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Doctors question study on statins.

DOCTORS in Bahrain have questioned a new report that claims a common type of drug designed for heart patients could actually do more harm than good.

The study focused on statins, which are commonly used to treat cardiovascular disease, and claimed patients who used them were more likely to could develop Type 2 diabetes.

It was published in The Pharmaceutical Journal last month and the author, Dr Aseem Malhotra, told the GDN that if a heart patient took statins every day for five years, their average life expectancy increased by just four days.

The study also challenged the conventional belief that high cholesterol levels could lead to heart disease.

Reservation

However, medical practitioners in Bahrain have expressed reservations about the results.

"It is incorrect to say that statins do more harm than good," said Salmaniya Medical Complex (SMC) cardiology department head Dr Rashid Al Banna.

"Statins in Bahrain led to a major reduction in heart attacks and strokes, reducing the risks by at least half.

"There are side effects, but that happens in only two or three of every 1,000 patients.

"The benefits of the drug definitely outweigh its risks."

Meanwhile, Joslin Diabetes Centre cardiology consultant Dr Amany Serag said she was unaware of a single statin user developing diabetes as a result of the medication.

"I have been here for almost 10 years and we prescribe statins to many who have hyperlipidemia, but I haven't come across any case where the use of the drug led to diabetes," she said.

"Some studies show it could lead to diabetes, but it depends on the risk-benefit ratio among patients.

"All guidelines (in Bahrain) recommend it (statins) as primary or secondary prevention for cardiac attacks and it is also used in diabetes patients."

However, Dr Malhotra defended his findings, which he said were based on dozens of studies over two decades.

He is consultant cardiologist at Hertfordshire's Lister Hospital in Stevenage, UK, and spearheaded the study called The Cholesterol And Calorie Hypotheses Are Both Dead - It's Time To Focus On The Real Culprit: Insulin Resistance.

"Statins are one of the most prescribed drugs in the world and they do have a margin of benefit in people who have had a heart attack," Dr Malhotra told the GDN.

"But for everybody else, the overwhelming majority of people taking statins are not going to benefit at all in delaying death or preventing a heart attack.

"Even in people who have a heart disease, you take a statin every day for five years and the average increase in life expectancy is four days.

"We need to have a more honest and transparent discussion with our patients about the true benefits of these medications.

"People taking statins would develop type two diabetes purely because of this drug.

"The benefits are very marginal. Furthermore, there is no scientific evidence from registry data of a single person suffering heart attacks or dying after stopping statins."

Meanwhile, he said the study challenged conventional theories about the link between cholesterol and heart disease.

"The association of cholesterol with heart disease is much weaker than people originally thought and should not be the primary focus at all," said Dr Malhotra.

"I tell my patients to stop fearing cholesterol and associating it with heart disease, unless you have familial hypercholesterolemia, which is a genetic condition.

"If you are over 60 there is an inverse association with so-called 'bad cholesterol', or LDL (low-density lipoprotein), and death - which is not associated with heart disease.

"Our research shows that the higher your LDL, the less likely you are to die.

"This is because cholesterol is a very vital molecule in the body that has a number of functions including being part of the immune system.

"Elderly are more vulnerable to infections such as pneumonia and stomach infections that can result in death and it is likely that cholesterol protects them against this."

Other researchers involved in the study included American paediatric endocrinologist at the University of California, San Francisco, Robert Lustig, who specialises in neuroendocrinology, and childhood obesity and award-winning investigative medical journalist Maryanne Demasi.

However, a senior SMC resident speaking on condition of anonymity said the new claims were just the latest twist in an ongoing debate over the benefits of statins.

"Sixty to 80 per cent of hyperlipidemia patients in Bahrain use statins, which are from three generations or types," he said.

"There have always been two schools of thought on statins and it is just another thought that statins could lead to Type 2 diabetes.

"When one group claims statins are causing harm, the other calls it an attack on the effectiveness of the cholesterol-lowering pill - which they defend with clinical trial data showing minimal side effects."

raji@gdn.com.bh

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Publication:Gulf Daily News (Manama, Bahrain)
Article Type:Report
Geographic Code:7BAHR
Date:Aug 5, 2017
Words:811
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