accepting advice, including mine, on medical conditions from the internet. It can be a good place to get ideas, but validate them with your doctor and other medical professionals first.
alan_s
Total Posts: 13,751
Topics: 189
High Fives: 1,227
Solutions: 140
Registered on: ‎10-30-2009

Re: Statin Use

[ Edited ]


ronaka wrote:

alan_s wrote:
I invite you to provide disinterested cites for that, in the same way as I requested cites from Chuck.

 Saying it is so does not make it so.


Check out the JUPITER study results. It is only one of many that have found the same thing. Yes, I know it is done by a drug company. That's who does all the studies. If you want to learn some facts you will have to give on the conspiracy theories. If we threw away all the drug company studies we would have no approved drugs to use. I guess that is what you want?


 

You may need to look up the meaning of disinterested.

 

Drug company studies are needed to discover and then develop drugs. But patients should be able to have trust in the FDA, or our TGA or your Canadian equivalent to supervise final approval trials and studies untainted by self-interest.There have been far too many past examples; a couple are mentioned below. Too many people have died to meet big Pharma's corporate targets.

 

Conspiracy theories? Begin here: Should Detectives, Not Just Academics, Review Drug Research?

 

But I know you won't read my blog. Instead, try some of the references I cite in that: 

 

Serving Two Masters — Conflicts of Interest in Academic Medicine, by Bernard Lo, M.D.


Glaxo's handling of Avandia concerns damned by US Senate committee


Avandia analysis: Authors with financial conflicts draw more positive conclusions

 

Researcher Reaches Plea Agreement on Charge of Fabricating Data. You may need to subscribe for that one so here is the precis:


Researcher Reaches Plea Agreement on Charge of Fabricating Data

A former influential pain drug researcher has reached a plea agreement with the Justice Department on a charge that he fabricated patient data. Federal prosecutors accused Scott Reuben, former chief of acute pain at Baystate Medical Center in Springfield, Mass., of falsifying patient data in trials of painkillers, including Merck’s Vioxx (rofecoxib) and Pfizer’s Celebrex (celecoxib). Reuben agreed to plead guilty to one count of healthcare fraud.

News reports on that appeared in several places, this is a brief extract from Medpage Today:

A Massachusetts anesthesiologist accused of fabricating data in studies of pain drugs will plead guilty to federal criminal charges under an agreement with prosecutors.

Scott Reuben, MD, a well-known pain researcher at Baystate Medical Center in Springfield, Mass., was charged with one count of healthcare fraud.

Early last year, the hospital announced that an internal audit had revealed that Reuben had made up research data out of whole cloth, affecting at least 21 published studies over a 15-year period. (See
Special Report: Few Gaps in Analgesic Practice After Reuben Retractions) The criminal charge arose from one of those studies, funded by Pfizer and published in Anesthesia & Analgesia in 2007.



In pharmaceutical research, those who pay the piper call the tunes. Provide disinterested studies and I will be prepared to consider them.

 

I'm out of time to answer Chuck; it is past 1 am here. Later.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Must I test Before Meals Too?)
Born Under a Wandering Star (Latest: Lisbon: Food and Fado)
Advisor
tclardy
Total Posts: 79
Registered on: ‎11-15-2011

Re: Statin Use

I have to chime in here.  The statement that there is no such thing as too high insulin is starting to be debunked.   There are signs pointing to the fact that the one thing in common with people who are in the metabolism b category (high lipids, elevated BG, elevated blood pressure, waistline fat) is high insulin.   There are studies being done that also show that high insulin levels may be responsible for inflamation which may be a the root cause of many problems such as cancer and cardicac events.   I am reading the book "why we get fat and what to do about it" by Gary Taubes and it is absolutely very interesting.  I also just read "the Diabetes Miracle"  by Diane Kress and the jury is certainly out as to what causes all this.   All this cholesterol and fat BS is funded by big pharma, don't trust it.  

 

I think the whole set of what has been accepted is going to change radically over the next few years.  I think processed food, high insulin levels that result from that, and the metabolic changes seen with this are going to be at the forefront.   The whole low fat/high carb thing and stating use model is startign to get shot full of holes.

 

Tim 

Update on 4/19/12-A1C 4.7, 208 pounds, dropped Lisinopril
Diagnosed Type 2 on 10/13/11. A!C-8.3, BG 231, Cholesterol 193, HDL 32, LDL 113, Triglycerides 251, 280 lbs.
Three month checkup on 1/24/12- A1C 5.0, Cholesterol 110, HDL 35, LDL 54, Triglycerides 109, 237 lbs
I am 50 and 6"3".

On Metformin 500mg twice daily. Lisinopril and Simvastatin.

alan_s
Total Posts: 13,751
Topics: 189
High Fives: 1,227
Solutions: 140
Registered on: ‎10-30-2009

Re: Statin Use

PS

 

From the JUPITER paper, for the record:

 

Clinical Implications of JUPITER (Justification for the Use of statins in Prevention: an Intervention

Trial Evaluating Rosuvastatin) in a U.S. Population Insights From the ARIC (Atherosclerosis Risk in Communities) Study

 

Eric Y. Yang, MD,*† Vijay Nambi, MD,*† Zhengzheng Tang, MS,§ Salim S. Virani, MD,*†

Eric Boerwinkle, PHD,‡ Ron C. Hoogeveen, PHD,*† Brad C. Astor, PHD,# Thomas H. Mosley, PHD,¶Josef Coresh, MD, PHD,# Lloyd Chambless, PHD,§ Christie M. Ballantyne, MD*†Houston, Texas; Chapel Hill, North Carolina; Baltimore, Maryland; and Jackson, Mississippi

{snip}

The ARIC study is a collaborative study supported by contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and

Blood Institute (NHLBI), Bethesda, Maryland.

 

Dr. Nambi has a research collaboration with General Electric, and has participated in clinical research conducted by

KOWA, Abbott, GlaxoSmithKline, Merck/Schering-Plough, Roche, and Genzyme.

 

Dr. Virani is on the Speakers’ Bureau for Abbott and Daiichi-Sankyo.

 

Dr.Ballantyne is a consultant for Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, KOWA, Merck, Merck/Schering-Plough, Metabasis, Novartis, Pfizer, Sanofi-Synthelabo, Schering-Plough, and Takeda; receives grant/

research support from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Sanofi-Synthelabo, Schering-Plough, and Takeda; has received honoraria from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Merck/Schering-Plough, Novartis,

Pfizer, Sanofi-Synthelabo, Schering-Plough, and Takeda; and is on the Speakers’ Bureau for AstraZeneca, GlaxoSmithKline, Merck, Merck/Schering-Plough, Pfizer, and Schering-Plough.

 

Drs. Yang and Nambi contributed equally to this work.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Must I test Before Meals Too?)
Born Under a Wandering Star (Latest: Lisbon: Food and Fado)
Advisor
tclardy
Total Posts: 79
Registered on: ‎11-15-2011

Re: Statin Use

Looks a like these three are all employed by drug manufactureres.  Hmmm.

Update on 4/19/12-A1C 4.7, 208 pounds, dropped Lisinopril
Diagnosed Type 2 on 10/13/11. A!C-8.3, BG 231, Cholesterol 193, HDL 32, LDL 113, Triglycerides 251, 280 lbs.
Three month checkup on 1/24/12- A1C 5.0, Cholesterol 110, HDL 35, LDL 54, Triglycerides 109, 237 lbs
I am 50 and 6"3".

On Metformin 500mg twice daily. Lisinopril and Simvastatin.