Forum: Statins Revisited

There had been previous discussions about the possible use of statins in a pandemic because of its ability to affect cytokine regulation. A recent paper Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis by David Fedson examines this issue in slightly greater detail.

Abstract:

“The next influenza pandemic may be imminent. Because antiviral agents and vaccines will be unavailable to people in most countries, we need to determine whether other agents could offer clinical benefits. Influenza is associated with an increase in acute cardiovascular diseases, and influenza viruses induce proinflammatory cytokines. Statins are cardioprotective and have anti-inflammatory and immunomodulatory effects, and they thus might benefit patients with influenza. This hypothesis should be evaluated by using administrative databases to search for reduced rates of hospitalization and death due to influenza-related conditions among people taking statins. These studies should be followed by laboratory studies of statins in animal and cell-based models of influenza virus infection and, later, by clinical trials. Positive results from such studies would provide physicians in all countries with something to offer patients for treatment and prophylaxis of pandemic influenza. Generic statins will be widely distributed and inexpensive. They might be the only agents that could alter the course of a global pandemic.”

Oh boy. People are gonna want prescriptions for statins now. Poor doctors can’t get a break.

The support for this idea was summarized by his presentation at the 12th ICID symposium: Pandemic Influenza: are we ready yet?

Fedson’s point of view is that vaccines are not going to be available to the majority of the people on this planet, and so there is a need to think out of the box, to find something that is affordable and widely available.

Data that would appear to support this approach include:

1) influenza increases the risk of acute myocardial infarction (AMI or heart attacks), congestive heart failure (CHF) and stroke, while influenza vaccination decreases all three.

2) pro-inflammatory markers (CRP, TNF-alpha, IL-6) increase risk of coronary vascular disease CVD, while statins decrease these markers and decrease risk of CVD

3) influenza viruses up-regulate pro-inflammatory cytokines, while statins down-regulate them.

Statin-associated Protection in Syndromes with Cytokine Dysregulation

There is another study by Schlienger which is submitted but not yet published which shows a compelling 53% reduction in pneumonia mortality for those patients taking statins.

Did they mention if the pharma’s would dole the pills out for free or does the govt have to give them a couple billion first? Come on, did that guy disclose a relationship with pharma?

Hi annon 22. At first glance, this comes across as a ‘solution looking for a problem’.

This looks like a pharmaceutical company pulling a rabbit out of the hat and calling it a bird.

I haven’t had a chance to read your resources yet but I hope this will not be suggested based on the weak correlations often used by epidemiologists hired by companies to sell the benefits of alcohol consumption, for example.

I don’t see a physiological basis upon which this specific drug is being sold as a solution…Do you see a connection?

Fedson calls this a possible epidemiological ‘signal of protection’ which requires more research. Certainly current state of knowledge is highly suggestive that statins might have a degree of protection in a pandemic. Whether that is the case and exactly how much protection there might be is something that needs urgent research.

Statins are inexpensive, and a lot of poorer countries are already making generic ones. However, there is a need to increase awareness, and the only way to do this is if we can find some way of funding research specifically for this purpose.

The problem is, people like cardiologists and respiratory physicians who see the benefits are not necessarily in communication with public health scientists, and vice versa. Attempts to get these people together to work on this have not been very successful so far.

So those very few privileged people, like the ones on the forum, who have access to this information will benefit, but not the millions who will have no knowledge and no way to obtain what may be their only hope of making a significant dent in mortality in the population.

I believe that this is a worthwhile cause the success of which may save more lives than we can ever imagine possible.

No, this is not a pharmaceutical company thing. The point is there are a lot of generic statins, and as I said even poor countries are making their own. They just don’t know that it might save lives in a pandemic.

The fact that there are a lot of generic statins might actually BE the reason for lack of interest to fund research IMHO.

You guys are such paranoid conspiracy junkies, but I love it just the same :-)

Hi annon 22. Aspirin and other drugs have anti-inflamatory properties. Why did they pick this candidate as the drug of choice, seems rather unusual to me as I have not heard of this correlation before?

