N.H.S Changes Advice on Asprin

Here we go again. This morning's BBC Breakfast reported that the  N.H.S. has changed it's advice on the use of aspirin for those with a risk of having a heart attack. I have been taking soluble aspirin as part of my medication routine since I had my heart attack in May 2006 so the news was of great interest to me. The Daily Telegraph reported it as follows:

'More than a million people with a common heart condition have been told not to take aspirin to guard against stroke, in a reversal of previous N.H.S. advice.'

'New medical recommendations warn that the pills are ineffective in reducing the danger for those suffering heart rhythm disorders and that the risk of side-effects outweigh the benefits.'

'Up to 7, 000 strokes and 2,000 premature deaths a year could be prevented if patients were put on new drugs instead, experts said.'

'Until now, adults suffering from arterial fibrillation have been advised to take a daily dose of aspirin- a blood-thinning drug- as the heart condition often causes clots, leading to a risk of stroke that is five times higher in other people.'

But revised guidance from the National Institute of Health and Care  Excellence (NICE) says a new generation of drugs is far better than aspirin at reducing the danger for such patients and is less likely to cause side-effects including internal bleeding.'

'Patients are advised to seek medical advice from their GP before stopping their current medication, but the guidance recommends that anticoagulant drugs which prevent clots should be prescribed instead.'

I will not be stopping my use of aspirin until I've spoken to my doctor as I don't obviously want to risk having a blood clot again which could cause another heart attack. All this chopping and changing over the use of various medications such as aspirin and statins which I take to prevent another heart attack is just a little bit confusing and annoying, to say the least.

Statin Controversy Rumbles On

More about the statins-controversy on B.B.C. Breakfast this morning. I'm not sure putting perfectly healthy people on statins is such a good idea. I know I was put on them after I had my heart attack in 2006, which I take to prevent a further heart attack. But I'm not sure the health benefits are worth the risk. What with muscle pain, cramps in my legs and so on which are the side-effects of taking them are such a trade-off for those who have no family history of heart problems. Why not put people on more natural products such as food with stanols in, such as Benecol and non-branded health drinks and yoghurts and get people to eat more healthily, such as being on a low-fat diet, eat more fruit, vegetables, less red meat and foods which have high levels of fats and cholesterol in such as butter, cheese, eggs and so on. Of course the drug manufacturers would want us to take more tablets of all kinds, including statins, as it undoubtedly increases their profits. If any of the research is done independently of the manufacturers, all well and good, but I don't tend to agree with just handing out more and more medication.

This was posted on the BBC Breakfast Facebook page this morning.

'Plans to extend the use of statins should be scrapped, according to a group of leading doctors and academics. The National Institute for Health and Care Excellence (NICE) says the use of cholesterol-lowering drugs should be extended to save more lives.

But in a letter to NICE, the experts said the benefits of statins don't justify putting up to 5 million more people in England and Wales on the medication.'

Foggy to Start, but Sunny Later . . .

There was a thick fog obscuring most of Milton Keynes early this morning. As the morning has worn on the fog has gradually lifted and as I write this the sun is out. There are definite signs of spring around here as there are primroses and daffodills blooming all along the sides of the grid roads around Milton Keynes. A definite sign of things getting better weather-wise. Our neighbour knocked on the front door a day or two ago and came to mow our front lawn. I now discover that he had a heart attack, and what makes it worse is that he was in his 30's when it happened. Much to young. Shock news that Bob Crow, leader of the R.M.T. railway union died of a heart attack at the age of 52. I can't say that I was ever a fan, but one can only admire someone who had such respect from people, even those who were of the opposing political view such as Boris Johnson. At least you have to admire the man as at least you knew what he stood for, unlike a lot of people in public life and in particular politics. 

Our dogs are enjoying the sunshine. We have managed to stop up the hole in the fence so they can go in and out of the house through the patio doors. Alfie loves to lay in the sunshine and spreads himself out so as to get the full benefit.

There was a headline in one of today's newspapers claiming that statins have no side effects. Who are they trying to kid? I'm sure that a lot of the aches and pains I get are caused by the statin tablets I'm taking, pravastatin. I know that they are supposed to keep my cholesterol levels low enough to prevent blood clots and then another heart attack, but it would be more conducive to my faith in this sort of medication if the professionals who are supposed to have my interests at heart (no sort of pun intended) would make up their minds one way or another as to their safety, efficacy or whatever.

'Thousands More to be prescribed statins in new NICE guidelines'

BBC Breakfast television news this morning had an item about NICE's  (National Institute for Health and Care Excellence) recommendations that more people should be prescribed statins to reduce cholesterol levels in their blood.

The following is a quote as it appears on the NICE website:

'Thousands more people could be prescribed statins to help lower cholesterol levels and reduce the risk of heart attacks and strokes, under draft guidance.'

