The Statin gun to the head

[Athena]

My husband says there is no evidence that taking statins was of any benefit unless you already had a heart attack.

Which medical board certifications does your husband have?

He has a PhD and analyses research data. One of the projects he worked on was statins, with a cardiologist.

Your husband sounds like he knows what he's looking for. Is there any particular reason why he's researched statins? If you could post any authoritative studies that show that statins are not useful, that would be very useful.

[kickingandscreaming]

Not knowing about your health conditions--as your doctor presumably does--I can't suggest any specifics.  But I would say that your doctor needs to go back for a psychology tune-up.  He sounds excessively catastrophic in his presentation.  He may be seeing something that red flags for urgency (I don't know that) but if so, should be able to tell you what that is. 

When I started down the road to kidney failure, my first nephrologist was an Iranian male.  I don't know if his culture influenced his style, but he was so catastrophic in how he presented material to me that I always felt like I was one foot from the grave (at 1.6 creatinine at the time).  Whenever I left his office, I felt as if I should immediately book a cemetery plot and that my remaining days numbered in days not years.  It took a full 7 yrs to get to where I am now. 

If I were you I would start  by getting a second opinion and perhaps a new doctor.  Some doctors are just not well-aligned to your personal style of receiving and processing information.

[MooseMom]

Athena, thanks for letting us know what your neph has told you.

I am unsure as to what exactly unsettles you about statins.  I am unaware of "controversy" other than the apparent frequency with which docs prescribe this class of medication.  I can certainly understand why anyone would be wary of taking a new drug; that wariness can be a good thing.  But one thing to keep in mind when doing research about any drug is that most of the research seems to be geared to people who do not necessarily have severe CKD.  We are a breed apart!

I've never understood why/how severe renal insufficiency leads to hyperlipidemia.  I don't understand that link, but it certainly seems to exist!

Apologies for the reference to a cardiologist.  I had cattlekid's post in my head as I was typing a response to you, I suspect! 

Would you consider trying an old school statin like pravastatin and see how you get on?

I wonder why your neph started banging on about calcium?  That's rather odd.  I've never heard of menopause being a contributing factor in a further decline of renal function.

Anyway, I am sorry you feel pressured into doing something you don't want to do.  I hope you find an answer that works for you.

[kickingandscreaming]

If I were to go the statin route, I would start with red rice yeast.  It is still a statin, although a naturally occurring form of it. I would also be sure to take coenzyme Q10 along with it since statins deplete the body's stores of CoQ10 and C0Q10 is a necessary element for heart health.  So taking statins alone to protect your heart's health is kind of an oxymoron.

[MooseMom]

If I were to go the statin route, I would start with red rice yeast.  It is still a statin, although a naturally occurring form of it. I would also be sure to take coenzyme Q10 along with it since statins deplete the body's stores of CoQ10 and C0Q10 is a necessary element for heart health.  So taking statins alone to protect your heart's health is kind of an oxymoron.

I know nothing about red rice yeast, but since you've mentioned it, I assume it is safe for kidney patients.  Do you think it would bring down Athena's cholesterol level to acceptable levels within the three month time limit her neph has given her?

[cassandra]

I just read that the FDA warned for using red yeast rice extract in 2007. It could cause kidney damage. Active ingredient in red yeast rice extract is LOVASTATIN. Which is a statin called .Mevacor.

 http://HTTP://nccih.nih.gov/health/redyeastrice

[Athena]

I just read that the FDA warned for using red yeast rice extract in 2007. It could cause kidney damage. Active ingredient in red yeast rice extract is LOVASTATIN. Which is a statin called .Mevacor.

 http://HTTP://nccih.nih.gov/health/redyeastrice

Thank you Cassandra for your post. I've looked it up and it's very interesting! Red rice yeast extract is a herbal remedy used traditionally for thousands of years in China but which has statin-like properties. It is not however a modern pharmaceutical statin at all (in it's traditional herbal format, that is). So this is essentially a non-drug natural remedy that may indeed lower cholesterol. it's the drug you have when you're not having a drug, in a way!

http://umm.edu/health/medical/altmed/supplement/red-yeast-rice

It poses the same risks apparently that pharmaceutical statins pose such a kidney and liver damage, muscle damage, etc. I will try to find out more about this soon.