Tom, Aspirins have other problems as you know, such as Reye’s syndrome in children etc.

But he did mention other possibilities:

1. ACE inhibitors
2. angiotensin-II receptor blockers(ARBs)
3. phosphodiesterase inhibitors
4. spironolactone
5. chloroquine

Tom, Granted it is not a well known correlation, but it is well known to cardiologists etc.

The point that Fedson is making, and I agree with him, is that we cannot promote or suggest large scale use unless there are some studies. He feels that there is enough preliminary data to support further study, but the obstacle has been the compartmentalization of medicine.

I might also add that Fedson is retired and was recently instrumental in getting vaccine companies (banging their heads together) to share information and work together to expedite pandemic vaccine research. In order to do that and not violate the numerous anti-trust rules, each meeting or conference call has to have a lawyer present, and apparently it was Fedson who kicked enough butt to get the lawyers to find a protocol that would not violate those rules. Now I heard this not from the guy but in London from the UK government folks working on pandemic vaccines. This just by way of background of where he’s coming from.

The following is from another slide, including his highlights:

1) Experimental, clinical and epidemiological evidence suggests statins might be protective

2) The clinical and public health need for an effective agent is profound

3) Generic statins are inexpensive and widely available worldwide

4) The statins/influenza hypothesis requires epidemiological, experimental and clinical confirmation

5) The research must be undertaken with a great sense of urgency

Hi annon 22. At first glance, it just doesn’t seem to make sense that they pulled this one drug out of thin air. Do they have solid not circumstancial physiological evidence that indicates it has anti-inflamatory properties not provided by standard drugs.

Usually when things don’t make sense there is a good reason. In this case, things don’t seem to add up…maybe I’m wrong but it doesn’t hurt to be skeptical until solid evidence of benefit is provided.

The short version of the problem is that cardiologists etc don’t think pandemic flu is their problem.

I think it could be promising - it makes some intuitive sense - but I won’t be running to my doc for meds on this one. You could be doing yourself more harm than good without some more evidence of effectiveness, dosages, etc. Asprin is anti-inflamatory but can also cause increased bleeding, something you don’t want in a “storm.” Same with Advild/Motrin. If the drug companies smelled an opporutnity to make $$ out of existing meds they will look into it!

annon 22 Thanks, I look forward to examining their evidence when it is avaliable. I have seen so many questionable epidemiological studies selling products in the past five years that every time a new epidemiological association is discovered, I immediately now look for the benefactor and funding agent of the study…which are usually one and the same.

If there is solid evidence for benefit…great…if not I would suggest they spend their money on masks, broad spectrum antibiotics, powdered oral electrolytes, anti-fever medication and prednisolone. These modalities have proven benefit and unless someone starts concentrating on them rather than ‘magic pills’, we are going to have a very difficult time if, in fact, this pandemic does hit sooner rather than later…

…we don’t have five years to research new innovative solutions…we have to stick to the boring solutions…but I know you already know everything I just stated. /:o)

Probably the most significant pointer to statins being possibly lifesaving in a pandemic is in its ability to down-regulate the cytokine system, with reduction in those pro-inflammatory markers that are associated with high mortality.

The other point is, of course, that they are safe and cheap.

If we think of the options:

1. antivirals
2. vaccine
3. statins

If you think of the issue of supply, out of the three, IF statins work even to a small degree, worldwide, it will translate to far more lives saved than antivirals and vaccines.

annon 22. When you hit me with vaccines and antivirals, you are hitting me in my soft spot!!

Okay if you put it that way, lets go for the statins.

Tom, the preliminary evidence IS available. The evidence for pandemic use is not, and will not be unless someone somewhere finds a way of connecting the dots,

I don’t think we need five years. What we need is to put together all the experts who understand statins and start them brainstorming with each other and with pandemic flu scientists. A lot of data may already be available.

IT IS ABOUT CONNECTING THE DOTS.

Because of their safety, the obstacles are a lot less than getting a reasonably good vaccine to a reasonable number of people.

