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| Author |
Message |
David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
|
 Posted: Sun May 28, 2006 11:00 pm Post subject:
Re: Statins and muscle damage
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|
Jason Johnson wrote:
| Quote: | One CK blood tests means nothing. However, if statin patient takes a CK
blood test every two months and the CK levels keeps going higher and
higher--that is evidence that the statins are the source of the problem
and symptoms. That's the reason that doctors conduct blood and urine tests
on statins patients on a regular basis to keep track of their Creatinine,
CK levels. They may also check other items on the blood and urine kidney
and liver function tests.
|
If doctors are checking routine CK levels on asymptomatic patients on
statins they are both wasting resources and not following recommended
monitoring protocols.
| Quote: | Just because [rhabdomyolysis] is a rare problem does not mean that it never happens.
Some statin patients may have it and not even be aware of it. They may
blame the symptoms on other things such as the regular pains assoiciated
with some types of exercises such as weight lifting or jogging.
|
People may not know they have "rhabdomyolysis" (most people don't know
the term, so they certainly aren't likely to diagnose themselves), but
rhabdo is not a subtle problem that they are just going to ignore. You
are confusing rhabdo with more mild forms of myositis.
--
David Rind
drind@caregroup.harvard.edu |
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Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
|
| Posted: Sun May 28, 2006 11:09 pm Post subject:
Re: Statins and muscle damage
|
|
|
In article <e5d9uo$hc4$1@reader1.panix.com>, David Rind
<drind@caregroup.harvard.edu> wrote:
Jason Johnson wrote:
| Quote: | One CK blood tests means nothing. However, if statin patient takes a CK
blood test every two months and the CK levels keeps going higher and
higher--that is evidence that the statins are the source of the problem
and symptoms. That's the reason that doctors conduct blood and urine tests
on statins patients on a regular basis to keep track of their Creatinine,
CK levels. They may also check other items on the blood and urine kidney
and liver function tests.
|
If doctors are checking routine CK levels on asymptomatic patients on
statins they are both wasting resources and not following recommended
monitoring protocols.
| Quote: | Just because [rhabdomyolysis] is a rare problem does not mean that it
never happens.
Some statin patients may have it and not even be aware of it. They may
blame the symptoms on other things such as the regular pains assoiciated
with some types of exercises such as weight lifting or jogging.
|
People may not know they have "rhabdomyolysis" (most people don't know
the term, so they certainly aren't likely to diagnose themselves), but
rhabdo is not a subtle problem that they are just going to ignore. You
are confusing rhabdo with more mild forms of myositis.
Do you agree or disagree that doctors that precribe statins are suppose to
conduct liver function and kidney function blood tests on a regular basis?
Do you agree or disagree that one of the main reasons for those blood and
urine tests is to look for signs of rhabdomyolysis and other liver
problems?
I know that when I took statins that my doctor paid more attention to the
creatinine levels than anything else listed on the blood test. She even
tested the CK levels when the creatinine levels started to go higher.
Jason |
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David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
|
| Posted: Mon May 29, 2006 12:57 am Post subject:
Re: Statins and muscle damage
|
|
|
Jason Johnson wrote:
| Quote: | Do you agree or disagree that doctors that precribe statins are suppose to
conduct liver function and kidney function blood tests on a regular basis?
|
The answer is somewhat different for liver funtion tests and for kidney
function tests. For liver function tests, prescribing information in the
US recommends periodically checking such tests. However the evidence for
doing this is very weak. See for instance:
Screening for statin-related toxicity: the yield of transaminase and
creatine kinase measurements in a primary care setting. Smith CC;
Bernstein LI; Davis RB; Rind DM; Shmerling RH. Arch Intern Med 2003 Mar
24;163(6):688-92.
So if, by "supposed to" you mean that the FDA recommends such testing of
liver function tests, then I agree. If by "supposed to" you mean that it
is actually important, then I disagree.
