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Medical Forum / General / General / February 2005Fatty liver and low platelets?
Can Fatty Liver disease cause mild thrombocytopenia? An ultrasound found that I have a fatty liver. Recently, my platelets dropped to 101,000 and my CBC also shows a mild reduction of Red Blood Cells? My internist says it's nothing to be concerned about. Any connection between the two irregularities? Thank you James - > Can Fatty Liver disease cause mild thrombocytopenia? > [quoted text clipped - 5 lines] > > Any connection between the two irregularities? Thank you Unless the fatty liver is causing cirrhosis and/or enlargement of the spleen, probably not, but check with your doctor to be sure.  Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather Thank you SignatureJames - > >> Can Fatty Liver disease cause mild thrombocytopenia? [quoted text clipped - 9 lines] > Unless the fatty liver is causing cirrhosis and/or enlargement of the > spleen, probably not, but check with your doctor to be sure. > Can Fatty Liver disease cause mild thrombocytopenia? > > An ultrasound found that I have a fatty liver. Recently, my platelets > dropped to 101,000 and my CBC also shows a mild reduction of Red Blood > Cells? [quoted text clipped - 4 lines] > > James Are you taking a cholesterol lowering medication? Zee Yes, I take 20 mg Zocor/day. It did help with my cholesterol. The product information does not refer to platelet-lowering as a side effect. Am I missing something? Thanks SignatureJames - > >> Can Fatty Liver disease cause mild thrombocytopenia? [quoted text clipped - 14 lines] > > Zee Statin induced liver adverse effects are among the most commonly reported to the Statn Study (see below). Here's the Zocor prescribing information from Merck. http://www.zocor.com/zocor/shared/documents/english/pi.pdf Here is the website for Dr. Beatrice Golomb's five-year NIH funded UCSD statin study of statin side effects. They respond to telephone and e-mail queries from people such as yourself, and have done so for thousands. http://medicine.ucsd.edu/SES/index.htm I suggest you contact Dr. Golomb's office with your question. Zee UCSD Statin Study John McGraw Department of Medicine University of California, San Diego (858) 558-4950 statinst...@ucsd.edu ~~~~~~~~~~~~~~~~~~~~~~ http://www.news8austin.com/content/headlines/?ArID=130702&SecID=2 "Problems arise when, having excluded the population at risk of having harm, people interpret absence of evidence of harm as evidence of absence of harm. In fact, the populations that tend to enroll in clinical trials are very small, non-representative, more robust, healthier subsets of the population. And it's quite routine to find that rates of adverse effects and quote 'observational studies' where you follow people who are actually put on drugs tend to be much higher than they are in clinical trials because of the selection issue," Golomb said. Golomb also says side effects of the drugs have not been extensively studied. "The question is how much have these adverse effects been studied? Well, very little. There certainly isn't any interest group who wants to invest lots of money looking at harms of drugs because there really isn't any financial gain behind that," Golomb said. Some studies suggest the use of statins is linked to: memory loss, muscle weakness, nerve damage, cancer, insomnia, personality and behavior changes and gastrointestinal problems. Golomb is worried doctors aren't telling their patients about these risks. "Physicians have heard so many of the wonderful things about statins and so little about the potential downsides that the physicians are persuaded that the statins can't possibly be related, and then the individuals stay on the drug, and the problem progresses and becomes very severe and debilitating," Golomb said. According to Golomb only white, middle-aged men who have or are at high risk for heart disease should take statins, which contradicts current guidelines set by the National Institutes of Health. "People who are female, even if they are at high risk of heart disease, people who are middle-aged males if they're at low