'In an update to the existing guideline on lipid modification, NICE is proposing that the threshold be halved for offering statins to people to prevent cardiovascular disease (CVD), the cause of 1 in 3 of all deaths in the UK.'

'Currently, only people with a 20 per cent or greater 10-year risk of developing CVD are offered statins. Draft guidance now recommends offering statins to people who have a 10 per cent or greater 10-year risk of developing CVD.'

'As many as 7 million people in the UK are currently believed to take statins, at an estimated annual cost of £450 million.'

'GPs should estimate the level of risk among their patients using the QRISK2 assessment tool and measurements including whether or not they smoke, their cholesterol levels, blood pressure, and body mass index. The calculator then provides a percentage risk of developing CVD in the next 10 years.'

'NICE had previously recommended the US Framingham risk tool before withdrawing advice about which risk assessment tool to use in February 2010. New evidence has suggested that QRISK2 is a more accurate CVD risk tool particularly among ethnic populations.'

'Patients with type 2 diabetes should, however, have their risk assessed using the UKPDS risk tool.'

'NICE recommends that GPs start statin treatment for the primary prevention of CVD with atorvastatin 20 mg. Patients with established CVD, type 1 diabetes or type 2 diabetes should be offered a higher strength 80mg dose of atorvastatin.'

I have been on statins since I had my heart attack in 2006. As I have mentioned in earlier posts on this blog, I had tried various forms of statins, Simvastatin for example, some of which had quite extreme side-effects, one being, when I was in hospital, being like having flu, muscle cramps,etc etc until I eventually settled on Pravastatin, which is what seems to have the least of the side effects. Reading the leaflet which is enclosed with the tablets you can see what these might be. They are, to mention only a few:

insomnia, dizziness, tiredness, headaches, sleep disturbances (surely insomnia would cover that?), muscle and joint pain, nausea, diarrhoea, wind, (I'm sure I suffer from most of these, unfortunately. I'm not so sure whether it's because of the statins though.) 

I think personally it's best to have a decent diet, low or fat-free food, for example I have always had semi-skimmed milk and use low-fat spreads instead of butter, eat plenty of fresh fruit and vegetable, give up smoking (I have never smoked so that doesn't matter to me, and cut down on alcohol intake (I drink very little so that doesn't effect me. I'd personally rather spend the money on a good book than alcohol, so I don't find that a hardship to give up.) Also, take plenty of exercise (we recently joined a gym and go swimming twice a week, and walk regularly. Not perhaps at the moment, but that's down to the poor weather, unfortunately. 

I don't personally think just putting healthy people on statins is such a good idea. If they have a risk of stroke or heart attack, maybe it's a good idea. As there was a family history of heart problems in my family then it would have been a good idea to be prescribed statins (as it happened I wasn't. Would it have prevented me having a heart attack? That, of course, is open to doubt. I was told by my doctor years ago to go on a low-fat diet, which is one reason why I went over to using semi-skimmed milk. It took some getting used to after having full-fat milk, but now I actually prefer it. Some low fat products are frankly awful, thin, tateless and now particularly nice, but there are quite  few quite nice alternatives, such as spreads, yoghurts etc etc.)

Heart Disease and Fatty Foods A Myth?

The following is taken from a website called Healthy3.co.uk  and may be of interest to those people who have had a heart attack or have been prescribed the use of statins in order to lower their cholestrol levels. I take statins, having had a heart attack and as a result my cholestrol level has been maintained at a reasonable level. I’m not sure whether I would want to risk having another heart attack, as a result of having a blood clot, but the information below is very interesting

Fats- The Cholestrol Myth?

‘A cardiology specialist has written about the “myth” of saturated fat in a leading medical journal. Dr Aseem Malhotra suggests that full fat butter and cheese are not as bad for the heart as previously been suggested. This view goes against that of the majority of the medical establishment.’

‘Dr Malhotra, a cardiology specialist registrar at Croydon University Hospital in London says that four decades of medical wisdom of cutting down on saturated fat to reduce the risk of heart disease may be wrong. He argues that the saturated fats have been given a bad reputation since a major study in 1970 linked high levels of heart disease with high cholesterol and high saturated intake. Dr Malhotra even suggests that eating foods that have not been processed such as cheese, butter, eggs and yoghurt may even be good for the heart.’

‘Saturated fat should not be confused with “trans fats”, which are found in margarines, cakes, chocolates and biscuits. Trans fats are universally recognised as being bad for our health, and unlike saturated fats from dairy food, do not contain any vitamins or minerals. Dairy foods are rich in vitamin A and D, calcium and phosphorus, which can help to support cardiac function.’

‘Cutting down on saturated fat has been the mantra from the health authorities, but these fats are being replaced with refined carbohydrates or sugars which are thought be more dangerous for cardiac health.’

