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Re: Splitting Crestor

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Re: Splitting Crestor

George10 Feb 2005 18:56
Sharon your conspiracy theories are well known around here.  We also
know about the unfortunate damage your husband suffered.

However anectdotal evidence however tragic and personal is not a
substitute for science.

Sharon Hope10 Feb 2005 06:00
>>You might want to have a "VAP" test or something similar done. What I mean
>>is
[quoted text clipped - 15 lines]
> percentage of the population taking statins have any side effects at
> all.

Sorry, that is definitely not well established.

Doctors are typically woefully uninformed.  I am, for example, contacted
almost weekly by worried spouses whose husbands have suffered memory loss on
statins, and have had the doctor adamantly deny that there could be any
possibility that the statins were involved.

Since there is such denial, the percentage claimed is completely bogus.
Indeed, one published study that included statins listed brain hemorrhage as
an "unrelated mortality" when that was a known result in dogs in early
testing, and is listed on the PI.

If you don't look for something it is often not found.

Another major reason for discontinuing statins after 2 years or more is that
the patient begins to forget to take the statin.  The memory loss typically
is not recognized by the physician as related to the statin.

George10 Feb 2005 04:37
>You might want to have a "VAP" test or something similar done. What I mean is
>that you might want to determine your LDL particle size distribution and the
>amount of lipoprotein a, Lp(a). If both of those are good, all the more reason
>to drop the statin.

Jim since I am seeing my GP at the end of the month I will ask about
these tests.  I will already have the standard cholesterol test
results since I get all my bloodwork done before I see him.  I do not
know if these tests are available in Canada though.

As far as the 60-75% stuff we were talking about I still think he
meant those who stopped statin treatment did so due to side effects.
It seems impossible to assume that he meant that 60-75% of all
patients stopped since it is well established that only a small
percentage of the population taking statins have any side effects at
all.  

Jim Chinnis10 Feb 2005 02:05
George <george@nowhere.com> wrote in part:

>>For an article touting itself as "sense" and "truth" it has a good deal of
>>nonsense and untruth. It cites the tired old "fact" that 60% or whatever of
[quoted text clipped - 3 lines]
>DISCONTINUE statin treatment discontinue due to side effects.  It does
>not say that 60-75% of the treated population suffer side effects.

Hi George. You are probably right. Let me go see...

The statement I referred to is the following: "Side effects are a major reason
that 60%-75% of people started on statins quit treatment.7,8"

That's not exactly what you said, and it's not exactly what I said!

What I object is those footnotes 7 and 8. I've read those papers and I don't
see the spin that Cohen applies. For instance, here's what reference 7 has to
say on the topic:

"While it is possible that patients discontinued therapy for good reasons,
such as the development of adverse effects given the known tolerability of the
statins, this explanation is less likely given the magnitude of nonadherence
we found. In the Scandinavian Simvastatin Survival Study (4S) study, the rates
of discontinuation due to adverse effects was only 6%, making up 50% of all
patients stopping therapy, while in the West of Scotland Coronary Prevention
Study, adverse effects accounted for only 2% of discontinuations, with the
overall discontinuation rate of 30% at 5 years.1, 25 Since we assessed the
entire drug class, if a patient was intolerant to 1 statin, switching to
another statin was possible and would not have been interpreted as
nonadherence. Like hypertension, hyperlipidemia is an asymptomatic condition.
Patients, particularly those without CAD, may perceive no immediate benefit
and discontinue medication without appreciating the long-term consequences of
their actions.17, 19, 26 Although patients in Ontario are mandated to receive
education on all initial prescriptions by pharmacists, patients refilling
prescriptions may not necessarily receive the same attention and education
regarding the importance of continued use of their statin. In addition, no
systematic, automated process is in place to encourage all pharmacists and
physicians to monitor ongoing adherence to medications."

Now would you use paper #7 to support a statement that "Side effects are a
major reason that 60%-75% of people started on statins quit treatment." It
says the exact opposite.

What the citation does is lend an air of completely undeserved scholarly
support to an assertion.

>I was put on 10mg Crestor about a year ago and my blood work was fine
>and I felt great, but when I went for a 2nd opinion to a different
[quoted text clipped - 13 lines]
>new variable though, something I will discuss at the end of the month
>with my GP when I have my annual physical.

You might want to have a "VAP" test or something similar done. What I mean is
that you might want to determine your LDL particle size distribution and the
amount of lipoprotein a, Lp(a). If both of those are good, all the more reason
to drop the statin.

>it's tough figuring out what the best course is to follow especially
>if you are not sick.  Just want to keep it this way "forever" lol

Agree.
--
Jim Chinnis   Warrenton, Virginia, USA

George09 Feb 2005 23:12
>For an article touting itself as "sense" and "truth" it has a good deal of
>nonsense and untruth. It cites the tired old "fact" that 60% or whatever of
>statin patients discontinue due to "side effects."

Jim I re-read that article and it says that 60-75% of patients WHO
DISCONTINUE statin treatment discontinue due to side effects.  It does
not say that 60-75% of the treated population suffer side effects.

I was put on 10mg Crestor about a year ago and my blood work was fine
and I felt great, but when I went for a 2nd opinion to a different
cardiologist for something else and he suggested I switch to a statin
more proven (Lipitor) even though I was doing fine.  I was going to
suggest the same thing actually to him, but he beat me to the punch.

I am one of those borderline cases taking a statin for prevention
((primary treatment) due to several risk factors but no disease.  My
LDL is just over normal my HDL has risen very nicely with a year of
hard core exercise (probably aided by the Crestor, in fact Crestor is
the only statin proven to raise HDL) and my tri's have always been
low.  I have been on and off them (statins) for about 4 years now and
am constantly wrestling with what the best approach is.  My numbers
are great when I am on and they revert back to about the same
borderline high when I am off.  The HDL being quite a bit higher is a
new variable though, something I will discuss at the end of the month
with my GP when I have my annual physical.

it's tough figuring out what the best course is to follow especially
if you are not sick.  Just want to keep it this way "forever" lol

Jim Chinnis09 Feb 2005 19:13
"Zee" <zwalanga@yahoo.com> wrote in part:

>You may only need a very small dose:
>
>http://www.medicationsense.com/articles/july_sept_04/crestor_truth.html

For an article touting itself as "sense" and "truth" it has a good deal of
nonsense and untruth. It cites the tired old "fact" that 60% or whatever of
statin patients discontinue due to "side effects." Tracking down the
citations, I find that this is based on two studies out of maybe 20 on the
subject; that it refers to elderly populations; and that the researchers
themselves (in a study with zero connection to pharma) state that
discontinuation very very unlikely to be due in any significant way on side
effects.

I wonder what the discontinuance rate is for Atkins, gym memberships, or Ace
inhibitors?

Etc., etc.
--
Jim Chinnis   Warrenton, Virginia, USA

Zee09 Feb 2005 18:02
> I've been splitting 80 mg. Lipitor into 20 mgs for years.  Saves a lot of
> money.
[quoted text clipped - 11 lines]
> --
> Remove -NOSPAM- to contact me.

You may only need a very small dose:

http://www.medicationsense.com/articles/july_sept_04/crestor_truth.html

John Keiser09 Feb 2005 04:13
I've been splitting 80 mg. Lipitor into 20 mgs for years.  Saves a lot of
money.

Crestor seems less expensive but I noted at least one webRx says "Crestor
cannot be split."

Is that true?  Why?

Ideally I would buy the 40mg and split to 10 mg or is that not physicaly
possible?  How large are the 20 mg and 40 mg tablets?

Thank you.

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