risk, or people who are elderly, even if they are male and high risk, none of those groups receive survival benefit with assignment to statins compared to placebo. So there's really not evidence that the benefits exceed the harms for women, for elderly or for men who aren't at high risk ... I don't believe that the current evidence supports elements of the current guidelines, Golomb said." ~~~~~~~~~~~~~~~~~~~ > Yes, I take 20 mg Zocor/day. It did help with my cholesterol. The product > information does not refer to platelet-lowering as a side effect. [quoted text clipped - 24 lines] > > > > Zee : Yes, I take 20 mg Zocor/day. It did help with my cholesterol. The product : information does not refer to platelet-lowering as a side effect. : Am I missing something? I am seeing so many people with liver problems and rhabdo on Statins. Apparently Statins also rob the body's CoEnzyme Q, which has implications for heart health. If I ever have high blood fats, i think i'll take up jogging. :) > : Yes, I take 20 mg Zocor/day. It did help with my cholesterol. The product > : information does not refer to platelet-lowering as a side effect. > > : Am I missing something? > > I am seeing so many people with liver problems and rhabdo on Statins. The symptoms of rhabdomyelosis are somehwat more spectacular than having a slightly low RBC count, though! I'm in the high-risk category for it myself (very low blood pressure, early kidney failure, and taking fibrates), so I, too, am avoiding statins. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather : > : Yes, I take 20 mg Zocor/day. It did help with my cholesterol. The product : > : information does not refer to platelet-lowering as a side effect. : > : > : Am I missing something? : > : > I am seeing so many people with liver problems and rhabdo on Statins. : The symptoms of rhabdomyelosis are somehwat more spectacular than having : a slightly low RBC count, though! I'm in the high-risk category for it : myself (very low blood pressure, early kidney failure, and taking : fibrates), so I, too, am avoiding statins. Why not go with the much cheaper, much safer alternative of flax seed oil capsules? They improved my Mom's lipid profile in 3 months. Oh, but the drug companies don't want you to know about that. ;) Emma :) Don't wait Emma. Jog now. Here is information about heart and statins. All from PUB MED (www.pubmed.org). Zee Phillips PS, Phillips CT, Sullivan MJ, Naviaux RK, Haas RH. Statin myotoxicity is associated with changes in the cardiopulmonary function. Atherosclerosis. 2004 Nov;177(1):183-8. PMID: 15488882 [PubMed - in process] Scripps Mercy Clinical Research Center, Scripps Mercy Hospital, Cardiology (Mer 74), Catheterization Laboratories, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103, USA. phillips.paul@scrippshealth.org "The mechanism of the muscle toxicity associated with lipid-lowering therapy remains obscure. Pathological and biochemical findings in patients with statin myotoxicity suggest impaired fatty acid oxidation. Exhaled gas analysis can be used to assess substrate utilization including fatty acid oxidation. In order to determine if muscle toxicity due to lipid-lowering therapy might be related to abnormalities in lipid oxidation, exhaled gas analysis was performed in the fasted state on 11 patients subsequent to statin-associated myositis reactions. Results were compared to those of 16 normal controls who were measured both on and off statin therapy. Post-myositis patients showed a depressed anaerobic threshold (AT) (P=0.009) compared to controls while age-adjusted maximal oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2) were not significantly different. The fasting respiratory exchange ratio (RER) of post-myositis patients off statins was abnormally increased (P=0.00001) as was their S1-slope (P=0.023). Controls demonstrated a significant increase in their RER while taking statins consistent with decreased lipid oxidation (P <0.00001). These findings suggest that abnormal lipid oxidation in certain patients may predispose them to the myotoxicity caused by lipid-lowering therapies." 1: Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction.Am J Cardiol. 