‘The current NHS guidelines recommend that the average man should eat no more than 30g of saturated fat a day and the average woman should eat no more than 20g of saturated fat a day. Cutting down on sugar should be more of a priority according to Dr Malhotra.’

‘Dr Malhotra said, “From the analysis of the independent evidence that I have done, saturated fat from non-processed food is not harmful and probably beneficial. Butter, cheese, yoghurt and eggs are generally healthy and not detrimental. The food industry has profited from the low-fat mantra for decades because foods that are marketed as low-fat are often loaded with sugar. We are now learning that added sugar in food is driving the obesity epidemic and the rise in diabetes and cardiovascular disease.”’

‘Dr Malhotra also questions the mass prescribing of statin medications, as he believes that doctors are not assessing the risk of heart disease correctly. Decades of warnings that high cholesterol levels cause heart disease have led to over medication of statins in health patients, he claimed.’

‘“The fact that no other cholesterol lowering drug has shown a benefit in terms of mortality supports the hypothesis that the benefits of statins are independent of their effects on cholesterol,” he wrote in the British Medical Journal.’

‘He goes on to suggest that a Mediterranean diet is more effective than taking a statin to promote a healthy heart and cholesterol levels.’

‘Dr Malhotra also pointed out an interesting fact that although the amount of fat consumed in the US has gone down in the past 30 years, obesity rates have rocketed. This is linked to the amount of carbohydrates and sugars that are in “low fat” versions of processed foods.’

Article written by Rahul Shah and published on October 23^rd 2013

Irish Surgeon Gagged over research into Cholesterol-lowering medicines

  The following item is here reproduced from the Irish Independent newspaper website, dated 5th October 2013:

'Sherif Sultan, a senior medic at University College Hospital, Galway, reviewed a range of studies of statins and found a lack of evidence to show they should be given as a means of prevention to healthy people with  high cholesterol but no heart disease.'

'Mr Sultan and his surgeon colleague Niamh Hynes said lifestyle changes to reduce cholesterol were better because this allowed people to avoid the risk of statins' side effects.'

'However, in a statement last night, Dr Pat Nash, a cardiologist and the group clinical director in University College Hospital said the recently published views of his colleagues were "not representative" of those in Galway or neighbouring hospitals.'

 ' "As group clinical director of the West/North West Hospitals Group, and a working cardiologist, I wish to reassure patients that statins are safe," said Dr Nash.'

 ' "These are very important, well-validated drugs for the treatment of elevated cholesterol. We have extensive evidence to show their benefit and to show that they improve outcomes for patients with heart disease and stroke and that they have a role in preventing heart disease and stroke.
"As always, if patients have any concerns, they should not discontinue their medication without discussing with their GP or consultant."'

'Asked to comment, Mr Sultan said: "I have received an official warning from the HSE and have been instructed not to liaise directly with the press in my capacity as a HSE consultant." '

 'However, he said he could continue to comment as a consultant vascular surgeon at the Galway Clinic, where he has a private practice.'

'The HSE declined to comment on the reasons for ordering Mr Sultan not to speak as a public consultant.'
 
'He said he stood by his analysis of the role of statins in otherwise healthy patients with high cholesterol. He pointed to another recently published review on exercise versus drug therapy in the management of pre-diabetes and cardiovascular disease.'

 ' "That 'British Medical Journal' analysis showed the superiority of exercise over drug therapy extends even to secondary prevention (where patients have developed disease).'

' "The most convincing evidence is in stroke prevention." '

 'He pointed out that his own review had found there were benefits in prescribing some dosages of statins for certain patients who were already diagnosed with heart disease or had a history of a previous heart attack or stroke.'

CONCERNS

 'He had advised any patient who was taking statins and had concerns to talk to their doctor about them and heed their advice. '

 'Around 250,000 prescriptions for statins are written monthly and they account for 8pc of the HSE's €1.7bn drugs spend. This amounts to one euro in every €12 spent on all drugs.'

'The Irish Medicines Board has received 59 reports of suspected adverse reactions to statins since the start of 2012. Side effects include a potential increased risk of diabetes, eye cataracts and male impotence.'

 'Women who are past the menopause and who are on statins were found to have a higher chance of developing diabetes and this was associated with taking the drug.'

 'The Irish Heart Foundation said the mainstay of preventing heart disease involved lifestyle changes, including not smoking, being active, having a healthy weight and getting regular checks for blood pressure and cholesterol.'

- Eilish O'Regan Health Correspondent

Irish Independent

   

Initial Trials for new cholesterol drug

I found the following article on the 'Mature Times' website. It was published on Wednesday 2nd October 2013.

 'A new approach to cholesterol-lowering that targets a regulator of harmful LDL cholestrerol could offer new treatment for patients with high  cholesterol, researcher have concluded.'

