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Re: [IPk] Atovastatin - Long Term Use



Hi Pat,

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 
GLUCOSE CONTROL.

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,

Melissa
Type 1 13 years; MiniMed pumper 7.5 years; Animas pumper 2 years 5 months


Melissa

----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 
no
 >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.

Cheers,

Pat
--
Pat Reynolds
email @ redacted
    "It might look a bit messy now,
                     but just you come back in 500 years time"
    (T. Pratchett)
.
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