Tom DVM – at 17:22 “annon 22. When you hit me with vaccines and antivirals, you are hitting me in my soft spot!!

Okay if you put it that way, lets go for the statins.”

I didn’t know you had a soft spot :-)

But I do think of them in the same category, and not in the category of masks and antibiotics.

lauraB – at 17:11 “I think it could be promising - it makes some intuitive sense - but I won’t be running to my doc for meds on this one. You could be doing yourself more harm than good without some more evidence of effectiveness, dosages, etc. Asprin is anti-inflamatory but can also cause increased bleeding, something you don’t want in a “storm.” Same with Advild/Motrin. If the drug companies smelled an opporutnity to make $$ out of existing meds they will look into it!”

First of all, statins are safer. Secondly, there IS a lot of information and Fedson is not the only one thinking this way. He happens to be the only one (that I know of) who is willing to take this - getting some research to verify the data - on as a cause.

Anon_22, what about niacin? My doctor indicated niacin in high concentrations reduces cholesterol just like most statins would do, but would niacin also have any anti-inflamatory effect?

De jure, I have not heard anything about niacin. Might be interesting. Will keep an eye out for it - among the many things that I am keeping an eye out for. :-)

Red Rice yeast is a generic statin product available cheap at any health food store. The FDA considered regulating it a few yrs. ago because it is a statin. For some reason they didn’t? I take 2 a day for hi Cholesterol. Nice thing about Red Rice yeast if it pans out as a possible help in this is no need for a script from a Dr. and cheap as shit to make and buy even in the US.

Anon_22, it’s a good thing you got that big dog afterall….so he can help you keep an eye out as well! By the way, there’s nobody that will better understand you after a hard day at work than your faithful companion…your dog, that is.

glennk – at 18:05 “Red Rice yeast is a generic statin product available cheap at any health food store. The FDA considered regulating it a few yrs. ago because it is a statin. For some reason they didn’t? I take 2 a day for hi Cholesterol. Nice thing about Red Rice yeast if it pans out as a possible help in this is no need for a script from a Dr. and cheap as shit to make and buy even in the US.”

So true. That’s why this is so promising.

I want to believe something like this or Elderberry Extract or some other natural remedy exists out here, but I realize it’s if it’s too good to be true it probably isn’t. Nevertheless, it’s time to think outside the box isn’t it? Waiting around for a vaccine isn’t going to cut it this time if the lethality of this beast stays so high is it?

Anon_22, how much does the red rice yeast lower the cholesterol? Mine is way up there (around 260…ouch!) That’s why I’m taking the niacin. Does red rice yeast make that much more of a difference, or is it just a modest difference?

New scientist mag published statins along with pneumovax as two things you can do now to prepare for pan flu - from memory around nov-dec edition.I think there may have been an indication of reduced mortality in seasonal flu for those who were alreaady taking statins(for x period of time? )It would be interesting to see if there was a diff between the newer classes of statins avail recently which have less general side effects - but of course more expensive and the older cheaper class which has been around for years.Prior to July last year when bird flu really started to catch my interest - New Scientist magasine was the best general source of info on bird flu that i could find. they have done a great job of alerting professionals and casual readers as to the true nature of this beast.

dr K what’s the best “new” statin available in your Prof. opinion? I have hi Chol. and probably should be on one. I’ve used Red Rice Yeast in the mean time as a natural Statin. Except for growing a third arm out of my chest I haven’t noticed any severe side efforts from it’s prolonged use. :)

dr Kockosh. I hope we are not dealing with another murky epidemiological study…many of their conclusions today are absolute bunk…I’m not saying that this one is though…lets hope they are right but in the end, the ‘proof will be in the pudding’.

Tom DVM, have they come out with any statins for pets yet? Not that I’d buy the animal equivalent, just curious…

Dejure. No. I’m not sure about this one…once again, I’m not sure it makes sense but you can bet someone will make money out of it.

We’ve got to face some facts about H5N1…it looks like it is a lot stronger than our medicine.