'The drug, called ALN-PCS, blocks production of the cholesterol regulator PCSK9, a protein that destroys receptors that normally clear harmful cholesterol from the blood.'

'In a trial involving 32 healthy volunteers with mildly to moderately raised LDL, or ‘bad’ cholesterol, people were randomly assigned to receive either an injection of ALN-PCS or saline as a placebo.

A single dose of ALN-PCS was shown to cut levels of ‘bad’ cholesterol by up to 57 per cent.'

'Professor Peter Weissberg, Medical Director at the British Heart Foundation, said: “People with extremely high cholesterol are at increased risk of a heart attack and this approach could offer new hope for those who are resistant to statins.'

 '“These initial results add to growing evidence that blocking the action of a certain protein can dramatically lower ‘bad’ LDL cholesterol. More research is now needed to confirm this approach is both safe and effective at preventing heart attacks in the long term before it becomes widely available.” '

The study was  originally published in The Lancet.

I personally dislike being referred to as 'mature.' Makes me sound like an over-ripe cheese. 

Statins Cholestrol protecting properties called into question

 The following is an article I found  from the C.B.C. website via Statin Nation through a post on Facebook


 'Cholestrol-lowering statins are heavily promoted for heart patients but new research is calling into question their use as a preventative medicine.

Statins such as atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) are among the widely used prescription drugs.

Since the drugs were first marketed 30 years ago in the U.S. for preventing a second heart attack or stroke in those who've already had one, there's been a shift toward prescribing statins for otherwise healthy people in Canada and the U.S.

"These are patients who really haven't had an event, a cardiovascular event, but they seem to be at high risk," said pharmacy Prof. Muhammad Mamdani, who works at St. Michael's Hospital in Toronto.

"You also get populations where people seem to be relatively healthy, their cholestrol-lowering aren't that high, but for whatever reason, they are placed on a statin. That's a patient population that is a lot more debatable and some practices may not be warranted."

More than 38  mllion prescriptions for the class of medications that includes statins were dispensed in Canada last year, according to IMS Brogan. (Kas Roussy/CBC)

The medical community is debating the pros and cons of using statins for prevention as more independent research comes out on side-effects. This week, a study in JAMA Internal Medicine suggested statins may be associated with an increase in musculoskeletal conditions and pain, especially in physically active individuals. 

"If you look at all the studies that have ever been done with statins for primary prevention, so for people who have never had a heart attack or a stroke, if you give a statin to a patient for about five years we can reduce the chance of a person having a heart attack or a stroke by about one per cent," said James McCormack, a professor of pharmaceutical sciences at the University of British Columbia. Shifting focus from cholesterol numbers.

Other potential side-effects include risk of Type 2 diabetes, reversible muscle damage and short-term kidney damage.

In Canada, as in the U.S., the majority of statin prescriptions go to primary prevention patients, not people with established heart disease, said Dr. Lee Green, a professor and chair of the department of family medicine at the University of Alberta who has surveyed doctors on their prescribing.

"It seems we need to retrain physicians, and the public, to focus on actual risks, not on a convenient number like cholesterol level," Green said in an email.

In March, epidemiologist Colin Dormuth, an assistant professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia, looked at the use of high potency statins and rates of admission for acute kidney injury.

"There are a lot of patients out there taking the drugs right now who don't have a history of heart disease who are hoping to prevent heart disease and in all likelihood will derive absolutely no benefit," Dormuth said.

In medical circles, discussions continue. A review published in January by British researchers who combed through trials sponsored by drug companies concluded that "statins are likely to be cost-effective in primary prevention."

People like Jim Matheson, 62, of Toronto, are left to decide with their doctor.

"Within five years he told me that I had a 20 per cent chance of either having a stroke or a heart attack," Matheson recalled. "He offered me the pill but I didn't want to take it."

Instead, Matheson opted to eat healthier foods and exercise more. His brother on the other hand decided to go on statins.

"I have sent him, probably for every article he has sent me on how good they are I have sent him 20 that says how bad they are. We're still having the dialogue," Matheson said.

"We'll see who lasts longer," he quipped.'

 

Could statins be adding to the epidemic of ‘heart failure’?'

 Doctor  John Briffa writes:

'Statins are drugs that reduce cholesterol by inhibiting an enzyme in the liver known as ‘HMG-CoA reductase’ which ‘drives’ cholesterol production (most of the cholesterol in the bloodstream is made in the liver and does not come directly from the diet). But HMG-CoA reductase also facilitates the production of a substance known as ‘coenzyme Q10’ which itself participates in the production of what is known as ‘adenosine triphosphate’ (ATP) – the most basic unit of energy ‘fuel’ in the body. The major biochemical process which involves CoQ10 that drives ATP and energy production in the body is known as ‘oxidative phosphorylation’.'

