Statin Nation (new documentary)

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rph3664

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It's not on Netflix yet, but it looks interesting. Has anyone else seen it?

I do agree that they are massively overused. When I worked at the LTC place, I was horrified to see people in their 90s with late-stage Alzheimer's on them. 😡

http://www.statinnation.net/
 
Just saw the preview....Looks very interesting. I do believe in statins. However, they are overprescribed in some elderly.
 
I also wonder how many of the people who have various chronic pain syndromes, including fibromyalgia, actually have statin-induced rhabdomyolysis.
 
rph3664 said:
It's not on Netflix yet, but it looks interesting. Has anyone else seen it?

I do agree that they are massively overused. When I worked at the LTC place, I was horrified to see people in their 90s with late-stage Alzheimer's on them. 😡

http://www.statinnation.net/
Click to expand...

Educate me please. Why is it such a bad thing? I thought statins are always first line for cholesterol. Why is it such a bad thing? I thought the start criteria mandates that statins are being underused in the elderly and that they should be used. Start low and go slow... What am I not seeing? Is gemfib, fenofibrate, lovaza any better? Bile acid seq? What is the big deal?
 
nycrxdream said:
Educate me please. Why is it such a bad thing? I thought statins are always first line for cholesterol. Why is it such a bad thing? I thought the start criteria mandates that statins are being underused in the elderly and that they should be used. Start low and go slow... What am I not seeing? Is gemfib, fenofibrate, lovaza any better? Bile acid seq? What is the big deal?
Click to expand...

I knew statins were not intended to be used casually when I found out they are pregnancy category X, meaning that there is no indication for use during pregnancy or lactation, because the risks always outweigh the benefits. The fetus, and later a nursing infant, needs cholesterol for proper brain and CNS development, and if a woman goes off them for a year or so, it really isn't going to hurt her. If she has very severe hypercholesterolemia (the homozygous condition, that kind of thing), she can use a bile acid sequestrant, although those tend to be constipating which is already an issue for many pregnant women.
 
rph3664 said:
I knew statins were not intended to be used casually when I found out they are pregnancy category X, meaning that there is no indication for use during pregnancy or lactation, because the risks always outweigh the benefits. The fetus, and later a nursing infant, needs cholesterol for proper brain and CNS development, and if a woman goes off them for a year or so, it really isn't going to hurt her. If she has very severe hypercholesterolemia (the homozygous condition, that kind of thing), she can use a bile acid sequestrant, although those tend to be constipating which is already an issue for many pregnant women.
Click to expand...
How many elderly patients are pregnant? Not sure what the argument is here. If you want to give a patient a category x drug, they had better not be pregnant plain and simple. That has no bearing on their prevalence or effectiveness.

I can see the argument for discontinuation in the elderly, as we think about a framingham 10 year risk in a patient who is unlikely to see ten more years anyway.

If they are used too often, it is because patients are unhealthy too often. Which other agents have mortality benefits?
 
Basically all drugs have side effects. Gem causes way too much muscle pain, fenofibrate not so much. Depends on patients insurance as well. I always wanted my mom on a statin, but since she is asian she cant be placed on it. Statins are first line after all... and they lower LDL, raise HDL and lower TG. Some of the older drugs cant do that.

When I was rounding, some asians cant even take statins because of their cyp genes. Its quite sad actually, because they have to use lovaza to control their TG... (But remember this drug raises the LDL) Bile acids were the first chol drugs to be invented... not that it is any better (very outdated)

Statins are pregnancy cat X, so you can use any other 2nd line drugs.
 
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nycrxdream said:
Basically all drugs have side effects. Gem causes way too much muscle pain, fenofibrate not so much. Depends on patients insurance as well. I always wanted my mom on a statin, but since she is asian she cant be placed on it. Statins are first line after all... and they lower LDL, raise HDL and lower TG. Some of the older drugs cant do that.

When I was rounding, some asians cant even take statins because of their cyp genes. Its quite sad actually, because they have to use lovaza to control their TG... (But remember this drug raises the LDL) Bile acids were the first chol drugs to be invented... not that it is any better (very outdated)

Statins are pregnancy cat X, so you can use any other 2nd line drugs.
Click to expand...

Where are you rounding where they are teaching you that Asians can not be on statins?
 