De jure, “Anon_22, how much does the red rice yeast lower the cholesterol? Mine is way up there (around 260…ouch!) That’s why I’m taking the niacin. Does red rice yeast make that much more of a difference, or is it just a modest difference?2

Sorry, I don’t have any specific information on this. My clinical medicine is now more broadbrushed than specific since I retired.

God, I love that R word… <g>

For the first time I can say I don’t mind having to take 80 mg of Lipitor daily. I wonder if protection, if any, would differ among long time users and new users? I wonder if those already on the medication are already compromised and perhaps would not receive the same benefits of someone who didn’t need the medication on a daily basis?

OK, I’m quoting some more from the study, on the issue of cost.

A 5 day course of tamiflu in the US costs around $60–90, a 5-day course of generic simvastatin costs $1.75.

The price difference will be even more profound in developing countries.

Rural Dweller – at 19:34 “For the first time I can say I don’t mind having to take 80 mg of Lipitor daily. I wonder if protection, if any, would differ among long time users and new users? I wonder if those already on the medication are already compromised and perhaps would not receive the same benefits of someone who didn’t need the medication on a daily basis?”

Good questions. The Schlienger would suggest positive benefits to those recently or currently on statins, but not those previously (>30 days prior) on the drugs. So I would say those already on are those who probably will receive more benefit.

As for how long you have to be taking them to see the effect, that is something that we should find out by doing clinical trials, IMO.

One caveat on crashing your cholesterol count with red yeast rice or the pharmaceuticals. It can also crash your mood. I don’t have the studies at hand but there is a definite correlation, and I believe I even read the molecular-level explanation for it. So you could lose your “fighting spirit” in the midst of the war (panflu).

That’s OK, Medical Maven, I’ve heard a good strong dose of caster oil mixed with turpentine is just the stuff to raise one’s spirits (just kidding, I couldn’t resist).

De jure: Or it might clear more than your head. : )

That’s interesting. being a quasi-Bi-polar person anyway I won’t care. If ur dead u have no mood issues anyway.

MM,

If you happen to stumble across those studies while you are Googling around, we’d be interested in seeing them.

Simvastatin Causes Changes in Affective Processes in Elderly Volunteers

J Am Geriatr Soc 54:70–76,2006

“In summary, the findings reported here support the hypothesis that Simvastatin can lead to adverse effects of affect and affective processes”.

Sorry, have not learned to tango with the URL thing.

But this study was just the tip of the iceberg. The jist of this study was that if you were predisposed to depression and/or experienced an adverse event of some sort you did not have the emotional resilience to fight off depression. It was conjectured that lower cholesterol levels might interfere with normal serotonin uptake in the brain. Also this cholesterol drug and another like it cross the blood/brain barrier which was a matter of concern for the authors as far as how it might cause neurological effects.

 Another study in another medical journal showed a proclivity for irritability.

If it were me, I would rather be emotionally resilient and have my wits about me in the midst of panflu.

glennk:

Red Rice Yeast had it’s cholesterol lowering effects taken out according to the folks at the Flu clinic. Niacin is supposed to still lower some. I didn’t do any research on RRY but my guess is NS1 will know.

Statins have been studied out the whazoo-anything to keep the patents alive for these companies. Several big studies on stroke prevention have just concluded and at least one with Lipitor has been called positive. But I’ve never and I’ve looked seen one for flu.

Anon 22-Did he mention how long you had to be taking a statin prior to catching the flu or could you just start the dose with the first sneeze?

“Anon 22-Did he mention how long you had to be taking a statin prior to catching the flu or could you just start the dose with the first sneeze?”

It is too early to say. I don’t think there is any data for whether the protection is present if you start the dose when you have symptoms.

That’s why we need those studies.

I am not much good at being an advocate by nature, but those of you who are please look through this and see if it is worth your while to pick this up. thanks.

