Re: 'Bad' LDL cholesterol may benefit elderly


"Sharon Hope" <shope@xxxxxxxx> wrote in message
news:7eKdnUNQv-b4W13enZ2dnUVZ_sydnZ2d@xxxxxxxxxxxxxx
>
> "David Rind" <drind@xxxxxxxxxxxxxxxxxxxxx> wrote in message
> news:dpnci9$fpf$1@xxxxxxxxxxxxxxxxxxxx
>> Sharon Hope wrote:
>>> "David Rind" <drind@xxxxxxxxxxxxxxxxxxxxx> wrote in message
>>> news:dpmv20$6ol$1@xxxxxxxxxxxxxxxxxxxx
>>>
>>>>Sharon Hope wrote:
>>>>
>>>>>http://www.abc.net.au/news/newsitems/200601/s1542183.htm
>>>>>
>>>>>Last Update: Thursday, January 5, 2006. 11:00am (AEDT)
>>>>>'Bad' LDL cholesterol may benefit elderly
>>>
>>>
>>>>We have large randomized trials showing that statins decrease mortality in
>>>>the elderly just like they do in everyone else. (The results of the
>>>>PROSPER trial which did not find this are overwhelmed by the entirety of
>>>>the data showing this).
>>>>
>>>
>>>
>>> Specifics pertaining to elderly?
>>
>> Sorry, I'm not sure I understand the question. There have been large
>> randomized trials of statins that showed the same benefits in the
>> subgroups of participants who were elderly as were seen in the groups as
>> a whole.
>>
>
> Please see the specifics that show NO benefit to the elderly, and, in fact,
> a higher likelihood of harm from adverse effects than a likelihood of
> benefit.
>

It does not say that. It says this:

"The impact was completely neutral on mortality despite selecting for an
elderly population at only moderately older age and selecting for particularly
high
risk of heart disease--the elderly group in whom greater benefits and lower
risks would be expected (Shepherd et al., 2002). "

The paper only addressed Adverse Effects - not benefits - and thus did not
compare the two, though it does say statins reduce the liklihood of strokes.