'Now that we have the potted biochemistry lesson over, we can see that statins have the potential, by lowering CoQ10 levels, to put a break on oxidative phosphorylation and ATP production in the muscles. The end result may be fatigue? Muscle pain is another potential consequence.

In a study published this week in the Journal of the American College of Cardiology (JACC), Danish researchers measured CoQ10 levels in individuals taking simvastatin (a commonly-prescribed statin), and compared them with those not taking statins [1]. The levels in those taking the statin were significantly lower.'

'Now, studies such as this one are what is termed ‘epidemiological’ in nature, which means it looks at associations between things, but cannot prove that one thing is causing another. However, of relevance here is other evidence which finds that giving statins to people does indeed have the capacity to lower levels of CoQ10 in the body [2]. '

'What was also interesting about the JACC study is that it found that those treated with statins had lower levels of oxidative phosphorylation than those not taking them. They also had reduced ‘insulin sensitivity’. This is relevant for a number of reasons, including the fact that insulin facilitates the uptake of nutrients such as glucose into the cells. Lowered insulin sensitivity can therefore ‘starve’ the cells of essential nutrients. Reduced insulin sensitivity is also the underlying fault in type 2 diabetes. It is perhaps worth bearing in mind that statin use has been proven to increase the risk of type 2 diabetes.'

'Another thing worth bearing in mind here, I think, is the fact that the heart is a muscle, and depleting it of CoQ10 may be hazardous for cardiac health. Specifically, it may weaken the heart and lead to what is known as ‘heart failure’ (also known as ‘congestive cardiac failure’). I think the ‘benefits’ of statins are vastly overstated, generally speaking. However, if someone is to take statins, I think it’s a reasonable safeguard to take CoQ10 on a daily basis. 100 mg a day is a decent dose, I think, though higher doses are likely to better when symptoms of statin toxicity are present.

In researching this article, I came across an interesting review of the evidence for statin-inducted CoQ10 depletion in both humans and animals [3]. Here’s what the authors of this review have to say in their concluding remarks:

Statin-induced CoQ10 deficiency is completely preventable with supplemental CoQ10 with no adverse impact on the cholesterol lowering or anti-inflammatory properties of the statin drugs. We are currently in the midst of a congestive heart failure epidemic in the United States, the cause or causes of which are unclear. As physicians, it is our duty to be absolutely certain that we are not inadvertently doing harm to our patients by creating a wide-spread deficiency of a nutrient critically important for normal heart function.'

The above quoted from drbriffa.com

Beta blockers don't work, new study finds

 I came across the following article on the New Scientist website. I reproduce it below. As I am myself on beta blockers since having a heart attack (I am on Bisoprolol Fumarate.) so I am now somewhat concerned that these types of drugs don't actually do what they are supposed to do, or so the newest research would suggest. The article is dated 12th November 2012, so it is pretty recent. The article is fairly complex, but it is worth reading it in full to understand what the content of the report says.

  'Beta  blockers are busted- What Happens Next?'

'They have treated heart disease for 40 years but it now seems that beta blockers don't work. What went wrong?'

'IT IS very rare for new evidence to question or even negate the utility of a well-established class of drugs. But after four decades as a standard therapy for heart disease and high blood pressure, it looks like this fate will befall beta blockers. Two major studies published within about a week of each other suggest that the drugs do not work for these conditions. This is a big surprise, with big implications.

The first beta blocker, Inderal, was launched in 1964 by Imperial Chemical Industries for treatment of angina. This drug has been hailed as one of great medical advances of the 20th century. Its inventor, James Black, was awarded the Nobel prize in medicine in 1988.'

'The 20 or so beta blockers now on the market are very widely used - almost 200 million prescriptions were written for them in the US in 2010. They are standard issue for most people with heart disease or high blood pressure. This may now change.'

'A large study published last month in The Journal of the American Medical Association found that beta blockers did not prolong the lives of patients - a revelation that must have left many cardiologists shaking their. (JAMA, vol 308, p 1340.)'

'The researchers followed almost 45,000 heart patients over three-and-a-half years and found that beta blockers did not reduce the risk of heart attacks, deaths from heart attacks, or stroke.'

'While this is not definitive, it's pretty damning, especially when another study - published just days earlier - found pretty much the same thing.( Journal of the American  Geriatrics Society, vol 60. p1854.)'

'The goal of this second study was to examine the effect of drug compliance on death rates in patients who had had heart attacks. About half of patients complied with their drug regimen. Unsurprisingly, these people were nearly 30 per cent less likely to die than those who did not comply.'

'This was to be expected, but there was one big surprise. While the result held for the standard classes of heart drugs - statins, anticoagulants and antihypertensives - it did not for beta blockers. Regardless of whether or not patients stuck to their regimen, their risk of dying was the same. Taken together with the JAMA study, it becomes very reasonable to question the benefit of beta blockers for treating these conditions.'