There are those “Elderly” of us (and maybe not quite so elderly) who are coping with the adverse effects of affect and affective processes which we didn’t even know we were supposed to be dealing with (darn, and I was looking for muscular pain). I think all persons have a proclivity to be depressed when experiencing an adverse event…uptake and crossing the blood/brain barrier looks good to me, I choose anti-inflammatory.

There are a couple of lawsuits out there for Lipitor. Apparently, there are claims that it has caused long-term nerve/muscle damage, and also problems with balance and memory.

Guggulipids are an interesting herbal alternative to statins. Right up there with Red Rice Yeast.

There is an interesting theory on high/bad cholesterol that I will share with you, for what it’s worth. The theory is this:

Most people don’t get enough vitamin C in their diet. Vitamin C maintains the integrety of the cell wall. If you do not have enough vitamin C in your diet, you could develop ‘leaky pipes’ (the arteries)…a mild form of scurvy! To prevent blood from leaking out of the weakened arteries, your body produces a sticky gluey substance to plug the holes (much like Bars Leak fixes the hole in the rad of the car) and this substance is what we call ‘bad cholesterol’. To stablize this quick glue fix, your body then plasters calcium on to the cholesterol to harden it. Now, you also have hardening of the arteries. This theory also claims that this condition is completely reversible with proper diet, exercise and use of appropriate herbs.

A statin drug that merely prevents the bad cholesterol from depositing on the arteries, is a ‘quick fix’, (a bandaide), that addresses the symptom but not the underlying cause.

So that’s the theory.

De jure - I believe niacin works to reduce cholesterol by dilating the blood vessels, and this effect is also one reason why drinking alcohol (in moderation) is supposedly good for the cardiovascular system. I took a high dose of niacin when I was in college (my mother took it for her heart and suggest I try it) and I experienced the worst skin flush and itchy skin feeling over my entire body. Never took it again.

Another thought: maybe this dilation of the blood vessels may not be a good thing in a potential cytokine storm? Or might it help?

There are 2 ways to approach this statin issue, and they are not mutually exclusive: the first is do I want it? for which each person will have to judge cost/benefit, but there is a wider public health angle where what is unacceptable risk for an individual with many options may be acceptable in a pandemic situation where there aren’t very many options at all.

The biggest need for statins will be in the developing countries where there will be NO antivirals and NO vaccines, IMO. I see this as something WE should advocate if only for that purpose alone.

annon 22. I assume this didn’t fall from the sky. Where did they come up with…and is their a shred of evidence anywhere…that statins may be effective…or is this a theoretical conclusion reached without clinical data.

I am puzzled.

Tom, it didn’t fall in the sky. If you search the literature on statins, there is a lot that they are continuing to learn, AFTER the drugs were marketed and used.

Here are some random ones that I found. I haven’t read them in detail, but this is just to give you an idea of the evolving state of knowledge with regards to the interface between cardiovascular diseases, inflammation, infection etc.

Statins’ benefits begin to sprout “a good drug has obviously gotten even better.”

The effect of prior statin use on 30-day mortality for patients hospitalized with community-acquired pneumonia

Cytokines as new treatment targets in chronic heart failure

Influenza and Cardiovascular Disease Is There a Causal Relationship?

Two-Year Follow-Up of the FLU Vaccination Acute Coronary Syndromes (FLUVACS) Registry

Role of Infectious and Immune Factors in Coronary and Cerebrovascular Arteriosclerosis

OK, I gotta go. Probably be in and out. :-)

annon 22 Thanks!!

Strange, My mother-in-law went to refill all her pills, and Lipitor is the only one they didn’t have. Do you suppose the word is out and people are hoarding? OOOOO

I agree research should be started now in drugs that have previousily been tested. My concern with people who have the flu is they can barely tolerate sips of fluid, much less swallow a growing list of potential helpful treatments. Drugs we could take prior to infection to prevent adverse effects would be helpful.

And to think I nearly went off Lipitor! Will have to try and get a buffer stock of 3 months supply now. I’ve had flu shots, pneumovax and take some zinc and C. Also B and fishoil. No bug is going to want to be in my system.

