Great piece on statin history and use ["Effectiveness of Statins Is Called Into Question," Aug. 9]. Over the years, I have joked with colleagues that, as with fluoride, statins should be added to our water supply.
In your fourth paragraph, you state that statins were initially approved for the prevention of repeat heart attacks and strokes, etc. Having practiced pharmacy for over 35 years, I have seen numerous drug products come and go. It is my memory that the first statins were approved for the reduction of serum cholesterol, and the tie-in to heart attack prevention came along later.
Prior to the statin class, products such as clofibrate and dextrothyroxine were fighting an uphill battle against cholesterol. In time, the body would compensate for the small and short-lived drops in serum cholesterol caused by these medicines, and the patient was back to square one. The statins reduced the level and kept in down.
I would not refer to the statin class as miracle drugs, but they were and are very valuable tools in our ever-aging population.
Your article seems to imply that the drug companies are the driving force for the use of statins, and this is simply not the case. Statins are one of the most studied and safest class of drugs ever developed.
I encourage you to read the conclusions of the independent Statin Safety Task Force of the National Lipid Assn. published in the April 2006 edition of the American Journal of Cardiology.
You base your whole article on the articles published in June in the Archives of Internal Medicine. The main paper was an opinion and did not contain any new data. There were more than 29 factual errors in the paper.
You discussed the JUPITER trial, which was conducted worldwide at several hundred centers, the data evaluated by independent statisticians. I think the data speak for themselves.
The opinion of almost all physicians who have a clinical practice in cholesterol management is that statins have been the best class of drugs available to treat high cholesterol and have shown marked reductions in cardiovascular events in all the trials to date.
Looking at cardiovascular mortality in a primary prevention trial is nearly impossible to achieve: Not enough people on statins or placebos die from cardiovascular disease in a short period of analysis, so to look at that endpoint would require that a primary prevention trial be conducted for 10 to 15 years. Thus, we are forced to look at other endpoints such as non-fatal heart attacks.
In the July 2009 edition of the British Medical Journal, two independent investigators looked at 10 trials that focused on primary prevention that enrolled a total of 70,388 people. The findings were that in patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.
Michael Richman, M.D., F.A.C.S.
The writer is a board-certified cardiothoracic surgeon and chief executive and president of the Center for Cholesterol Management.
Re: your Aug. 9 story "Pinning Down the Side Effects of Statins," my experience supports Dr. James Wright's contention that "I don't think we know all the harms yet."
I had been on statins for several years. During that time, I developed atrial fibrillation, stenosis of heart valves and sleep apnea, accompanied by breathing difficulties and lack of energy.
By chance I ran out of my pills and did not take the statin for two days. It was almost like magic: My sleep and breathing problems remarkably diminished.
My doctor had me try a lower dosage of a different statin. The problems reapperared. After quitting the statin, again my problems diminished significantly. Coincidence — or for real?
Patients can step up
I read with great interest Valerie Ulene's Aug. 2 article regarding being silent on bad doctors ["The M.D.: Silence on Bad Doctors"]. I don't think that what she stated is great news to any of us who, because of an ongoing condition, are forced to deal with the medical monopolies and institutions that exist.
I wasn't even greatly surprised by the number of bad doctors that were quoted in the article.
What did surprise me was that doctors are not willing to report other bad doctors and that Ulene did not tell you what you as a patient and consumer have the right to do. You have the right to file a complaint with the Medical Board of California. Their e-mail address is http://www.medbd.ca.gov (click on "Enforcement Public Documents"). This site provides great information as to when a complaint is allowed and allows you to fill in an online form and file a complaint against any physician that you feel has been medically negligent, or inappropriate, or acted illegally in any manner.
I really disagreed with the way Dr. Ulene's article made it seem as though only physicians have any power over other physicians. Patients have rights, and there is a way to receive justice.
La Cañada Flintridge
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