I don't think any reputable body recommends routine kidney function
tests in patients on statins, so I suppose that counts as "disagree".
| Quote: | Do you agree or disagree that one of the main reasons for those blood and
urine tests is to look for signs of rhabdomyolysis and other liver
problems?
|
Not sure how to answer that since:
1) Rhabdo is not a liver problem
2) When done, liver functions test are indeed performed to look for
liver problems, but, as above, are probably not necessary routinely
3) Urine tests are not routinely performed for monitoring statins
4) Kidney tests are not routinely performed for monitoring statins
5) If someone wanted to monitor for rhabdo and lesser muscle problems,
they would not do this by performing liver or kidney tests
Again, rather then simply telling us what you think ought to be done, or
what some book you have read says should be done, why not post
references to some primary research supporting your position.
--
David Rind
drind@caregroup.harvard.edu |
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| Back to top |
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Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
|
| Posted: Mon May 29, 2006 1:35 am Post subject:
Re: Statins and muscle damage
|
|
|
In article <e5dgpn$csv$1@reader1.panix.com>, David Rind
<drind@caregroup.harvard.edu> wrote:
Jason Johnson wrote:
| Quote: | Do you agree or disagree that doctors that precribe statins are suppose to
conduct liver function and kidney function blood tests on a regular basis?
|
The answer is somewhat different for liver funtion tests and for kidney
function tests. For liver function tests, prescribing information in the
US recommends periodically checking such tests. However the evidence for
doing this is very weak. See for instance:
Screening for statin-related toxicity: the yield of transaminase and
creatine kinase measurements in a primary care setting. Smith CC;
Bernstein LI; Davis RB; Rind DM; Shmerling RH. Arch Intern Med 2003 Mar
24;163(6):688-92.
So if, by "supposed to" you mean that the FDA recommends such testing of
liver function tests, then I agree. If by "supposed to" you mean that it
is actually important, then I disagree.
I don't think any reputable body recommends routine kidney function
tests in patients on statins, so I suppose that counts as "disagree".
| Quote: | Do you agree or disagree that one of the main reasons for those blood and
urine tests is to look for signs of rhabdomyolysis and other liver
problems?
|
Not sure how to answer that since:
1) Rhabdo is not a liver problem
2) When done, liver functions test are indeed performed to look for
liver problems, but, as above, are probably not necessary routinely
3) Urine tests are not routinely performed for monitoring statins
4) Kidney tests are not routinely performed for monitoring statins
5) If someone wanted to monitor for rhabdo and lesser muscle problems,
they would not do this by performing liver or kidney tests
Again, rather then simply telling us what you think ought to be done, or
what some book you have read says should be done, why not post
references to some primary research supporting your position.
Hello,
You are correct that Rhabdo is not a liver problem. Even if doctors do NOT
perform kidney function blood tests for monitoring statins--those doctors
either perform (or at least should perform) creatinine blood tests for
monitoring statins. As you know, muscle problems are one of the known
statin side effects and the creantine blood test is one method of checking
for that statin side effect. In my case, the doctor did not do a CK test
until my creatinine level rose from 1.1 to about 1.3 MG/DL on one of those
blood tests. It's my opinion that creatinine and CK blood tests should be
performed for monitoring statins. However, opinions are like a
nose--everyone has one. I know a wonderful lady that has a husband that
lost the use of his legs, arms and kidneys as a direct result of Rhbdo.