2004 Nov 15;94(10):1306-10. PMID: 15541254 [PubMed - indexed for MEDLINE]"This study evaluated left ventricular diastolic function with Doppler echocardiography before and after statin therapy. Statin therapy worsened diastolic parameters in most patients; coenzyme Q(10) supplementation in patients with worsening diastolic function with statin therapy improved parameters of diastolic function." 2: Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Statin cardiomyopathy? A potential role for Co-Enzyme Q10 therapy forstatin-induced changes in diastolic LV performance: description of a clinical protocol.Biofactors. 2003;18(1-4):125-7. PMID: 14695927 [PubMed - indexed for MEDLINE]"Lipid-lowering statins are thought to have a favorable safety profile. Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting step of mevalonate synthesis. Mevalonate is the substrate for further synthesis of cholesterol and Co Enzyme Q10 (CoQ10). CoQ10 plays an important role during oxidative phosphorylation in the myocardial cell. Since myocardial diastolic function is a highly ATP dependent, we reasoned that early changes of diastolic function may be an early marker of ventricular dysfunction. METHODS: Patients who are to commence on statin therapy will be enrolled in the trial. Baseline measurements of plasma CoQ10, total cholesterol, LDL, HDL, CoQ10/LDL ratio, peak E, peak A velocities, E/A ratio, deceleration time, isovolumetric relaxation time, color M-mode propagation velocity will be performed and patients will then begin to take Oral atorvastatin (Lipitor, Parke-Davis) 20 mg daily for three to six months. All baseline measurement will be repeated after 3 to 6 months of statin therapy. Those patients demonstrating > 1 measurement of diastolic LV function that worsened during the 3 to 6 months of statin therapy will be supplemented with CoQ10 300 mg. daily for 3 months. A followup echocardiogram and blood CoQ10 level will be measured in patients who received CoQ10 supplementation. RESULTS: Statistical analysis will be performed using the paired t test to compare coenzyme levels and echocardiographic indices at baseline and after treatment and after supplementation." 3: Langsjoen PH, Langsjoen AM. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications.Biofactors. 2003;18(1-4):101-11. Review. PMID: 14695925 [PubMed - indexed for MEDLINE]"The depletion of the essential nutrient CoQ10 by the increasingly popular cholesterol lowering drugs, HMG CoA reductase inhibitors (statins), has grown from a level of concern to one of alarm. With ever higher statin potencies and dosages, and with a steadily shrinking target LDL cholesterol, the prevalence and severity of CoQ10 deficiency is increasing noticeably. An estimated 36 million Americans are now candidates for statin drug therapy. Statin-induced CoQ10 depletion is well documented in animal and human studies with detrimental cardiac consequences in both animal models and human trials. This drug-induced nutrient deficiency is dose related and more notable in settings of pre-existing CoQ10 deficiency such as in the elderly and in heart failure. Statin-induced CoQ10 deficiency is completely preventable with supplemental CoQ10 with no adverse impact on the cholesterol lowering or anti-inflammatory properties of the statin drugs. We are currently in the midst of a congestive heart failure epidemic in the United States, the cause or causes of which are unclear. As physicians, it is our duty to be absolutely certain that we are not inadvertently doing harm to our patients by creating a wide-spread deficiency of a nutrient critically important for normal heart function." COENZYME Q10 (UBIQUINONE) DEFICIENCY CAUSED BY STATINS http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 2353945&dopt=Abstract Study report: http://www.annals.org/issues/v137n7/nts/200210010-00004.html Dr. Phillips study mentioned in a Wall Street Journal article (This is smooth muscle, not cardiac muscle.) Conclusion "statin therapy may be associated with increased oxidation injury.mild adverse effects of statins that are difficult to assess might be much more prevalent than