Bill


> http://www.geriatrictimes.com/g040618.html
>
> Statin Adverse Effects: Implications for the Elderly
> by Beatrice A. Golomb, M.D., Ph.D.
> Geriatric Times May/June 2004 Vol. V Issue 3
>
>
> Excerpts:
> "Evidence suggests the balance of benefits to risks may be less favorable in
> the elderly: Cholesterol becomes a less potent predictor of cardiovascular
> problems, and adverse reactions from drugs, including statins, may become
> more prominent. While patients at high risk for cardiovascular disease
> receive mortality benefit from statins in studies predominating in
> middle-aged men (Scandinavian Simvastatin Survival Study Group, 1994), no
> trend toward survival benefit is seen in elderly patients at high risk for
> cardiovascular disease (Shepherd et al., 2002). A less favorable
> risk-benefit profile may particularly hold for patients older than 85, in
> whom benefits may be more attenuated and risks more amplified
> (Weverling-Rijnsburger et al., 1997). In fact, in this older group, higher
> cholesterol has been linked observationally to improved survival. This paper
> will review a selection of the risks and adverse effects of statins that
> have special implications for elderly patients."
>
> "Discussion
>
> Observational studies show that as age increases within the elderly age
> range, high cholesterol flattens then reverses as a risk factor for
> mortality (Weverling-Rijnsburger et al., 1997). Although it remains to be
> fully clarified whether these findings have relevance to
> cholesterol-lowering treatment, the exclusive major randomized trial of
> statins conducted in the elderly does nothing to dispel a possible causal
> association, as it did not show benefit of statins to survival. The impact
> was completely neutral on mortality despite selecting for an elderly
> population at only moderately older age and selecting for particularly high
> risk of heart disease--the elderly group in whom greater benefits and lower
> risks would be expected (Shepherd et al., 2002). There are reasons for
> concern that still older people--those elderly not selecting for high
> cardiac risk and those who are frailer than clinical trials generally
> select--might fare less well. Caution should be exercised in provision of
> statins as with all treatments in elderly patients. Any time a patient
> develops a new problem or worsening of an existing problem, the medication
> list should be reviewed and a possible contribution by medications should be
> considered. This principle is by no means confined to statins. It is
> particularly true in elderly patients who may be on many medications with
> interacting effects, and in whom ability to withstand adverse drug reactions
> may be attenuated."
>
>
> "References
>
> Bassuk SS, Wypij D, Berkman LF (2000), Cognitive impairment and mortality in
> the community-dwelling elderly. Am J Epidemiol 151(7):676-688.
>
> Crook MA, Velauthar U, Moran L, Griffiths W (1999), Hypocholesterolaemia in
> a hospital population. Ann Clin Biochem 36(pt 5):613-616.
>
> Frisoni GB, Fratiglioni L, Fastbom J et al. (1999), Mortality in nondemented
> subjects with cognitive impairment: the influence of health-related factors.
> Am J Epidemiol 150(10):1031-1044.
>
> Golomb BA, Kane T, Dimsdale JA (2004), Severe irritability associated with
> statin cholesterol-lowering drugs. QJM 97(4):229-235.
>
> Golomb BA, Yang E, Denenberg J, Criqui M (2003), Statin-associated adverse
> events. P95. Presented at the 43rd Annual Conference on Cardiovascular
> Disease Epidemiology and Prevention. Miami; March 5-8.
>
> Guralnik JM, Ferrucci L, Pieper CF et al. (2000), Lower extremity function
> and subsequent disability: consistency across studies, predictive models,
> and value of gait speed alone compared with the short physical performance
> battery. J Gerontol A Biol Sci Med Sci 55(4):M221-M231.
>
> Guralnik JM, Ferrucci L, Simonsick EM et al. (1995), Lower-extremity
> function in persons over the age of 70 years as a predictor of subsequent
> disability. N Engl J Med 332(9):556-561 [see comment].
>
> Guralnik JM, Simonsick EM, Ferrucci L et al. (1994), A short physical
> performance battery assessing lower extremity function: association with
> self-reported disability and prediction of mortality and nursing home
> admission. J Gerontol 49(2):M85-M94.
>
> Heart Protection Study Collaborative Group (2002), MRC/BHF Heart Protection
> Study of cholesterol lowering with simvastatin in 20,536 high-risk
> individuals: a randomised placebo-controlled trial. Lancet 360(9326):7-22
> [see comments].
>
> King DS, Jones DW, Wofford MR et al. (2001), Cognitive impairment associated
> with atorvastatin. Presented at the American College of Clinical Pharmacy
> Spring Practice and Research Forum. Salt Lake City; April 22-25.
>
> King DS, Wilburn AJ, Wofford MR et al. (2003), Cognitive impairment
> associated with atorvastatin and simvastatin. Pharmacotherapy
> 23(12):1663-1667.
>
> Korten AE, Jorm AF, Jiao Z et al. (1999), Health, cognitive, and