[kickingandscreaming]

I suppose, in a sense, that it is moot to think about using red yeast rice as it is unavailable in the US.  Of course, it may be available in the UK and in other countries (whose FDA isn't quite as in the pocket of Big Pharma).  It seems to be reflexive to cast shade on non-Pharma versions of Big Pharma drugs.  So they are often cast in doubt and suspicion.  If "supplements" are obtained from trusted and well-reputed sources they can be as safe as useful as any market drug.  They can also cause similar side effects to the drugs they replace.  Statins have been shown to promote diabetes and yet they are reflexively prescribed to pre-diabetics and diabetics.  They can destroy muscle tissue and yet they are prescribed to protect that major muscle, the heart.  They are given out like breath mints.  What's wrong with this picture?

[OneForTheBirds]

My husband says there is no evidence that taking statins was of any benefit unless you already had a heart attack.

Which medical board certifications does your husband have?

He has a PhD and analyses research data. One of the projects he worked on was statins, with a cardiologist.

Interesting.   I had a long talk with the MD who ran the Framingham Heart Study for many years and he claims to have data that supports the correlation between statin lowered cholesterol and heart attack rate.   So, I guess the experts just can't agree.

They took a serious second look at that data in particular, among other things.  I'm just parroting what he says, which is that the effect only applies to people having had a heart attack previously, and the effect is not a large one.  That is the state of the evidence.  Maybe statins help people that have not had heart attacks.  But in his opinion, this has not been satisfactorily demonstrated.  Maybe it does, maybe it does not.  We don't know.

[OneForTheBirds]

Your husband sounds like he knows what he's looking for. Is there any particular reason why he's researched statins? If you could post any authoritative studies that show that statins are not useful, that would be very useful.

No particular reason - he is contacted by clinicians that want data analyzed or are planning clinical trials.

You cannot show that anything is not useful... let's just say it's more a lack of evidence, and only for people not having had heart attacks.  "Lack of evidence" is not the same as "not useful."

[Athena]

If I were to go the statin route, I would start with red rice yeast.  It is still a statin, although a naturally occurring form of it. I would also be sure to take coenzyme Q10 along with it since statins deplete the body's stores of CoQ10 and C0Q10 is a necessary element for heart health.  So taking statins alone to protect your heart's health is kind of an oxymoron.

Thanks so much for this K&S, I've just re-read this earlier post after the subject in this thread has turned to red rice yeast extract! It is a naturally occurring statin, and therefore likely to be 'gentler' than the pharmaceutical version. It would have other properties as well that may or may not be of concern.

My naturopath has already mentioned this traditional remedy about 2 visits ago and told me he will research whether it may be safe for me from the renal point of view. I hope to find out soon about this!

I have also found this interesting article on RRY that is a lot more sobering. It does warn about potential kidney toxin contaminants.

https://sciencebasedpharmacy.wordpress.com/2009/08/06/red-yeast-rice/

[Athena]

Your husband sounds like he knows what he's looking for. Is there any particular reason why he's researched statins? If you could post any authoritative studies that show that statins are not useful, that would be very useful.

No particular reason - he is contacted by clinicians that want data analyzed or are planning clinical trials.

You cannot show that anything is not useful... let's just say it's more a lack of evidence, and only for people not having had heart attacks.  "Lack of evidence" is not the same as "not useful."

Thank you for that. What is confusing for me is the very clear and rather brutal message from my docs that if I don't start taking a statin, I will soon implode by having a heart attack or stroke. I've had 3 specialists issue this warning over the last 3 months.

I have not had any cardio event and feel generally healthy. But I am a long-term diabetic with CKD and have had elevated LDL cholesterol readings over the last few years. I am also going through menopause. There are risk factors galore! But I am unsure of whether a statin will actually benefit my health or not.