widely considered " http://www.impostertrial.com Is Myopathy Part Of Statin Therapy? Dr. Phillips study website, with info for Patient and Physician Cohen & Gold, Mitochondrial Cytopathy in Adults: What we know so far http://www.ccjm.org/pdffiles/COHEN701.PDF (See "Heart" in table page 4, and section on page 7) CoQ10 If statins cause CoQ10 deficiency, and CoQ10 deficiency causes mitochondrial disease, what are the symptoms of mitochondrial disease? Heart pain is one of them. Oxidation Injury in Patients Receiving HMG-CoA Reductase Inhibitors: Occurrence in Patients without Enzyme Elevation or Myopathy. US Patents: # 4,933,165 http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=/ netahtml/srchnum.htm&r=1&f=G&l=50&s1=4933165.WKU.&OS=PN/4933165&RS=PN/4933165 see also subsequent related patents: Do a search by patent number at: http://patft.uspto.gov/netahtml/srchnum.htm for the following: United States Patent 5,082,650 United States Patent 5,849,777 United States Patent 6,264,960 Merck Patent application stating that statins interfere with CoQ10 and that deficiency causes problems. They documented that they knew this about statins in 1989, 10 years before the 100+ deaths by Rhabdomyolysis! http://sites.huji.ac.il/malaria/maps/ubiquinonemetpath.html Malaria Parasite Metabolic Pathways Ubiquinone Metabolism another version: http://www.stdgen.lanl.gov/stdgen/images/KEGG/00130.html DEFINITION Ubiquinone biosynthesis - Reference pathway. Diagram of the Ubiquinone (aka CoQ10) metabolic pathway, highlighting exactly where the Statins interrupt it. All of the 17 or so steps have to happen correctly for the body to produce CoQ10, but statins interrupt (or retard) this in step #2. Introduction to the Citizen's petition to the FDA: http://www.vaccinationnews.com/DailyNews/July2002/StatinInduced8.htm by Dr. Peter Langsjoen This is the introduction to the petition. (It is aimed at getting attention, and the wording may be more alarming than necessary.) To the FDA: "Citizen Petition To Change The Labeling For All Statin Drugs (Mevacor, Lescol, Pravachol, Zocor, Lipitor, And Advicor) Recommending Use Of 100-200mg Per Day Of Supplemental Co-Enzyme Ql0 To Reduce The Risk Of Statin-Induced Myopathies (Including Cardiomyopathy And Congestive Heart Failure)," by Dr. Julian Whitaker, MD: http://www.fda.gov/ohrms/dockets/dailys/02/May02/052902/02p-0244-cp00001-01-vol1.pdf or as html: http://216.239.33.100/search?q=cache:4qAiX-YbZLYC:www.fda.gov/ohrms/dockets/dail ys/02/May02/052902/02p-0244-cp00001-01-vol1.pdf+Statin-Induced+Cardiomyopathy+In troduction+To+The+Citizen%27s+Petition+On+Statins&hl=en&ie=UTF-8 Statin Depletion of CoQ10 is linked to heart problems. Exhibit A of FDA Petition: "The clinical use of HMG CoA-reductase inhibitors (statins) and the associated depletion of the essential co-factor coenzyme Ql0; a review of pertinent human and animal data." by Dr. Peter Langsjoen MD: http://www.fda.gov/ohrms/dockets/dailys/02/May02/052902/02p-0244-cp00001-02-Exhi bit_A-vol1.pdf Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Am J Cardiol. 2004 Nov 15;94(10):1306-10. Heart Failure Institute, Department of Medicine, Advocate Christ Medical Center, University of Illinois/Christ Cardiovascular Disease Fellowship Program, Oak Lawn, Illinois 60453, USA. marc.silver@advocatehealth.com <marc.silver@advocatehealth.com> "This study evaluated left ventricular diastolic function with Doppler echocardiography before and after statin therapy. Statin therapy worsened diastolic parameters in most patients; coenzyme Q(10) supplementation in patients with worsening diastolic function with statin therapy improved parameters of diastolic function." Examples of the heart and other problems associated with statin depletion of CoQ10. 1: Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Effect of atorvastatin on left ventricular diastolic function and ability ofcoenzyme Q10 to reverse that dysfunction.Am J Cardiol. 2004 Nov 15;94(10):1306-10. PMID: 15541254 [PubMed - indexed for MEDLINE] 2: Rundek T, Naini A, Sacco R, Coates K, DiMauro S. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at riskfor cardiovascular disease and stroke.Arch Neurol. 