The following is a letter I just sent off to my doctor:
* * *
Thank you for acting so quickly to get the atorvastatin to
me by mail. It arrived yesterday and I
took my first 20 mg. pill.
I have decided, however, not to take any more until or
unless I have built up greater confidence that statins are a good idea.
After resisting advice to take statins for some years now, I
made the decision to go ahead with a statin regimen after hearing that the American
Heart Association and the American College of Cardiology had put out new
guidelines suggesting that because of my age and risk profile, statins were highly
recommended.
My understanding is that you are working at Kaiser with guidelines that have been in place since 2001.
According to these guidelines, my triglyceride level should be under
199mg/dL (as of last August, it was at 98), my HDL level should be 40 or greater (it is at 38) and
my LDL level should be 129 or lower (it is at 144). Furthermore, according to the risk calculator
you have been using, statins are advisable for someone my age when the risk of
heart attack goes over 20%. My risk
level is calculated at 22%. Elsewhere I see the cutoff level at as low as 7.5%.
Because of the potential side
effects of statins, which I understand to be “muscle pain and muscle damage; an increased risk of
diabetes; memory loss and confusion; cataracts; and, to a lesser degree, kidney
or liver damage,” and because of an inclination to want to avoid drugs
on general principles, I have resisted taking your advice, with considerable misgivings.
Then the new AHA and ACC guidelines came out, and I relented
and began taking the atorvastatin yesterday.
But no sooner do I do this, than I begin to hear reports
from people who appear to be in the know that these new guidelines are a bad
idea.
1) An article in the Boston
Globe claims the new guidelines are a mistake for two reasons. They suggest we should ignore LDL levels in
favor of a risk calculator, but then it turns out the risk calculator
overestimates risk by up to 150%. That
would bring my risk level below 20%, and if the LDL level is not a useful
number, (except for people who have already had a heart attack – which does not
include me) there go the reasons for starting the statin regimen.
2) In the Globe and
Mail of Toronto, health reporter André
Picard confirms the information in the Boston
Globe. Picard reports on a study published in the British Medical Journal arguing just the
opposite of the new American guidelines, namely that “statins have no
overall health benefit in this population and that prescribing guidelines
should not be broadened.”
3) An editorial in the New
York Times expresses reservations even more starkly:
Patients in
good cardiovascular health would be well advised to stay away for now from
following the cholesterol guidelines issued last week by the nation’s two
leading heart organizations.
I will keep the medication (it has a discard date of 21 May
2016) until the heart
organizations reassess their risk calculator, and provide me with greater motivation for going back to the statin regimen.
Please,
by all means, let me know if you see flaws in my thinking. I could do with a whole lot more information
and am keeping an open mind on the question.
* * *
Remember the days when the doctor gave you advice and you simply took it, no ifs, ands or buts?
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