Would you personally take a statin?

Started by El Trombopag
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El Trombopag

El Trombopag

Full Member
7+ Year Member
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This is a random question for what is presumably a young(ish) cohort of practicing pharmacists. Many of us certainly have high cholesterol, and with the new guidelines more of us would probably be 'encouraged' to start a statin. I work in a hospital, and certain core measures have us bringing up the lack of a statin for certain indications/admission types, and I certainly do that part of my job.

But for me, personally, I just have a hard time with that particular drug class. My blood pressure is low, but my cholesterol has always been over 200 [with a decent HDL]. I just left my 30's, and am getting to that age range where every doctor is going to try to put me on one. It's the thought of irreversable inhibition of cholesterol synthesis that bugs me. . .and considering the critical role of cholesterol in cell membranes, hormone synthesis, etc. -- LOTS of potential downstream effects that wouldn't necessarily be noticed within the first month of therapy.

I've been forced to read the studies, as I'm sure most of you have. I just can't get myself to be OK ever taking one. They creep me out, and I wonder if other pharmacists have a similar reaction.
 
I wouldn't take it at this point, but if I needed to, I wouldn't see a huge problem with doing so. Despite its MOA, side effects (in practice so far) are rare compared to many other drug classes.

I'd probably stick with rosuvastatin, which seems to have the fewest adverse effects and DDIs.
 
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Are you skinny fat or just fat? Start extreme life style modification. Wait 3-6 months and retest.

If you still have high cholesterol/bad genetics, then you better start taking meds...
 
I would seriously try everything else before I would go on a statin. I think doctors tend to give them out like candy, and the new (but quite controversial) recommendations encourage that even more. The big thing is statins are now believed to cut down on blood vessel inflammation-decreasing stroke risk, in addition to their cholesterol lowering effects, which is why they are being recommended in high doses for seemingly everyone. Still, I think the side effects of statins are often ignored, patients complain to me about statins far more than any other drug (usually terrible muscle pain that cuts into their daily activities), and when I tell them they need to talk to their doctor, they tell me they have and their doctor doesn't believe them.

So to some extent, I'd rather take the risk of dying young while being able to do everything I like to do, then living long on a statin, but I can't do anything requiring fine muscle control or heavy use of large muscles because of muscle pain. Like anything, the benefits should outweigh the risks, and if I were at a point where I was convinced the benefits would outweigh the risks, I would take them.
 
Been been on lipitor 10mg for over a year now. Had total cholesterol 260 despite an hour of daily workout. Bad genes and carnavor diet I guess. Works great and no side effects noted.

Strangely, under the new guideline I don't fall under any of the 4 indicated groups because I don't meet the age or risk score requirement. But since plaque formation and inflammation occurs over time, I am not going to ask my physician to to stop it now and then restart it down the road.
 
Unless you're trying to get pregnant, I agree, it should be in water. Primary prevention for so many issues and it has antioxidant properties. Win Win
 
I'd try diet and lifestyle modifications first, I'm not keen on taking any medication on a chronic basis.
 
I love people who go to school get an education and then when confronted with facts about themselves, disregard that information and act like an idiot patient.

Here is what we do know. People who have total cholesterol levels over 200 and LDL over 100 should be treated. I know that these guidelines have been supplanted by the risk calculators, so use the risk calculator and plug in your information.

Primary treatment is lifestyle changes. Increase your exercise and see a dietician. Just like you know drugs, they know food. Be mindful of the fact that the best you can get out of moderate life style changes is about 15%.

It is also clear that lowering cholesterol appears not to account for the fact that statins seem to prevent heart attacks. Zetia and Niacin also reduce cholesterol but have no effect on long term morbidity or mortality the way statins do. While data is lacking it cetainly appears that statins exert their real effects through some kind of anti-inflammatory process.

Now, stop acting like a child. But on your big boy pants and make an informed decision. Understand there are risks to your long term health if you take the statins (cost, side effects, etc) and there are long term costs to not taking the statins (CAD, PAD, Stroke, etc). Weigh them and come to the best decision for your self. But jeeppers, creepers, grow up and like a man and stop dithering about.

What would you do if a patient came in and presented these facts to you? Would you advise they take a statin?