I seem to recall, when statins were discussed in a previous thread, that there was a paper cited that said that their protective effects as regards influenza/pneumonia were not apparent unless the patient had been on the drug for at least 2(?) years.

Does anyone have that reference?

EveReady I like your attitude and intend to follow suit. However, I also intend to have Tamiflu and Relenza and a few other drugs on hand just in case. This bug doesn’t seem to care much for any of us and I’m not going to count just on good health or vitamins to stave it off. remember , in 1918 it killed the young and the healthy! If I or any of my family get it I’m going to be ready to smash it fast with Tamiflu et al.

Pfizer must be cracking the bottles of champaign open at the newest possibility that Lipitor will be the next wonder drug. Ka - ching, ka - ching go the cash registers. Dividends and increased stock prices. As to the efficacy of using a statin during a pandemic….personally I tend to agree with NS1′s methodology. No disrespect intended to anon_22.

http://tinyurl.com/cacj3 http://tinyurl.com/olfqj

Many cats,

All of the studies are earlier on this thread.

In looking for the article I remember (I think it was from a now closed thread), I came across this one:

Statin-induced fibrotic nonspecific interstitial pneumonia by Lantuejoul et al. (PMID 11936540)

Granted it is a case study (involves a single patient), however the discussion included the following:

“…Similarly, in statin-induced lung pneumonitis, the mechanisms of injury remain unknown. The identical description of intralysosomial lamellar inclusions in pneumonocytes and in interstitial cells is highly suggestive of an effect upon lipid metabolism. However, whether it is a direct toxic effect or an indirect toxic effect related to the activation of an inflammatory immune response, needs to be clarified.”

emphasis is mine. Further:

“In addition to the more classical hypersensitivity pneumonitis, a fibrotic nonspecific interstitial pneumonia should henceforth be considered. Whereas hypersensitivity pneumonia usually shows a good response to corticosteroid treatment, the presence of a fibrotic process may be associated with slow and partial responses, accounting for a less favourable prognosis.”

“classical” as in a side-effect seen in some patients on statins.

So, the bottom line is, proceed with caution.

Also found this one. The title is self explanatory:

Influenza vaccine-a possible trigger of rhabdomyolysis induced acute renal failure due to the combined use of cerivastatin and bezafibrate by Plotkin et al. (PMID 10809833)

Again a single patient case study, but something to consider if a vaccine were (ha ha) to become available and you were taking statins.

For those who want a translation: rhabdomyolysis is the breakdown of muscle, leading to muscle breakdown products “clogging” up the filtration apparatus of the kidneys resulting in kidney failure.

Again, proceed with caution.

Last one for now:

Statin-induced proinflammatory response in mitogen-activated peripheral blood mononuclear cells through the activation of caspase-1 and IL-18 secretion in monocytes. by Coward et al. (PMID 16621994)

“Statins, which inhibit 3-hydroxy-3-methylglutaryl CoA reductase, have been shown recently to promote proinflammatory responses. We show in this study that both atorvastatin and simvastatin induced proinflammatory responses in mitogen-activated PBMCs by increasing the number of T cells secreting IFN-gamma.”

IFN-gamma is a cytokine that induces the production of IP10, one of the 2 cytokines listed in the original papers discussed on the Paris Anti-Avian Influenza Conference thread that was SIGNIFICANTLY raised in H5N1 patients. The above study was done in vitro and seems to be a consideration at lower doses only.

While statins are useful in many respects and have some clinical data to show some effects of the type we are looking for, they are not without risk and need further evaluation.

…this kind of thing is one of the reasons I though we should be discussing cytokines…

Sorry to be a thread hog, but for emphasis:

Statin-induced proinflammatory response in mitogen-activated peripheral blood mononuclear cells through the activation of caspase-1 and IL-18 secretion in monocytes. by Coward et al. (PMID 16621994)

“Statins, which inhibit 3-hydroxy-3-methylglutaryl CoA reductase, have been shown recently to promote proinflammatory responses. We show in this study that both atorvastatin and simvastatin induced proinflammatory responses in mitogen-activated PBMCs by increasing the number of T cells secreting IFN-gamma.”