2004 Jun;61(6):889-92. PMID: 15210526 [PubMed - indexed for MEDLINE] 3: Ornato JP. Questions & answers. I take a statin to lower my LDL (bad) cholesterol level,but I've heard statins inhibit the production of coenzyme Q10 (CoQ10). Should Itake a CoQ10 supplement?Health News. 2004 Apr;10(4):16. No abstract available. PMID: 15088591 [PubMed - indexed for MEDLINE] 4: Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Statin cardiomyopathy? A potential role for Co-Enzyme Q10 therapy forstatin-induced changes in diastolic LV performance: description of a clinicalprotocol.Biofactors. 2003;18(1-4):125-7. PMID: 14695927 [PubMed - indexed for MEDLINE] 5: Passi S, Stancato A, Aleo E, Dmitrieva A, Littarru GP. Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affectingother antioxidants and PUFA.Biofactors. 2003;18(1-4):113-24. PMID: 14695926 [PubMed - indexed for MEDLINE] 6: Langsjoen PH, Langsjoen AM. The clinical use of HMG CoA-reductase inhibitors and the associated depletionof coenzyme Q10. A review of animal and human publications.Biofactors. 2003;18(1-4):101-11. Review. PMID: 14695925 [PubMed - indexed for MEDLINE] 7: Pettit FH, Harper RF, Vilaythong J, Chu T, Shive W. Reversal of statin toxicity to human lymphocytes in tissue culture.Drug Metabol Drug Interact. 2003;19(3):151-60. PMID: 14682607 [PubMed - indexed for MEDLINE] 8: Wolters M, Hahn A. Plasma ubiquinone status and response to six-month supplementation combinedwith multivitamins in healthy elderly women--results of a randomized,double-blind, placebo-controlled study.Int J Vitam Nutr Res. 2003 May;73(3):207-14. PMID: 12847998 [PubMed - indexed for MEDLINE] 9: Hargreaves IP. Ubiquinone: cholesterol's reclusive cousin.Ann Clin Biochem. 2003 May;40(Pt 3):207-18. Review. PMID: 12803831 [PubMed - indexed for MEDLINE] 10: [No authors listed] Extra co-enzyme Q10 for statin-users?Treatmentupdate. 2001 Jun;13(2):4-7. PMID: 11570288 [PubMed - indexed for MEDLINE] 11: Fosslien E. Mitochondrial medicine--molecular pathology of defective oxidativephosphorylation.Ann Clin Lab Sci. 2001 Jan;31(1):25-67. Review. PMID: 11314862 [PubMed - indexed for MEDLINE] 12: Kaikkonen J, Nyyssonen K, Tomasi A, Iannone A, Tuomainen TP,Porkkala-Sarataho E, Salonen JT. Antioxidative efficacy of parallel and combined supplementation with coenzyme Q10 and d-alpha-tocopherol in mildly hypercholesterolemic subjects: a randomizedplacebo-controlled clinical study.Free Radic Res. 2000 Sep;33(3):329-40. PMID: 10993487 [PubMed - indexed for MEDLINE] 13: Levin WM. Statin drugs: a double-edged sword?Hosp Pract (Off Ed). 1997 Aug 15;32(8):44. No abstract available. PMID: 9275961 [PubMed - indexed for MEDLINE] 14: De Pinieux G, Chariot P, Ammi-Said M, Louarn F, Lejonc JL, Astier A,Jacotot B, Gherardi R. Lipid-lowering drugs and mitochondrial function: effects of HMG-CoA reductase inhibitors on serum ubiquinone and blood lactate/pyruvate ratio.Br J Clin Pharmacol. 1996 Sep;42(3):333-7. PMID: 8877024 [PubMed - indexed for MEDLINE] 15: Fjelstrup A. [Statin therapy and heart failure. There is a difference between statins]Tidsskr Nor Laegeforen. 1994 May 20;114(13):1561-2. Norwegian. No abstractavailable. PMID: 8079255 [PubMed - indexed for MEDLINE] 16: Carlsen SM, Fougner KJ. [Statin therapy, Q10 and heart failure. Is there any difference between statins?]Tidsskr Nor Laegeforen. 1994 Apr 30;114(11):1345. Norwegian. No abstractavailable. PMID: 8079217 [PubMed - indexed for MEDLINE] 17: Hyams DE, Roylance PJ, Kruger K, Bodd E. [Do we kill our cardiac patients with statin therapy? Coenzyme Q10, what do we know?]Tidsskr Nor Laegeforen. 1994 Feb 20;114(5):590. Norwegian. No abstractavailable. PMID: 7748252 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2 247468&dopt=Abstract Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8931-4. PMID: 2247468 [PubMed - indexed for MEDLINE] A 1990 study showing depletion of CoQ10 by Lovastatin - includes descriptions of cardiac patients. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 1479481&dopt=Abstract A 2001 discussion on "The effect of pravastatin and atorvastatin on coenzyme Q10" |
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