Finally:
El Trombopag said:
It's the thought of irreversable inhibition of cholesterol synthesis that bugs me. . .and considering the critical role of cholesterol in cell membranes, hormone synthesis, etc. -- LOTS of potential downstream effects that wouldn't necessarily be noticed within the first month of therapy. I've been forced to read the studies, as I'm sure most of you have. I just can't get myself to be OK ever taking one. They creep me out, and I wonder if other pharmacists have a similar reaction.
Click to expand...

You have not one single study that backs up any adverse effects in cell membranes or hormone synthesis or any other imaginary fairy tale like effects of statins. You read the studies and on what basis do you make these inane claims?
 
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El Trombopag said:
It's the thought of irreversable inhibition of cholesterol synthesis that bugs me. . .and considering the critical role of cholesterol in cell membranes, hormone synthesis, etc. -- LOTS of potential downstream effects that wouldn't necessarily be noticed within the first month of therapy.

I've been forced to read the studies, as I'm sure most of you have. I just can't get myself to be OK ever taking one. They creep me out, and I wonder if other pharmacists have a similar reaction.
Click to expand...
xiphoid2010 said:
Been been on lipitor 10mg for over a year now. Had total cholesterol 260 despite an hour of daily workout. Bad genes and carnavor diet I guess. Works great and no side effects noted.

Strangely, under the new guideline I don't fall under any of the 4 indicated groups because I don't meet the age or risk score requirement. But since plaque formation and inflammation occurs over time, I am not going to ask my physician to to stop it now and then restart it down the road.
Click to expand...

You would have to use your pre-treatment cholesterol levels and current age in order to determine your risk if you are a current statin user.
 
I'd like to say that with my active lifestyle, I wouldn't need one. Butttt,
Like George Bush, I run and have a resting HR of 50. He still managed to get a heart attack. I'm not too sure I would want to be on a statin for me personally. I have a great lipid profile. High HDL, low LDLs etc. But if I were to get a MI? Would I take one? Lets see, with an already low LDL, which would I rather have...dementia or another heart attack...Tough question. At this point, I'm just hoping I won't get either.
 
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Old Timer said:
You would have to use your pre-treatment cholesterol levels and current age in order to determine your risk if you are a current statin user.
Click to expand...

My pre-statin total was like 260 and LDL was 156 which was why I was put on lipitor 10mg in the first place (and bam, took LDL down to 69). But under the 2014 guideline, I don't qualify under the 4 statin treatment groups because (1) age <40 (2) LDL < 190 (3) don't have clinical CVD (4) not diabetic, and (5) 10 yr risk score <1%.

But like I said, since inflammation damage/plaque build up over decades and I haven't noted any side effects, so I'll ask to stay on lipitor even if my family doc says ok to come off of it.
 
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Counseling with statins will become important as more pharmacists offer cholesterol testing and Pfizer is trying to make lipitor as OTC status.
 
rxgolfer said:
I'd like to say that with my active lifestyle, I wouldn't need one. Butttt,
Like George Bush, I run and have a resting HR of 50. He still managed to get a heart attack. I'm not too sure I would want to be on a statin for me personally. I have a great lipid profile. High HDL, low LDLs etc. But if I were to get a MI? Would I take one? Lets see, with an already low LDL, which would I rather have...dementia or another heart attack...Tough question. At this point, I'm just hoping I won't get either.
Click to expand...

You follow the data. Right now there is only association and no proof of dementia with statins or what other conditions along with statin therapy or length of statin therapy that would be related to the cause of dementia in patient's on statins.
 
Before considering starting a statin one has to take a realistic look at the amount of alcohol they consume. That being said, I have no desire to start a statin.
 
u have to weigh the risks vs benefits. if the risks isn't noticeable or measurable, then on top of statins u also need some xanax or klonopin.
 
sb247 said:
(not a pharm person at all, but came across a slightly related study and thought of this thread)

In general I prefer lifestyle adjustment over meds if it's possible to do so, but anyway....here's the article

http://www.nejm.org/doi/full/10.1056/NEJMoa1009744#t=article
Click to expand...

Trouble is two fold. Unless you go vegan or Pritikin or some other non moderate lifestyle change the best you can get is 15% from diet and exercise. So if your total cholesterol is 200 diet and exercise might do it for you if it's 300, you need meds. Also, this study is old and now we know that statins most likely exert their beneficial effects unrelated to their cholesterol lowering effects....
 
