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Statin side effects caused by patients' 'expectation of harm'


Mmmm, this has become even more interesting. Correct me if I am wrong: (1) Under the setting of the blinded trial( at least the patient did not know what they were taking ) , statin only increased the risk of muscle-related side effects by 2.03-2.00 divided 2.00 multiplied by 100= 1.5% but when patients knew what they were taking in real life situation, the risk is increased by 1.26-1.00 divided by 1.00 multipled by 100= 26% . These are relative increase in risks . One can debate the absolute risks are still small. (2)Well , this is a bit of in vivo Vs in vitro comparison, isn't it? More importantly, it is also about the psychodynamics of a behaviour called pill taking bearing in mind , we are not allowed to prescribe placebo and patients must be consented with information of what medications they are taking in real life situation. One also has to consider the meaning and implications of muscle-related side effects to our patients especially in the elderly. (3)Philosophically, there is a simple message ,' if you believe in something, it will more likely to work for you with no set back.' (4) The headache here is how to counsel our patients in the frontline. Yes , there is easily an argument that the attitude of the prescriber matters to some degree but also one cannot stop people from first of all , reading the medication leaflets and secondly , sharing experiences with friends and family . (5) I welcome this new evidence because it stimulates a different kind of debate on how to 'sell' statin to our patients. No doubt , the two schools of thought on both sides of the argument will haves e more heated debates , especially in primary prevention in the absence of pre-existing cardiovascular diseaes , but based on a threshold of 10 years risk of CVD, for instance , 10%.

Posted date

03 May 2017

Posted time