[tigtink]

I've been taking Zocor (simvastatin) for about 4 years now. My cholesterol was high originally. It brought my cholesterol into normal range in three months and has kept it there consistently.  I have had NO side effects, and certainly no muscle weakness (I've been exercising twice a day for the last six months to lose weight). Any medication, including over the counter meds, will have side effects in a small percentage of the population especially when they are commonly prescribed. With the higher risk of cardiac problems that comes with CKD, it was well worth the risk to me to at least try the statins. I'm glad I did because they have worked very well for me.

[Simon Dog]

I just celebrated my 4 year D anniversary.

I have been taking statins for 25+ years now, under the direction of two different MDs.  The current one is the former director of the Framingham Heart Study.  I was motivated to take an aggressive approach since my father had a major MI at age 52 w/95% left main occlusion (I'm 58 now).

I just had an echo and nuclear stress test, and got great results - 60-65% EF; no sign of LVF (thank you NxStage); and no signs of ischemia on the scan.

Despite the scare stories, I'll stay on my current path.

I have not had any cardio event and feel generally healthy. But I am a long-term diabetic with CKD and have had elevated LDL cholesterol readings over the last few years. I am also going through menopause. There are risk factors galore! But I am unsure of whether a statin will actually benefit my health or not.

Consider asking your MD if a nuclear stress test would be advisable.    It's just like the standard treadmill test, but you are injected with a radioactive tracer and given a non-invasive scan before and after the gerbilling.

[OneForTheBirds]

 It is a naturally occurring statin, and therefore likely to be 'gentler' than the pharmaceutical version.

Or it could be rougher than the pharmaceutical version.  And what constitutes an effective dose?  Once a month?  Included in three meals a day? 

[Simon Dog]

 It is a naturally occurring statin, and therefore likely to be 'gentler' than the pharmaceutical version.

Or it could be rougher than the pharmaceutical version.  And what constitutes an effective dose?  Once a month?  Included in three meals a day?

And what about the fasting lipid test as well as liver enzyme monitoring?

[Athena]

 It is a naturally occurring statin, and therefore likely to be 'gentler' than the pharmaceutical version.

Or it could be rougher than the pharmaceutical version.  And what constitutes an effective dose?  Once a month?  Included in three meals a day?

And what about the fasting lipid test as well as liver enzyme monitoring?

Simon, I have regular lipid testing every 3 months, along with my other tests for kidney, liver enzymes, full blood count, PTH, iron, etc, etc. So whatever impact any supplement or new med may have, will soon be seen in my regular lab results that is conducted through my Neph or primary physician. In that regard, I do have some sense of safety and reassurance.

I now recall that in the past, with a previous naturopath, I was put on some cholesterol lowering herbs that did work. I had only marginally elevated cholesterol levels that were pretty close to normal in my blood tests for a brief time. I see my existing naturopath tomorrow, where hopefully he can give me some verdict on this whole question. It doesn't mean I will go with any supplement he may recommend though - I am just keen to receive advice at this stage.

[Athena]

Just an interesting update. Saw my naturopath today and discovered that Red Yeast Rice extract is banned here in Australia as well! So there goes that option.

He has instead suggested RHUBARB ROOT as a raw herb that can be boiled as tea (the root, not the leaf parts). This herb has been used for a long time in Chinese medicine and is commonly prescribed. I've done a bit of a search on this and have generally found that there does seem to be some evidence of this herbs having some positive effect on cholesterol levels.

https://www.drugs.com/npp/rhubarb.html

My naturopath is only concerned that I may have potentially some digestive complaints like diarrhea but this will be closely monitored. We're in research mode right now. If he and I decide to proceed, I could start this in 2 weeks time.

Opinions are eagerly wanted.

[kickingandscreaming]

Attached is an article on alternative therapies for cholesterol, etc. from Medscape (need to register to read it there).

[Athena]

Thanks so much KS for that article! Well, rhubarb is on the list of potentially useful herbal remedies for cholesterol.

[Fabkiwi06]

I am on Lipitor now, and so far I haven't had any side effects. It's still too soon to see if it's doing anything with my numbers.

I think, as with most medicine, it's not a one size fits all pill. Our bodies are so complex, what works for me isn't going to work for the next person.