'To understand what is going on, consider how they work. Like many drugs, beta blockers target receptors embedded in the surface of cells. Receptors are "molecular switches" - when a specific molecule binds to them, they change shape and send a signal to the cell to perform a certain function. Beta blockers target beta receptors, which respond to the "fight or flight" hormones adrenalin and noradrenalin.'

'In humans, there are two principle types of beta-receptor - beta-1, primarily found in the heart, and beta-2, located at multiple sites, including the smooth-muscle cells of the bronchial tubes and in veins.'

'When adrenalin and noradrenalin bind to beta-1 receptors, they signal the heart to beat faster and pump harder. Binding to beta-2 receptors causes smooth muscle relaxation, especially in the airways, explaining why beta-2 activators are used as asthma drugs.'

'Beta blockers bind to both types of receptor, but do not activate the cellular response. This blocks adrenalin and noradrenalin from reaching their target and activating the response. By preventing the normal hormone-receptor interaction, the beta blockers slow the heart and cause it to pump less forcefully, lowering blood pressure.'

'The premise of beta-blocker therapy has been that giving the heart a rest will diminish the frequency of heart attacks. In the light of the two new studies, it is clearly time to question this.

Which raises the question: why has it taken so long to find out? It is worth noting at this point that this is not yet another case of a drug entering the market only to be withdrawn later because of lack of efficacy or even adverse reactions which could have been noticed with longer or larger trials. It is simply a new medical revelation. The authors of the JAMA paper provide a reasonable explanation of the conflict between their results and earlier studies.'

'The key word is "earlier". Most clinical trials on beta blockers took place before reperfusion therapy became standard treatment following heart attacks. Reperfusion involves opening the blocked artery by surgery or pharmaceuticals, and has been shown to significantly reduce damage to the heart.

Damaged hearts are more prone to fatal irregular beats, and beta blockers are useful in controlling this. But with the advent of reperfusion therapy, people who survived heart attacks suffered less cardiac damage, so the frequency of fatal arrhythmias was lower. Put simply, the beta blocker effect was significant before the advent of this improved treatment, but the beneficial effect has since disappeared.'

'Additionally, newer and better drugs such as anticoagulants, statins and antihypertensives are now routinely used in heart disease. These more effective therapies swamp any smaller benefit that the beta blockers might provide, minimising any measurable effect.'

'What comes next is impossible to predict, but we may well be seeing a rare case of medical wisdom being overturned almost overnight. Beta blockers are not dangerous and have been in use for such a long time that it is unlikely that we will see an immediate cessation. But these results are hard to ignore, and cardiologists will be paying careful attention.'

Heart Disease Genetic link being missed

 The following news item was featured in BBC Breakfast this morning. The following is taken from the BBC News website:

Genetic link to high cholestrol is being missed

'About 100,000 patients have not been tested for a preventable form of heart disease in the UK, according to an audit of the NHS.

Familial hypercholosterolaemia is genetic; when people are diagnosed, their families should be tested.

The audit of nearly 2,500 patients by the Royal College of Physicians found that very few relations were being screened, especially in England.

The British Heart Foundation said it was frustrating and unacceptable.

Around 500 people in the UK have familial hypercholesterolaemia, which causes hight levels of “bad” cholestrol (LDL) in the blood.

If it is not treated then half of men develop heart disease before they are 55 and a third of women by the time they are 60.

Taking cholestrol-lowering drugs, statins, and living a healthier lifestyle do reduce the risk to normal levels.

Because of the genetic nature of the disease, the National Institute for Health and Clinical Excellence recommends DNA and cholestrol tests for family members, but the study says this is not happening everywhere.'


My grandparents had heart disease. I am pretty sure my grandmother (on my mother's side) had heart problems, and I am sure that she died of a heart attack. My mother had a stroke, and had angina in the later years of her life (although she never talked to us about any of her ailments. Well, parents in those days never discussed these sorts of things with their children.) She eventually died of a heart attack. This was almost exactly 30 years ago. So I know that I must have inherited my heart problems. My doctor kept an eye on my health, with regards to my family history of heart disease. So it was really no surprise when I had my heart attack in May 2006. I was told to cut down on fatty foods, which I did. I went over to drinking semi-skimmed milk and using low fat spreads and attempting, wherever possible, to always choose the lower-fat option when eating foods. 

Statins prescribed 'needlessly'

'Up to 3 million people are taking statins needlessly, doctors warn today in a comprehensive study that suggests they are ineffective in many cases and could be doing more harm than good.'

'An authoritative review shows there is little evidence that the cholestrol-lowering drugs protect people who are not already at a high risk of heart disease.'

'As a result, the NHS is wasting large sums of money on giving the drug to the "worried well", the researchers warn. In some cases, the side effects of taking statins could outweigh the benefits, they say.'

'A number of studies have linked statins to liver problems, acute kidney failure and muscle damage.'