> psychosocial factors as predictors of mortality in an elderly community
> sample. J Epidemiol Community Health 53(2):83-88.
>
> Leardi S, Altilia F, Delmonaco S et al. (2000), [Blood levels of cholesterol
> and postoperative septic complications.] Ann Ital Chir 71(2):233-237.
>
> McDermott MM, Greenland P, Ferrucci L et al. (2002), Lower extremity
> performance is associated with daily life physical activity in individuals
> with and without peripheral arterial disease. J Am Geriatr Soc
> 50(2):247-255.
>
> Muldoon MF, Barger SD, Ryan CM et al. (2000), Effects of lovastatin on
> cognitive function and psychological well-being. Am J Med 108(7):538-546.
>
> Muldoon MF, Ryan CM, Flory JD, Manuck SB (2002), Effects of simvastatin on
> cognitive functioning. Presented at the American Heart Association
> Scientific Sessions. Chicago; Nov. 17-20.
>
> Node K, Fujita M, Kitakaze M et al. (2003), Short-term statin therapy
> improves cardiac function and symptoms in patients with idiopathic dilated
> cardiomyopathy. [Published erratum Circulation 108(17):2170.] Circulation
> 108(7):839-843.
>
> Orsi A, Sherman O, Woldeselassie Z (2001), Simvastatin-associated memory
> loss. Pharmacotherapy 21(6):767-769.
>
> Pasternak RC, Smith SC, Bairey-Merz CN et al. (2002), ACC/AHA/NHLBI Clinical
> Advisory on the Use and Safety of Statins. Stroke 33(9):2337-2341 [see
> comment].
>
> Penninx BW, Ferrucci L, Leveille SG et al. (2000), Lower extremity
> performance in nondisabled older persons as a predictor of subsequent
> hospitalization. J Gerontol A Biol Sci Med Sci 55(11):M691-M697.
>
> Phillips PS, Haas RH, Bannykh S et al. (2002), Statin-associated myopathy
> with normal creatine kinase levels. Ann Intern Med 137(7):581-585 [see
> comments].
>
> Phillips CT, Gray NL, Puhek LM et al. (2004), Basal respiratory exchange
> ratio is altered with statin use in normals. J Am Cardio 43(suppl A):233a.
>
> Read TE, Harris HW, Grunfeld C et al. (1993), The protective effect of serum
> lipoproteins against bacterial lipopolysaccharide. Eur Heart J 14(suppl
> K):125-129.
>
> Scandinavian Simvastatin Survival Study Group (1994), Randomised trial of
> cholesterol lowering in 4444 patients with coronary heart disease: the
> Scandinavian Simvastatin Survival Study (4S). Lancet 344(8934):1383-1389.
>
> Shepherd J, Blauw GJ, Murphy MB et al. (2002), Pravastatin in elderly
> individuals at risk of vascular disease (PROSPER): a randomised controlled
> trial. Lancet 360(9346):1623-1630 [see comments].
>
> Silver MA, Langsjoen PH, Szabo S et al. (2003), Statin cardiomyopathy? A
> potential role for coenzyme Q10 therapy for statin-induced changes in
> diastolic LV performance: description of a clinical protocol. Biofactors
> 18(1-4):125-127.
>
> Smits CH, Deeg DJ, Kriegsman DM, Schmand B (1999), Cognitive functioning and
> health as determinants of mortality in an older population. Am J Epidemiol
> 150(9):978-986.
>
> Wagstaff LR, Mitton MW, Arvik BM, Doraiswamy PM (2003), Statin-associated
> memory loss: analysis of 60 case reports and review of the literature.
> Pharmacotherapy 23(7):871-880.
>
> Weverling-Rijnsburger AW, Blauw GJ, Lagaay AM et al. (1997), Total
> cholesterol and risk of mortality in the oldest old. [Published erratum
> Lancet 351(9095):70.] Lancet 350(9085):1119-1123 [see comment]."
>
>
>
> See also information on the class action suit:
>
> http://www.communitycatalyst.org/resource.php?doc_id=946
>
>
> In particular, see #9 in the FAQ
>
> See also:
> http://www.caregivershome.com/news/article.cfm?UID=714
> Posted: October 04, 2005
> Did Drug Giant Mislead Women and Seniors About Lipitor?
>
> Excerpts:
>
> "A lawsuit against Pfizer claims the world's largest drug company misled
> elderly consumers into using its anti-cholesterol drug Lipitor despite the
> absence of evidence from clinical trials that these drugs are of any benefit
> to large segments of the population."
>
> "According to John Abramson, MD, clinical instructor of ambulatory care at
> Harvard Medical School and author of Overdosed America: The Broken Promise
> of American Medicine, the scientific picture is clear.
>
> "The idea that lowering cholesterol always reduces the risk of heart disease
> has become the conventional wisdom, which drug companies like Pfizer have
> taken great pains to promote. But for women under 65 and people over 65 with
> no history of heart disease or diabetes, the evidence just isn't there,"
> Abramson said."
>
>
>
> "The proposed class action seeks to represent women who have taken Lipitor
> and who have no history of heart disease or diabetes; people aged 65 and
> over who have taken Lipitor and who have no history of heart disease or
> diabetes; and third-party payers such as insurance companies, union health
> and welfare funds, self-insured employers and others, who paid for Lipitor
> for patients in either of these two groups."
>
>
>
>
>
>> --
>> David Rind
>> drind@xxxxxxxxxxxxxxxxxxxxx
>
>
>


.

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