That being said, I totally believe that you can control a lot of what happens by controlling what you eat. I love butter in everything, but I know that if I put that extra smear on my toast it'll be an issue in the long run. I've switched to using a lot more olive oil and eating more avocados (shhh... don't tell my renal dietician). Also, been making a bigger effort to exercise more. I know we're all sick of hearing it, but those are the easiest things to do to take care of a lot of issues.

[MooseMom]

That being said, I totally believe that you can control a lot of what happens by controlling what you eat. I love butter in everything, but I know that if I put that extra smear on my toast it'll be an issue in the long run. I've switched to using a lot more olive oil and eating more avocados (shhh... don't tell my renal dietician). Also, been making a bigger effort to exercise more. I know we're all sick of hearing it, but those are the easiest things to do to take care of a lot of issues.

This is true for most people, but we with advanced renal disease are not "most people".

The first time I met with my PCP after reviewing my surprisingly catastrophic lab results, he told me that I "could eat cardboard" for the rest of my life and still have high blood lipids because of my crappy renal function.

All we can do is the best we can, like eating well and exercising (which I've done my whole life), accept it when our best may not be enough, and then do what we need to do and be grateful that we have options.

[Athena]

Moosemum, I've been pondering on this for a little while and though I can't be sure what may apply to everyone with CKD, it would seem that not every one's lipids & trigs seem to go terribly pear-shaped, like what yours did.

I can't be sure of this of course. But not all long-time kidney patients seem to complain of extremely high cholesterol or triglycerides levels. My elevated LDL was apparent even before CKD reared its ugly head and it was explained as 'genetic'.

Perhaps some types of KD, like FSGS, seems to be more prone to lipid abnormalities than others?

I don't read much about there being a strong link between CKD and high cholesterol levels in general. There are warnings about CKD causing CVD, but it doesn't seem to be through the traditional high cholesterol route, more to do with things associated with electrolyte imbalances that flows on from kidney dysfunction, if I'm not mistaken.

[kickingandscreaming]

I'm on PD and have been dx'd with CKD since 2009 (and undoubtedly had it earlier), I'm also Type 2 Diabetic (although my Endo no longer wants to call me that as my A1c is in normal range for a woman of my age-74).  Although I was vegetarian for many, many years (and during that time ran a total Cholesterol of 200 +/-) some years ago I started eating low carb to manage my diabetes.  At the time I also started eating meat and other animal foods (and did not in any way restrict my intake of fats, saturated and otherwise). My last total cholesterol reading (December) was 188.  If cholesterol issues are part and parcel of CKD, then it somehow got it's wires crossed.  Clearly, there is such a thing as familial hyperlipidemia, but I'm not sure it has much to do with the kidneys.  Liver, perhaps, but not kidneys.  Frankly, I think the typical diet that most renal patients are on is an invitation to all kinds of issues.

[MooseMom]

Moosemum, I've been pondering on this for a little while and though I can't be sure what may apply to everyone with CKD, it would seem that not every one's lipids & trigs seem to go terribly pear-shaped, like what yours did.

I can't be sure of this of course. But not all long-time kidney patients seem to complain of extremely high cholesterol or triglycerides levels. My elevated LDL was apparent even before CKD reared its ugly head and it was explained as 'genetic'.

Perhaps some types of KD, like FSGS, seems to be more prone to lipid abnormalities than others?

I don't read much about there being a strong link between CKD and high cholesterol levels in general. There are warnings about CKD causing CVD, but it doesn't seem to be through the traditional high cholesterol route, more to do with things associated with electrolyte imbalances that flows on from kidney dysfunction, if I'm not mistaken.

You are no doubt right on all accounts.  It is entirely possible that some types of CKD have a much more profound effect on lipid levels, and I don't know why mine in particular were so high.  That is why I've tried to make it very clear that my experience is only that...MY experience.  But I wanted to respond to your question merely to reassure you that not everyone has terrible side effects to statins and that we all have to weight the pros with the cons.  But you already know that!

Anyway, I am very eager to know what you decide to do in the end and how well your choice of medication, whether it be a natural alternative or a statin, works for you.  I will continue reading this thread with great interest.  Thank you for starting this discussion!