IFN-gamma is a cytokine that induces the production of IP10, one of the 2 cytokines listed in the original papers discussed on the Paris Anti-Avian Influenza Conference thread that was SIGNIFICANTLY raised in H5N1 patients. The above study was done in vitro and seems to be a consideration at lower doses only.

In other words, if you are getting a prescription for statins, you should also try to get a prescription for antivirals and wait until the whole issue becomes a little clearer before you abandon one for the other. Just my 2cents…

Many Cats,

I think everyone ought to proceed with caution in any decisions and keep looking up the science as time passes. However, we are also talking about something else, the possibility that statins may have a protective function, and I must say that the numerous studies including the ones quoted by Fedson with the large number of cases for me outweighs the negative bits.

So again I am looking at this as a possibility NOT just for individuals here on this forum but as a mitigation response for huge numbers living in the third world, etc. In that context, statins may have low success and maybe some problems (although statins track record would suggest these as likely to be not too big a problem) but a small degree of success in a pandemic can translate into many lives saved.

mmmelody47,

I don’t mind what you say at all. :-)

But as I am emphasizing to Many Cats, the outcome is primarily aimed at trying to find out if we can do something for people in third world countries who will have no access to antivirals and vaccines but who can have generic statins at very low cost(hence no worries about Pfizer etc).

anon_22: I, too, would take statins if I had nothing else. But people have to know the good and the bad. My doctor prescribed statins and I haven’t taken them yet (at least I will have a 3 month supply since I have to go in for my 3-month blood check and she will see there is a big time patient compliance issue—either that or she will up my dose thiniking it is currently too low). I have a hard time taking drugs that don’t have DECADES of track records. I don’t like the idea of a drug needing a blood check for the rare event of liver damage. Sorry but if I’m the one whose liver goes south, it won’t seem rare to me. My mother won’t take her bisphophonates for osteoporosis, even though she is much more likely to suffer a fracture than to wind up with the very rare complication of jaw bone necrosis, but you think twice if you find out that taking a med may make your jaw rot out, no matter how low the risk. Look at estrogens—the blush is off that rose. And many of the newer statins have not been on the market that long. I worked in a lab looking at the effects of antiviral medications at one point. The ones I looked at were of a new class, but the earlier ones had caused deaths in patients even though the animal studies were fine. The problem was the animal studies were not conducted for a long enough period of time. As a result of that, laws were changed regarding how drug studies are conducted to prevent similar tragedies from occurring. I do not wish to say more as anyone with background in this area would be able to figure out which drugs I am speaking of and it is a small world. In any case, everyone’s intentions were admirable and nothing was done improperly according to what was known at the time. But the road to Hell is paved with good intentions and again, caution must be our guide to the extent that we can exercise it, but if H5N1 were to hit tomorrow, you can bet I would be popping those statins religiously.

Many Cats.

Usually about once a week, I read a really remarkable amd unique piece of writing that makes me consider things in a whole new light…

…I haven’t done so for quite a few weeks until I read your post above. Thanks.

Tom DVM: :)

bump

anon_22 – at 22:12

You are truly a gentlelady!!

I thought it may be better to put that one slide up here rather than me trying to explain it :-)

So, should we get statins in our portfolio or not?

We need more data :-)

From the abstract cited at 21:53:

“We show in this study that both atorvastatin and simvastatin induced proinflammatory responses in mitogen-activated PBMCs by increasing the number of T cells secreting IFN-gamma. This is abolished by the presence of mevalonate, suggesting that statins act specifically by blocking the mevalonate pathway for cholesterol synthesis to promote the proinflammatory response.”

So interference with the mevalonate pathway has both pro-inflammatory activity yet may be involved in the protective effects against avian influenza. A very complex issue, indeed. Thus, as anon_22 points out, we need more data.