'Statins are thought to be taken by one in three people over the age of 40. Up to seven million people in England take them, costing the NHS at least £450 million a year. A large proportion of these are at low risk of heart problems and take the drugs to ward of future disease.'

'Experts who advocate the use of statins say they have helped prolong thousands of lives by preventing heart attacks and other cardiovascular events.'

This is taken from today's "Daily Telegraph" and the report was also mentioned on the BBC Breakfast News this morning.

Medications Side Effects

It's one thing having had a heart attack, but it's quite another that you have to contend with the side effects of the medications that you are prescribed. When I originally went into hospital, having had my heart attack, I was put on a range of medication, mostly to relieve pain. I had Warfarin to thin my blood and thus to prevent further blood clots. I recall that when a nurse was taking out the canula which was in my wrist, at around the time I was discharged, there was a quite a spectacular flow of blood as she had not noted that I was on Warfarin (which prevents not only blood clots, put prevents wounds from healing quickly.) I was put on statins, and the first type had the effect of giving me flu-like symptoms, which were rather unpleasant, to say the least. It wasn't until I discussed my state of health with one of the nurses on the C.C.U. ward that I learnt that this flu-like symptom was a side effect of taking this particular statin drug (which is used to control cholestrol levels in the blood.) I don't exactly remember what the name of this drug was, but I was soon put on another statin which didn't at first appear to have such violent side effects. I was also put on Bisoprolol (which I am still on, but at a much lower dosage, 5 mg.) I was also on Clopodogrel and soluble asprin (another drug to keep the blood thin and thus prevent clots.) 

Some of the side effects of the drugs, particularly statins, are that they give you muscle cramps. Without beating around the bush, another is rather unpleasant, bloating, flatulance and diarrhoea. Sometimes this can be very violent and you can spend quite a lot of time running to the toilet, and it can be quite uncomfortable. On the other hand, it can also have the opposite effect, constipation. Sorry if this is rather  too graphic for some people, but I'm writing this on this blog to try and help anyone else who is going through a similar experience. If my experiences can be shared with others then I hope it comes as some sort of comfort to know that there are others who have had a similar experience.

According to the leaflet which comes with a packet of Pravastatin it gives a list of possible side-effects. It reads as follows:
Dizziness
Headache
Sleeping problems
Sleeping disturbances
Vision disturbance such as blurred or double vision
Stomach upsets (such as feeling or being sick, constipation, diarrhoea, flatulance, indigestion and stomach pains.)
Hair loss
Rash
Itchiness
Tiredness
Feeling of weakness
Changes in the way your liver works
Heartburn
Bladder problems (painful or frequent urination

Very rare side effects:
Numbness or loss of sensation in the arms and legs
Tingling or pins and needles (paresthesia)
Inflammation of the liver or pancreas
Severe allergic reactions including localised swelling of the face/lips and/or throat
Yellowing of the skin and whites of the eyes (jaundice)
Muscle and joint pain

When I was first put on statins (although it might have been caused by other drugs I was on.) I used to get tingling in my feet and sometimes my fingers, and a sort of numb sensation in the soles of my feet, but that gradually went off after a couple of weeks. 

Immediately after I had the heart attack (which was back in May 2006.) I felt really depressed. I was told that this was a normal reaction to what had happened to me. I discussed this with a nurse on the C.C.U. Most men don't like to talk about their health, and particularly not depression. I have had a few periods of clinical depression, a couple of years before my heart attack, but I haven't experienced anything that severe since my heart attack. 

I was put on isosorbide mononitrate fairly recently, as an alternative to using glycerol trinitrate spray, which I used whenever I got an attack of angina. It was prescribed the last time I was in hospital back in October. It does seem to work, and I haven't had any severe angina attacks since then. But I get quite severe headaches and I'm sure it's that medication which causes insomnia. I go to bed as normal, but after a few hours I wake up, generally to go to the toilet, but then I cannot get back to sleep. I was told by my consultant at Milton Keynes Hospital that this drug would cause headaches for the first month or two, but that it would gradually ease off, which it did, but the headaches seem to have come back, but not quite as severely as when I first took this drug. The drug makes the blood vessels widen so as to increase blood flow, and this is very prominent in the brain, hence headaches (if you use the red spray,glyceryl trinitrate, you do find that you get headaches, as well as feeling light-headed, which is another effect of the iosborbide mononitrate, although I admit that it's not unpleasant, rather similar to the feeling you get when you've had one too many alcoholic drinks, but without the other unpleasant side-effects you get with alcohol.)

I can feel extremely tired. This particularly was a side effect of not only taking some of the drugs, but the effect of actually having a heart attack. A heart attack is a very traumatic experience in itself, and tiredness is the body's way of repairing itself. If I over-exert myself, like going on long walks, I find that my leg muscles can get quite painful, but if I rest for a short while, stop and sit down, this soon eases off. 

