Re: Today in the NEJM

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Yes, , I have an opinion on this very subject but it isn't fit to appear here. Not that it isn't valid, it's just that I would have to exercise the most valiant self-restraint possible to try to keep it printable. And I'm not normally one to swear! You see, I was poisoned by my criminally-negligent, lying ex-doctor (my assessment, not the judgment from any court of law, unfortunately--in my state it's virtually impossible to sue a doctor anymore unless you're ny-on-the-spot immediately following injury, and even then the cap on pain & suffering is so low, good luck finding an attorney who'll take the case for so little money). He had me on 80 mg. for two whole years, vehemently denied it was the Lipitor that was making me so sick, and insisted that I must continue on it. Which almost immediately rendered my mental functioning even lower than his dedication to his Hippocratic Oath, which in his case I

prefer to refer to as Hypocritic Oath.. Fortunately, I did recover some of my mental abilities after I quit the poison, not because I was capable of realizing it was the Lipitor that was causing me to be so ill; rather, it was because I was barely able to reason that I my horrible weakness and pain must be due to ALS and so what was the point of continuing to take such expensive meds when I wouldn't live long enough to see any benefit from it. Even now, most doctors look at me like I'm some freak of nature if I was that unable to tolerate statins. Although my cognitive abilities have recovered to some degree, the same can't be said for the physical devastation. Myopathy, neuropathy, weakness, constant pain, some loss of kidney function, you name it. A rheumatologist recently put a label on it--severe fibromyalgia and chronic fatigue. No doctor I've been to since I was poisoned has done the proper testing to put the blame squarely where it

belongs, and I don't feel up to dealing with their ignorance. There is a book, however, that explains why some patients are at greater risk for the most devastating effects of the statins' toxicity. It's "Death by Prescription," by Dr. Ray Strand, and he explains that the problem lies in each individual's liver enzyme systems. When I saw a chart in the book that showed a particular enzyme system that is required to metabolize statins, it was BINGO! That same system is also required to metabolize codeine and, if I remember correctly, Predniisone as well, and I have never been able to tolerate either of those as they would make me deathly ill. What happens is that, especially in the case of one of the offending meds on a long-term basis, the unmetabolized substance builds up to even more toxic levels in the body, and you wind up suffering from a massive overdose. As if 80 mg. Lipitor weren't already a massive overdose for a

125-pound woman! I'm still amazed I've lived to tell about it. I thought I'd never see the day when the NEJM would publish such an anti-statin report. I don't know if the "SLCO1B1" in their report has anything to do w/that enzyme system, but there has to be some such connection. Maybe there's hope yet! Thanks for passing it along! Manzari <dpmanzari@...> wrote: This was in the New England Journal of Medicine today. Any opinions? D 3. Statin-Induced MyopathyORIGINAL ARTICLE, SLCO1B1 Variants and Statin-Induced Myopathy — A Genomewide Study, The SEARCH Collaborative Group, Abstract | Full Text | PDF | PPT Slide SetEDITORIAL, Pharmacogenomics and Drug Toxicity, Y. Nakamura, Extract | Full Text | PDFA genomewide screen of patients with myopathy who were taking high-dose simvastatin (80 mg per day) showed a strong association between myopathy and variants of SLCO1B1. Approximately 60% of the cases of myopathy was associated

with these variants. Genotyping SLCO1B1 variants may be helpful for tailoring the dosage of statins and safety monitoring.Figure 2. Odds Ratios for Myopathy Associated with the SLCO1B1 rs4149056 Genotype among Subgroups of Patients Taking 80 mg of Simvastatin Daily. topClinical Pearls Statin-Induced MyopathyIn rare cases, statins can cause muscle pain or weakness in association with elevated creatine kinase levels (i.e., myopathy), and, occasionally, this leads to muscle breakdown and myoglobin release (i.e., rhabdomyolysis), which confers a risk of renal failure and death. The mechanisms by which statins cause myopathy remain unknown but appear to be related to statin concentration in the blood. The incidence of frank myopathy is typically only about

1 case in 10,000 patients per year with standard doses (e.g., 20 to 40 mg of simvastatin daily) but it increases with higher doses (e.g., 80 mg of simvastatin daily) and with concomitant use of certain drugs (e.g., cyclosporine which can inhibit statin metabolism).Table 1. Relative Risk of Myopathy Associated with Selected Baseline Characteristics among 6031 Participants Assigned to 80 mg of Simvastatin Daily in SEARCH. Increased Risk for Statin-Induced

MyopathyThis study by The SEARCH Collaborative Group, reports small increases in the risk of myopathy among older participants and women, as well as among those with evidence of impaired renal function and those who were taking calcium antagonists at baseline. top Morning Report Question Q: What cardiac drug increases the risk that a statin will cause myopathy? A: Amiodarone can increase the risk that a statin will cause myopathy, for example when amiodarone is taken with 80 mg of simvastatin daily the risk of statin-induced myopathy increases significantly.-----

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, It comes as little surprise. What is good is that this is the NEJM. The more we see papers of this type (linking statins to bad happenings) that mainstream and well regarded publications such as NEJM publish this type of finding, the faster will come the mindset change required to ban statins.JeffOn 21 Aug 2008, at 22:28, Manzari wrote: This was in the New England Journal of Medicine today.Any opinions?D 3. Statin-Induced MyopathyORIGINAL ARTICLE, SLCO1B1 Variants and Statin-Induced Myopathy — A Genomewide Study, The SEARCH Collaborative Group, Abstract | Full Text | PDF | PPT Slide SetEDITORIAL, Pharmacogenomics and Drug Toxicity, Y. Nakamura, Extract | Full Text |PDFA genomewide screen of patients with myopathy who were taking high-dose simvastatin (80 mg per day) showed a strong association between myopathy and variants ofSLCO1B1. Approximately 60% of the cases of myopathy was associated with these variants. Genotyping SLCO1B1 variants may be helpful for tailoring the dosage of statins and safety monitoring.Figure 2. Odds Ratios for Myopathy Associated with the SLCO1B1 rs4149056 Genotype among Subgroups of Patients Taking 80 mg of Simvastatin Daily.topClinical Pearls Statin-Induced MyopathyIn rare cases, statins can cause muscle pain or weakness in association with elevated creatine kinase levels (i.e., myopathy), and, occasionally, this leads to muscle breakdown and myoglobin release (i.e., rhabdomyolysis), which confers a risk of renal failure and death. The mechanisms by which statins cause myopathy remain unknown but appear to be related to statin concentration in the blood. The incidence of frank myopathy is typically only about 1 case in 10,000 patients per year with standard doses (e.g., 20 to 40 mg of simvastatin daily) but it increases with higher doses (e.g., 80 mg of simvastatin daily) and with concomitant use of certain drugs (e.g., cyclosporine which can inhibit statin metabolism).Table 1. Relative Risk of Myopathy Associated with Selected Baseline Characteristics among 6031 Participants Assigned to 80 mg of Simvastatin Daily in SEARCH. Increased Risk for Statin-Induced MyopathyThis study by The SEARCH Collaborative Group, reports small increases in the risk of myopathy among older participants and women, as well as among those with evidence of impaired renal function and those who were taking calcium antagonists at baseline.topMorning Report QuestionQ:What cardiac drug increases the risk that a statin will cause myopathy?A:Amiodarone can increase the risk that a statin will cause myopathy, for example when amiodarone is taken with 80 mg of simvastatin daily the risk of statin-induced myopathy increases significantly.