Okidokie: consider statins a hedge bet. It may not turn out to be a miracle drug for H5N1, but if the time comes when you need it, you might not be able to get it. You know my feelings on statins from my post at 22:32

Many Cats:

I had to leave the beach to attend the funeral of a family friend. Liver failure due to statin (age 51). This man travelled a lot and worked away from home sometimes for several months. He would see doctors for other type problems. According to wife, he assumed that if he went to any doctor and reported he was on a statin they would do what was required to make it safe. He went on statin and missed his first blood draw appt, his muscle problems didn’t develop until later. He saw specialists, and other doctors overseas but unfortunately, none drew the bloodwork on liver enzymes. He was put on the liver transplant list, but didn’t make it. If you take these drugs, be proactive and make sure the labwork is drawn every six months. It may be rare but the liver transplant lists tells the story. Note:specialists leave such matters up to the prescribing doctor unless you specifically ask them to draw the bloodwork because you’re concerned and in a doctors office.

Closed due to length. Conversation is continued here.

Leo7: You have my sincerest condolences on the loss of your friend.

As I said, virtually everyone I know in drug R+D has drug safety as a paramount concern and for the others, the legal system keeps them honest. I know NOTHING about what happens after drugs hit the market, but I worry a little (and I have NO proof to base this on) about whether or not the bean counters start to take over and companies begin to look at the bottom line for their shareholders. It can take more than a decade of research and investment to bring a drug to market and if that drug fills a specific niche, the company has a limited time to recoup its investment through its patent coverage before generics can be made or before competitors come up with a similar formulation. At the point of initial release, you see heavy promotion to the physicians to prescribe the drug. This is not bad thing because: 1. We need drugs (osteoporosis, high cholesterol and avian influenza are all bad) 2. Drug companies need to be profitable or they won’t be in business to make new drugs (and we all are looking for an avian influenza drug that works) 3. Drugs are tested as well as is reasonably possible for safety before they are approved, but that is the rub. Drugs can’t be tested for decades before they are released and only after the drug is released—when thousands of people (male, female, pregnant or not, infants, children and the elderly), on all types of other medications, and in all type of health are exposed to the drug for extended periods—will the full spectrum of the drug’s effect, good AND BAD, become known. Researchers do the best they can, as do the folks in manufacturing and quality control to ensure the best possible product. And so do the marketing folks, who SINCERELY believe they are helping to bring suffering patients a new drug, and so do the salesmen, who SINCERELY believe they are helping to spread the word about a great new product to help people (as I said in a previous post, most salespeople I know are quite ethical). The problem I see is when a drug goes out to the marketplace and “previously unforseen complications” arise, there must be (again, I am ASSUMING) intense pressure felt in some levels of management to keep the new drug on the market, because of the costs, the investment in advertising and image, and the need to remain profitable. I worry that some companies may look at the risks (lawsuits from harmed individuals) versus benefits (number of people helped and return on investment) and make decisions based on the finances of cost/benefit analysis. I have no real complaint about that (we did have a thread about how do you ration ventilators, since you know someone will die as a result of your decision) EXCEPT that the REAL POTENTIAL CONSEQUENCES associated with these drugs MUST BE MADE CLEAR so that people, like your friend can decide whether they want to take the drug. If they are REALLY INFORMED about the full spectrum of possible complications, they may even help to bring any problems to the attention of their doctors. I am so sorry your friend was not supplied with enough information about the side effects of statins, which are advertized so benignly, to think to ask for a blood test when his doctors did not. I would hope that companies would find their images enhanced by being totally up front about potential problems and how to spot them rather than burying the problems in the very very fine print of their patient information sheets. There should be an OBVIOUS statement UP FRONT rather than leaving it to the physician to discuss or the patient to wade through. The lack of this type of IMMEDIATELY VISIBLE warning system leaves people mistrustful of pharmaceutical companies and will likely hurt them in the long run legislatively. The real tragedy is that it can leave families like your friend’s without loved ones.

While I have full faith in the good intentions of drug manufacturers, I still will not take drugs without LONG track records except in unusual circumstances and this is why. Peace to your friend’s family.