I'm doing a series on stopping statins. I did another one recently on an article
that just came out August of 2017 showing that patients who had a stroke
and stopped their statin were much we're more likely to have another stroke
within a year and to die from that stroke. But there are there studies out
there which indicate it may be safe to stop statins. Why are we seeing this
difference in the literature? some saying it's safes others & saying it's not
safe well there's a pattern there... let's get deeper into it but let me just
introduce myself it's Ford Brewer with PrevMed heart attack and stroke
prevention and here we go. This is big news this whole thing about stopping
statins. CNN covered a headline on it and they said statins what happens to
patients who stopped taking them after side effects well there's actually a
study on that. (There's a study on anything, isn't there?) But this is an important topic
researchers in Massachusetts looked at 28,000 patients and they found that 3 in
10 stopped their statins because of side effects statins are not easy to take.
They can make you feel bad. They can make you feel muscle fatigue or soreness.
Here's what happened to them. 8.5% of those that stopped their statin went on
to have a heart attack or stroke - or a cardiovascular event. 7.6 %
7.6% of those who stayed on their statins had a heart attack or stroke and
this is very significant given the fact that it was so many patients 28,000
patients now many people would look at that and some of my patients I think
might look at that and say if that's all I'm getting for some of the side effects
I'm having I'll take the trade
that's just for events again the difference between death rates for these
two populations is similar about a 1% increase in death rates for folks not on
statins (who stopped their statins). now why would you want to stop taking statins? I covered this in the
other video. There are a lot of reasons side effects is the most common one, the one
covered in the the last slide, fatigue, muscle soreness, things like that. I added
a couple of other ones. Maybe you were put on the statin for the wrong reason
and need to get switched from one statin to another. Cost, fear, frustration
you just don't like taking medications. There's been a major
reaction around statins based on - a lot of it came from 2 medical journals the
British Medical Journal and Lancet I've covered that in a couple of videos
bottom line was - based on the headlines coming out of that a lot of people
stopped their statins. And there are studies which show the ones that stopped their
statins had a higher death rate and higher event rate. now let's look at this one
this is back in2004 dr. Mary McGowan of the New England Heart Institute in
Manchester New Hampshire did a study which was nested into the TNT study I'll
talk about the TNT study in just a minute but the TNT study design required...
- it was looking at, it changed the standards for the targets for LDL
lowering - but in order to look at that, they had to take some people off of
statins for at least a six week period. so that's what she did she studied those
people that had to be taken off of their statins for this study design and found
that there was no increase we'll talk about it a little bit more
now this is the TNT study it was published in the New England Journal and
yes it was a big deal. It's treating two new targets here's the bottom line on
this study. they looked at I think it was hey there were two doses of a statin. The
one they looked at was lipitor. up till then the standards had been to get
somebody below an LDL of 100. as a result of this study I think almost all
of us would agree you want an LDL below 70 even if you're in that Bale - Doneen
camp even if you're I'm guessing Paul Ridker who started all this about
cardiovascular inflammation I'm guessing he would agree you still want LDL below
70 and all of that's a result out of that landmark study TNT but this is a
study that was part of it like I said before dr. McGowan was looking at the
fact that in order to participate in the TNT studies a lot of people had to be
taken off of their statins for a short time period well like I said what they
found was that it was safe for these patients. Let's go back and think about
it again during the same time period 2002 2004, early 2000s there were still studies
that were coming out and I think they're valid studies withdrawal of statins
increases event rates in patients with acute coronary syndrome why do we see
the differences again as we said before I think this all
reflects biological reality. The studies showing safety of stopping statins is
with stable patients. And it's a time-limited thing. It's not a permanent
thing like you even saw with the CNN coverage of the of the
Massachusetts study with 28,000 patients. That was a longer term
study and there was a decrease. OOPs, no an increase in mortality and heart attack
event rate when they went off their statins. Studies that show hazard
involve recent stroke heart attack other cardiovascular event. Why
is that?Well plaque instability is systemic there's no such thing as that
single vulnerable plaque the vulnerable plaque theory is on its last legs and
again if you've got one or two or three vulnerable plaques it's a biochemical
thing it's a it's what's going on in your bloodstream not in that specific
area . In your entire arterial tree. So one or two or three vulnerable plaques means
that ...most if not all of your plaques are vulnerable and vice
versa if you have stable plaque then most of those plaques are probably going
to be stable so again it just underlines the concept. Plaque instability is a
systemic issue not a local issue and if you're stable you can go off of these
for a while can you go off of them forever safely well I mean you can go
off of them forever but you have some you have to pay the piper in terms of
safety just like the the original study said
your probability of having an event and dying or increased thank you