A few years ago, my cholesterol was over 200 and my MD threatened to put me on a statin. I cut way back on meat and started getting more exercise (I run about 10 miles/week now). A year later, my cholesterol had dropped below 200 and my MD decided I didn't need a statin after all. If I hadn't been successful, however, I would have gone on a statin. I hope to still be doing all the stuff I enjoy thirty years from now, plus I need to set a good example for patients.
 
I believe that a lot of people who think they have fibromyalgia actually have statin-induced rhabdomyolysis. I don't think they should be used except for familial hypercholesterolemia or people who have multiple risk factors.

When I worked at the LTC place, I couldn't get over the 95-year-olds with late-stage Alzheimer's who were on them. Other people have told me about filling them for hospice patients. ZOMG.
 
rph3664 said:
I believe that a lot of people who think they have fibromyalgia actually have statin-induced rhabdomyolysis. I don't think they should be used except for familial hypercholesterolemia or people who have multiple risk factors.

When I worked at the LTC place, I couldn't get over the 95-year-olds with late-stage Alzheimer's who were on them. Other people have told me about filling them for hospice patients. ZOMG.
Click to expand...
So you think that there are lots of people with extended Rhabdo without an increase in CPK or development of kidney disease? Every physician I have talked with about their Fibromyalgia criteria uses a negative CPK as part of their rule out for other causes of muscle pain.
 
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I don't believe statins work so I would never take them. Not a single study has ever shown that they work as a replacement to diet and exercise.
 
BenJammin said:
I don't believe statins work so I would never take them. Not a single study has ever shown that they work as a replacement to diet and exercise.
Click to expand...
If there was such a study people would just dismiss it as it wasn't placebo controlled.
 
rph3664 said:
I believe that a lot of people who think they have fibromyalgia actually have statin-induced rhabdomyolysis. I don't think they should be used except for familial hypercholesterolemia or people who have multiple risk factors.

When I worked at the LTC place, I couldn't get over the 95-year-olds with late-stage Alzheimer's who were on them. Other people have told me about filling them for hospice patients. ZOMG.
Click to expand...

Now I know why you left the profession. You are bad at it. Stick to gardening. You are conflating two things and making a statement for which you have not one single study to back you up. Your views are so far out of the main stream they are like Jenny Mccarthy's anti vaccine crusade. Hysterical and not supported by the evidence..

There is no reason for any 95 y/o person in or out of hospice to be on a statin. I agree with that. After that your argument goes off the rails. The facts are these are life saving drugs that reverse atherosclerosis that results from our utterly ******ed food system that has been bought out by big food. If you meet the criteria, you would be a fool not to take a stain unless you really just want to experience an MI for the sport of it. The best you can get with moderate lifestyle changes is about a 15% reduction. A severe life style change can get you more, but there are about 16 people in the country who eat could roots and rhizomes all day. Statins do not have irreversible side effects. If you get myalagia which is common you can stop it and the maylagia will abate. Mayalga rate is 1.5 to 5% and the rate of rhabdomyolysis is 0.44%. They are not the same and you should be ashamed of yourself for claiming so.

Listen people, all drugs have side effects. This class of drugs saves lives. While it's pretty amazing to find a drug that lowers morbidity it's rare to find one that decreases mortality. If your cholesterol is high (especially LDL) get your ass to a dietitian and start exercising. If that does not work, take some Lipitor or you will have an MI. It's up to you....

How can you hope to help a patient make an informed decision when you are so lacking in facts......
 
The original question was just too funny not to respond with sarcasm. What kind of question is "would you personally take a statin" anyway? haha
 
Statins can save lives and the outcome they prevent is deadly. Here is another one - would you personally take Finasteride for male pattern baldness or not ? Are you comfortable with recommending it to patients ? The side effects especially the sexual ones, are reportedly permanent in some cases.
 
aldolase said:
Statins can save lives and the outcome they prevent is deadly. Here is another one - would you personally take Finasteride for male pattern baldness or not ? Are you comfortable with recommending it to patients ? The side effects especially the sexual ones, are reportedly permanent in some cases.
Click to expand...

nope, I sure wouldn't. Nor Latisse, I am not a fan of lifestyle drugs, completely unnecessary risks, IMO. As for recommending them, my job is to let people know the risks and benefits of drugs, whether or not they choose to take them is their decision to make.
 
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