It is well documented that one of the rare side-effects of statin use in the elderly is cognitive impairment. Always think about that and the anticholinergic load with elderly nursing home patients among other things.

:laugh:

naseuy said:
Where are you rounding where they are teaching you that Asians can not be on statins?
Click to expand...

Haha. Just want to nip this in the bud before more people read this and start saying this to their preceptors. Prescribing statins to those of Asian descent is not an absolute contraindication. They just found in a few studies that high dose simvastatin (80mg - which people are moving away from for new patients) along with niacin greater than 1000mg (also no longer kosher) may lead to increase myopathy.
 
naseuy said:
Where are you rounding where they are teaching you that Asians can not be on statins?
Click to expand...
Its not a C/I. But a small population of asians can not take statins.
http://www.ncbi.nlm.nih.gov/pubmed/17261409
It leads to toxicity more. Thats why I think some Doctors dont want to prescribe it at all. But it is still first line therapy, I have yet to see a drug that works better than a Statin. Ill pm you the place I rounded if you are interested.
 
nycrxdream said:
Educate me please. Why is it such a bad thing? I thought statins are always first line for cholesterol. Why is it such a bad thing? I thought the start criteria mandates that statins are being underused in the elderly and that they should be used. Start low and go slow... What am I not seeing? Is gemfib, fenofibrate, lovaza any better? Bile acid seq? What is the big deal?
Click to expand...

There is no reason your 91 year old grandma who has dementia should be paying $93 a month for her DAW 1 lipitor 10mg Rx.

Statin nation: To put everyone on a statin. Helllllllllllllllll no. MD's need to learn when to stop a statin too. Not every super old patient needs to be a on a statin. Statins don't work overnight to prevent a heart attack or stroke. They take a long time to work. For someone who is at the near end of life, there is no point to keep them on a cholesterol medication to reduce their LDL from 120 to 100 or even 180 to 150 or whatever example you want to give. It's really pointless.

In school we learned that once you stop a statin, the benefits of it will last 5 to 10 years. How really true is this? I don't know. But if your 91, please just stop, its not necessary.
 
farmadiazepine said:
There is no reason your 91 year old grandma who has dementia should be paying $93 a month for her DAW 1 lipitor 10mg Rx.

Statin nation: To put everyone on a statin. Helllllllllllllllll no. MD's need to learn when to stop a statin too. Not every super old patient needs to be a on a statin. Statins don't work overnight to prevent a heart attack or stroke. They take a long time to work. For someone who is at the near end of life, there is no point to keep them on a cholesterol medication to reduce their LDL from 120 to 100 or even 180 to 150 or whatever example you want to give. It's really pointless.

In school we learned that once you stop a statin, the benefits of it will last 5 to 10 years. How really true is this? I don't know. But if your 91, please just stop, its not necessary.
Click to expand...
There are other statins instead of lipitor... in fact lipitor came out to be generic now. If your insurance doesnt cover the generic version there is always simvastatin. Ill get back to you when I round in Ged...
 
I find it hilarious that we are unable to even consider the idea that statins may be a bull**** class of drugs. If you look at cholesterol and mortality, it is a U-Shaped curve with the bottom somewhere between 180-220. Besides, this entire low-fat no-cholesterol mantra hasn't improved outcomes. Who cares though, as long as we make money of these stupid fat type 2 diabetics etc. .....😛
 
pharmalt82 said:
I find it hilarious that we are unable to even consider the idea that statins may be a bull**** class of drugs. If you look at cholesterol and mortality, it is a U-Shaped curve with the bottom somewhere between 180-220. Besides, this entire low-fat no-cholesterol mantra hasn't improved outcomes. Who cares though, as long as we make money of these stupid fat type 2 diabetics etc. .....😛
Click to expand...

It depends on your diet does it not? Statins just work on the cholesterol that is produced in your body. Endogenous, not exogenous (which is what we eat)

Where did you see this research?
 
nycrxdream said:
There are other statins instead of lipitor... in fact lipitor came out to be generic now. If your insurance doesnt cover the generic version there is always simvastatin. Ill get back to you when I round in Ged...
Click to expand...

That wasn't his point... At 91 and with dementia any statin is pretty unnecessary
 
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