Bisher AKIL, MD

Archive for September 13th, 2013|Daily archive page

Not all statins are equal

In General Health, Heart on September 13, 2013 at 7:57 pm

Because statins lower the incidence of adverse cardiovascular and cerebrovascular events — even in low-risk patients — they are used broadly. Statins’ reported adverse effects include myalgias (muscle pain) , myopathy(muscle disease), rhabdomyolysis (muscle damage / breakdown), transaminitis (elevated liver enzymes) , and diabetes mellitus. In a meta-analysis of 135 randomized trials (247,000 participants) that involved seven statins (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin [Crestor], simvastatin, and pitavastatin [Livalo]), investigators evaluated adverse effects associated with statins overall and individually. The overall rate of statin discontinuation owing to adverse effects was low (6%) for all statins combined. Statins as a class caused no more medication discontinuations, myalgias, creatinine kinase elevations, myopathy, rhabdomyolysis, or cancer than placebo. However, statins significantly increased relative risk for transaminase elevations (by 50%; baseline incidence, 1%) and diabetes (by 9%) compared with placebo. Simvastatin( Zocor)  and pravastatin(Pravachol)  were associated with best overall tolerability and lowest discontinuation rates. Compared with controls, atorvastatin( Lipitor) and rosuvastatin (Crestor)  were associated with the highest discontinuation rate because of adverse events; whereas atorvastatin (lipitor) and fluvastatin( LesCol)  were associated with higher risks for transaminase elevations (odds ratios, 2.6 and 5.2, respectively). Higher doses of all statins were associated with higher risk for transaminase elevations. Although low doses of simvastatin (Zocor) appeared to be safest, daily doses >40 mg significantly raised risk for creatinine kinase elevation (OR, 4.1) and transaminase elevation (OR, 2.8).

Appeared in NEJM Journal Watch

Source: Naci H et al. Comparative tolerability and harms of individual statins: A study-level network meta-analysis of 246 955 participants from 135 randomized, controlled trials. Circ Cardiovasc Qual Outcomes 2013 Jul; 6:390. –

Comments: Useful analysis; choosing the safest statin is exceedingly important, particularly when we have significant side effects such as diabetes and elevated liver enzymes, and muscle problems. Unfortunately, we are often obligated to use other than the safest statins to achieve the desired effect on lipids, leading to the choice of the lesser of the two evils; this is certainly a discussion to have with the PCP _BA

Dude, you need Estrogen.

In General Health on September 13, 2013 at 7:32 pm
Androgen deficiency reduces muscle mass and strength in men; estrogen deficiency is associated with increase in fat mass; and deficiencies in both impair sexual function, according to an industry-supported study in the New England Journal of Medicine. Some 200 healthy men aged 20 to 50 years first received goserelin acetate for suppression of estradiol and testosterone. They were then randomized to various doses (0-10 g) of daily 1% testosterone gel for 16 weeks. Another cohort of 200 men were similarly treated and also given anastrozole daily to inhibit the aromatization of testosterone to estrogen, leading to an estrogen-deficient state.In the first cohort, patients who received low doses of testosterone saw increases in body fat percentages and reductions in lean mass. In the second cohort, the percentage of body fat increased in all groups as aromatization was blocked. In both cohorts, sexual desire declined and erectile dysfunction worsened with lower doses of testosterone.Source: Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men; N Engl J Med 2013; 369:1011-1022September 12, 2013DOI: 10.1056/NEJMoa1206168Comments: We should measure both hormones, firstly because they are related chemically, and now they appear to have separate functions.BTW Goserelin acetate (Zoladex) is an injectable gonadotropin releasing hormone superagonist (GnRH agonist), also known as a luteinizing hormone releasing hormone (LHRH) agonist.  Goserelin acetate is used to suppress production of the sex hormones (testosterone and estrogen), particularly in the treatment of breast and prostate cancer.(from Wikipedia)