New Heart Drug

 A new heart drug looks as if it's on it's way. From what I've heard about it, it sounds as if it has the same sort of effect as statin drugs, reduces the amount of cholestrol in the blood, thus cutting the risk of clots and, consequently, heart attack. The following was taken from the Reuters website:

'An experimental Merck & Co heart drug, from a class of medicine with a troubled past, appeared to be safe and had a "jaw dropping" effect on both good and bad cholesterol levels, according to data from a clinical trial.

Merck's anacetrapib increased good HDL levels by a stunning 138 percent after 24 weeks of treatment, and lowered levels of bad LDL cholesterol by 40 percent in patients already taking LDL-lowering statins, researchers said.

"The lipid effects are jaw dropping in both directions," said Dr. Christopher Cannon, the study's lead investigator from Brigham and Women's Hospital in Boston. He presented the data at the American Heart Association scientific meeting in Chicago on Wednesday.

Researchers found no anacetrapib safety issues during the 18-month study, and patients receiving the drug had fewer serious heart problems than those given a placebo.

Even if development of the medicine continues without a hitch, it will likely be at least five years before Merck can begin selling the drug.

Anacetrapib belongs to a class of drugs called CETP inhibitors that produced one of the most spectacular clinical failures in pharmaceutical history. A pivotal study of Pfizer Inc's highly touted torcetrapib was stopped in late 2006 after higher death rates were found among those taking the drug, pulling the plug on an $800 million Phase III program.

Based on the data from the anacetrapib trial, called Define, "we are 94 percent confident that anacetrapib doesn't have the clinical (side) effects of torcetrapib," Cannon said.

The HDL increase seen with anacetrapib "is double what torcetrapib does; it's four times what niacin can do if you can push niacin to its full 2 gram dose; and 10 times the effect seen with statins," Cannon said, comparing anacetrapib with other therapies.

It is believed that HDL has a heart protective effect, possibly by carrying LDL away from the arteries.'

By Bill Berkrot and Ransdell Pierson

NEW YORK/CHICAGO | Wed Nov 17, 2010 8:44pm IST
 

 (Reuters)

All very fine, but what about the side effects? Will there be muscle cramps, and other side effects? Most notably, running to the toilet a lot, which is a side effect of statins. 

Doctor's Appointment

On Friday I put in a repeat prescription at the doctor's surgery, as my medication is beginning to run out. I like to get this sorted out fairly rapidly, as I don't want to find that I am down to one or two tablets before I put in the repeat prescription. Then, at midday, I got a call from the surgery to say that I would have to make an appointment with one of the doctors before they'd give me a prescription. I think it's the statins that they are concerned about. As I've mentioned in this blog elsewhere, I have had problems with statins from the first time I was prescribed, and have been taking Pravastatin for quite a while without too many side effects. One of them has been muscle pain. So I attempted to make an appointment by telephone this morning. I started ringing at 8.15, and the automated system told me 'the surgery isn't open at the moment . . .' and a few minutes later I got through and the message was 'the surgery is experiencing a hight demand' etc. I then decided, as the surgery wasn't too far away, I'd drive there. The traffic was quite heavy, but I got there fairly quickly, parked the car and then walked into the surgery. There was quite a long queue at the reception desk, but I got to the receptionist and managed to get an appointment at 9.50, so I returned home as there was no point waiting at the surgery for an hour and a half.

On returning I didn't have to wait long. I was hoping that the surgery would have had the letter from the hospital regarding my consulatant's appointment last Thursday, and the doctor had it on his computer screen. I mentioned that I was getting headaches and imagined it was a result of taking Isoborbide Mononitrate. The doctor now tells me that it would be as a result of taking Bisoprolol, the headaches are the cumalative effect of taking this particular drug, and that I should take only 5 mg rather than 10 mg each morning. I am to continue taking the Isorbide Mononitrate. I am to have a blood test and he wants to check my cholestrol, so on the way out of the surgery I made an appointment at reception and have to come back at 9 tomorrow morning. The doctor printed out a prescription and I took this to the pharmacy in Netherfield, a short walk from the surgery, to get it made up. One of the advantages of reaching the age of 60 is that I don't have to pay for my prescriptions, which is quite a considerable saving. The prescription was made up, except of part of the Pravastatin order, which was incomplete, so I will have to return tomorrow sometime to get the remainder of the prescription.

I got home to discover the Post had been delivered. There was a bank statement and a buff, official-looking envelope, which I never like the look of as they invariably mean trouble, but, on opening it, I discover it contains good news. A cheque from H.M. Inland Revenue, a rebate of Tax for nearly £500. I was expecting it, so I immediately drove into the centre of Milton Keynes to deposit it in my Nationwide account. It should be cleared through the account by Friday.