You may be right about the statins—part of what spooked me about them was running into a woman whose husband had taken permanent muscle damage from them, which suggested to me that the side effect might not be all that rare.
You mentioned that it was important for them to be correctly prescribed. How common is it for them to not be correctly prescribed?
Rhabdomyolysis, which I think is the kind of severe permanent muscle damage you’re talking about, is well-known enough as a side effect of statins that it’s taught in first year medical school classes. There was one statin that may have had a relatively high (1/2,000 per year) rhabdomyolysis rate and was withdrawn from the market after a couple of years for that reason. The statins currently on the market have about a 1⁄20,000/year rhabdomyolysis rate, which is actually low enough that no one is entirely sure it’s not background noise although no one’s taking any chances. Since they also have a 1+/500/year heart attack prevention rate, they prevent something like 50 heart attacks for each case of rhabdomyolysis they cause, which seems “worth it”.
Muscle damage rates increase by a lot if you take statins with fibrates (another cholesterol lowering drug). I think (not sure) that prescribing these two drugs together is Officially Discouraged, although there might be some leeway in cases of people with crazy high cholesterol. I’ve also heard having grapefruit juice with statins increases the risk (grapefruit juice messes with liver enzymes) but I’m not sure if that is practically important or just random clinical trivia.
As for correct prescription: I am only a student, I haven’t checked the official guidelines, and if you hear otherwise from any doctor trust the doctor and not me—however, as I understand it there is pretty good evidence for giving a statin to people who have already had a cardiovascular event in order to prevent a second one, and much weaker evidence (depending on whose studies and meta-analyses you prefer) for giving it to someone who’s never had a cardiovascular event. Many doctors give them to the latter category anyway just because irreversible side effects are so rare and they would rather be safe than sorry regarding heart attacks; I see some merit in both sides of the argument.
My only evidence is that they’re mostly by large and respected institutions, considered exemplary by the medical community, and that reading a one page summary of them I didn’t come across anything that made me think they weren’t.
You may be right about the statins—part of what spooked me about them was running into a woman whose husband had taken permanent muscle damage from them, which suggested to me that the side effect might not be all that rare.
You mentioned that it was important for them to be correctly prescribed. How common is it for them to not be correctly prescribed?
Rhabdomyolysis, which I think is the kind of severe permanent muscle damage you’re talking about, is well-known enough as a side effect of statins that it’s taught in first year medical school classes. There was one statin that may have had a relatively high (1/2,000 per year) rhabdomyolysis rate and was withdrawn from the market after a couple of years for that reason. The statins currently on the market have about a 1⁄20,000/year rhabdomyolysis rate, which is actually low enough that no one is entirely sure it’s not background noise although no one’s taking any chances. Since they also have a 1+/500/year heart attack prevention rate, they prevent something like 50 heart attacks for each case of rhabdomyolysis they cause, which seems “worth it”.
Muscle damage rates increase by a lot if you take statins with fibrates (another cholesterol lowering drug). I think (not sure) that prescribing these two drugs together is Officially Discouraged, although there might be some leeway in cases of people with crazy high cholesterol. I’ve also heard having grapefruit juice with statins increases the risk (grapefruit juice messes with liver enzymes) but I’m not sure if that is practically important or just random clinical trivia.
As for correct prescription: I am only a student, I haven’t checked the official guidelines, and if you hear otherwise from any doctor trust the doctor and not me—however, as I understand it there is pretty good evidence for giving a statin to people who have already had a cardiovascular event in order to prevent a second one, and much weaker evidence (depending on whose studies and meta-analyses you prefer) for giving it to someone who’s never had a cardiovascular event. Many doctors give them to the latter category anyway just because irreversible side effects are so rare and they would rather be safe than sorry regarding heart attacks; I see some merit in both sides of the argument.
Thank you for doing the research.
I’ve had a little more time to think—how sure are you that the studies you cite were well-constructed?
My only evidence is that they’re mostly by large and respected institutions, considered exemplary by the medical community, and that reading a one page summary of them I didn’t come across anything that made me think they weren’t.