Re: [IPk] Atovastatin - Long Term Use
Ask them for some journal article references or names of investigators whose
studies have shown that statins are protective in type 1s with normal lipids
and no other cardiovascular risk factors.
They won't have any, or I owe you 2 drinks next time I see you.
Then ask them about the EDIC study finding that was presented at the
American Diabetes Association meeting a year ago that showed intensive
control of glucose levels reduces cardiovascular/stroke risk by 57% (RRR),
regardless of statin use. I would not be surprised if they say they haven't
looked into it.
I was at a joint session of cardiologists and diabetologists at the 2005
Diabetes UK APC where they banted about the idea of prescribing statins for
all type 1s over 25 regardless of lipid profile. They were talking about
whether there might be an "X factor" that means good lipid levels in someone
with type 1 are not protective. The X factor, as the EDIC data show, is
If your A1C is 8.5 and your lipids are not great, and your relatives died of
heart disease, for heaven's sake take more insulin (when you need it, not
with the goal of giving yourself hypos, obviously) and take the statin. If
your A1C is <7 and your lipids are fine and there are no other red flags in
your file with regard to CVD risk, talk about the effects of statin use with
your doctor. The possibility of neuropathy being exacerbated by a statin is
really not good news if your glycemic control's been very good for the past
couple of years, your lipids are good, and you have no other huge risk
factors for CVD, is it??
It bothers me a lot when doctors prescribe small molecule drugs to people
who don't have the problem that the drug is supposed to address, without
evidence that there is likely to be clinical benefit from off-label use.
Recently a friend quoted a professor of pharmacology whom she knows: "There
are no 'side' effects, only effects of the compound that happen to be
undesirable". Food for thought. If the cost:benefit ratio in a situation
means you are getting little measurable benefit and experiencing discomfort
or unknown, potentially serious risks, you gotta ask yourself, "Why am I
doing this?" Intensive glycemic control in type 1 diabetes is very effective
for preventing or delaying all types of vascular complications and no one
knows the long-term effects of statin use by people whose lipids are
actually fine. Hmm. But which is *easier*: popping a pill daily or having a
total lifestyle makeover?
Doctors are not bought and sold by the pharmaceutical companies, at least
most of them aren't. It does seem to me that many of them wish a cocktail of
pills could accomplish the same degree of health improvement or maintenance
as patient education, counselling, exercise, dietary advice, and
self-monitoring data analysis. In type 1 diabetes you can't throw pills at
the problem and expect it to improve automatically. The most effective
strategies for managing it involve hard work and are time- and
labour-intensive. We live in a culture that says "throw pharmaceuticals at
the problem until it feels better"; obviously that model doesn't serve
chronic diseases well at all. ACE-inhibitors have been shown to improve
kidney function remarkably and that's wonderful - but not everyone needs to
be on one 'just in case'. I have trouble understanding how a statin got to
be considered a 'just in case' therapy. It is a potent type of drug, not a
Smartie!! Mysteries of the universe....
Stepping off my soapbox,
Type 1 13 years; MiniMed pumper 7.5 years; Animas pumper 2 years 5 months
----Original Message Follows----
From: Pat Reynolds <email @ redacted>
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] Atovastatin - Long Term Use
Date: Mon, 5 Jun 2006 08:40:18 +0100
In message <email @ redacted>, Melissa P. Ford
<email @ redacted> writes
>And if you are on a statin only because your doctor thought
>it sounded like a good idea even though your cholesterol and triglycerides
>were fine, for heaven's sake have an argument with your doctor. There is
>clinical evidence to suggest that it does anyone any good to take a statin
>unless the lipids are out of order. I
Hmm ... my new clinic said it's indicated for all type 1s, even with
lipids in good order, as it's protective ...
Thank you for reminding me that doctors are being mislead on statin use.
email @ redacted
"It might look a bit messy now,
but just you come back in 500 years time"
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