GPs urged to screen for statin-induced muscle damage

Very few GP colleagues with whom I have raised this question consider it to be fact or, worse, important. It is fact, it is important and it needs to be addressed.

I am delighted to see that Pulse are bringing this issue to the attention of its readership. I have been conducting an informal study into the adverse reactions to HMG-CoA reductase inhibition for more than 2.5 years. I have now completed the first informal report and it has been sent to many agencies around the world that have a brief for pharmacovigilance. The report is published by The Journal of Independent Medical Research and is freely available at the following URL under the following title: Cable J: Adverse Events of Statins - An Informal Internet-based Study. JOIMR 2009;7(1):1 http://www.joimr.org/JOIMR_Vol7_No1_Dec2009.pdf The information was derived from the accounts of signatories to an e-petition at the following URL: http://www.gopetition.com/petitions/investigate-statins.html If you mouse over the signatures link at the top right of the page of instructional rubric, you will see the list of signatures. Any name that has an underlined link named 'View' in the comment column will reveal the patient account of up to 500 words if you mouse over the 'view' link. Currently there are 1072 signatories who can each have a 500 word space to write something in support of their signature. The information in the informal report was collated from the first 888 signatures which included 62 clinicians and 4 pharmacists. As statins are available in the UK as an OTC preparation, it is vital that adverse reactions are given more attention. The recent MHRA imprecation anent statins and the modified information that should appear on the patient information leaflet, in addition to being discussed with the patient at the time that a statin therapy is being considered, points to "sufficient evidence for a causal relationship" between statins and the newly acknowledged adverse reactions. A significant number of clinicians had not understood that the symptoms complained about by their patients were related to statin treatments. In the UK, the MHRA reporting system is not the easiest of systems to negotiate if you do not have a computer and if your literacy level is average. I believe that this contributes to a significant under-reporting of adverse reactions by the patients who suspect that they may be experiencing adverse events. It is not a great leap to imagine that the situation may well be compounded by treating clinicians ascribing symptoms that may mimic a dementing state, to an age-related category, in view of the age of most of the patients who will be suitable for statin therapy. By the time patients reach their fifth decade, they are starting to complain about numerous and sundry aches and malfunctions that could possibly be written of as apoptosis and a natural end to a healthy body and life. Under such a circumstance in a busy surgery one could see how easily any GP who is under pressure of workload and targets, may take the line of least resistance. I don't mean any clinician to take this as an assault on their integrity for it is not an intentional attack. When I last worked within the NHS, the morning clinics would sometimes have as many as 180 patients all waiting to be seen during a four hour clinic so I do understand the madness that sometimes attends a very busy service. What I would like to request now is that the GP's, who are the backbone of the NHS, take the time to understand the depth of statin adverse effects and why it is inevitable that your patients will suffer with very severe adverse reactions. There is no medical literature that details the necessity for the inhibition of dolichols, heme A, Coenzyme Q10 and prenylated proteins within the mevalonate metabolic pathway, in the pursuit of curing cholesterol levels disease. The essential role of dolichols in the formation of neuropeptides, cell identification and cell communication is well understood. Heme A is vital for the production of energy. Mitochondrial oxidative decay is accelerated by micronutrient deficiencies. Yet we appear to be happy to permit the lowering of cholesterol to interfere with these essential processes. It is to be hoped that the majority of clinicians who read Pulse will feel impelled to read the informal report. If there is any commentary, critique or discussion to follow, I am willing to point the readers to a wealth of credible research that details precisely why lowering cholesterol is the wrong target and why serious adverse effects are inevitable.

Statin side effects are far more extensive than we expect. Are there ethnic differences in adverse effect rates? We don't know. ACE inhibitors produce far higher side effect rates - especially cough and sinus symptoms - than the quoted rates. This too only comes to light with direct questioning.