Jason
Jason |
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Andrew B. Chung, MD/PhD
medicine forum Guru
Joined: 25 Mar 2005
Posts: 8540
|
| Posted: Mon May 29, 2006 2:01 am Post subject:
Re: Statins and muscle damage
|
|
|
eml wrote:
| Quote: | David Rind wrote:
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
the following may interest those responding to this OP:
"Statins may alter the response of muscle to exercise stress by
altering the action of the UPP, protein folding, and catabolism,
disrupting the balance between protein degradation and repair. "
Atherosclerosis and Lipoproteins
Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal
Muscle With Exercise and Statins
Maria L. Urso; Priscilla M. Clarkson; Dustin Hittel; Eric P. Hoffman;
Paul D. Thompson
From the Department of Exercise Science (M.L.U., P.M.C.), University of
Massachusetts, Amherst, Mass; the Division of Cardiology (P.D.T.),
Henry Low Heart Center, Hartford Hospital, Hartford, Conn; and the
Research Center for Genetic Medicine (D.H., E.P.H.), Children's
National Medical Center, Washington DC.
Objective- Statins are safe medications but have side effects
including myalgia and rhabdomyolysis. How statins provoke muscle damage
is not known, but this effect is exacerbated by exercise.
Methods and Results- Healthy subjects took Atorvastatin (80 mg/daily)
or placebo for 4 weeks. Biopsies of both vastus lateralis muscles were
performed 8 hours after eccentric exercise (known to result in muscle
soreness and damage) of the left leg at baseline and the right leg
after statin/placebo treatment. Gene expression was determined using
Affymetrix GeneChips, and selected genes confirmed by polymerase chain
reaction (qRT-PCR). Atorvastatin had little effect on gene expression
at rest. When combined with exercise, 56 genes were differentially
expressed with 18% involved in the ubiquitin proteasome pathway (UPP)
and 20% involved in protein folding and catabolism, and apoptosis.
Conclusion- This is the first investigation to our knowledge to
implicate involvement of the UPP in skeletal muscle in response to
combined exercise and statin treatment, possibly explaining the onset
of myalgia with exertion. Statins may alter the response of muscle to
exercise stress by altering the action of the UPP, protein folding, and
catabolism, disrupting the balance between protein degradation and
repair.
Statins are safe medications but have side effects including myalgia
and rhabdomyolysis. How statins provoke muscle damage is not known, but
this effect is exacerbated by exercise. This is the first investigation
to our knowledge to implicate involvement of the UPP in skeletal muscle
in response to combined exercise and statin treatment, possibly
explaining the onset of myalgia with exertion. Statins may alter the
response of muscle to exercise stress by altering the action of the
UPP, protein folding, and catabolism, disrupting the balance between
protein degradation and repair.
|
Yes, I am familiar with the concerns about long term statin use.
Again, the goal is to eventually get folks off the statins and this
happens for most when they become lean and trim.
Prayerfully in Christ's amazing love,
Andrew
http://tinyurl.com/jjl29 |
|
| Back to top |
|
|
David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
|
| Posted: Mon May 29, 2006 2:17 am Post subject:
Re: Statins and muscle damage
|
|
|
Jason Johnson wrote:
| Quote: | Hello,
You are correct that Rhabdo is not a liver problem. Even if doctors do NOT
perform kidney function blood tests for monitoring statins--those doctors
either perform (or at least should perform) creatinine blood tests for
monitoring statins. As you know, muscle problems are one of the known
statin side effects and the creantine blood test is one method of checking
for that statin side effect.
|
No, this is incorrect.
First, a creatinine measurement is a test of kidney function and no one
recommends performing this in people on statins. You are confusing this
with a creatine kinase (CK) test, a muscle enzyme test.
Second, routine measurements of CK are not needed in asymptomatic
patients on statins, (and, additionally, unlike liver function tests,
such tests are not recommended by the US FDA prescribing information).
--
David Rind
drind@caregroup.harvard.edu |
|
| Back to top |
|
|
Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
|
| Posted: Mon May 29, 2006 3:14 am Post subject:
Re: Statins and muscle damage
|
|
|
In article <e5dlg0$7lp$1@reader1.panix.com>, David Rind
<drind@caregroup.harvard.edu> wrote:
Jason Johnson wrote:
| Quote: | Hello,
You are correct that Rhabdo is not a liver problem. Even if doctors do NOT
perform kidney function blood tests for monitoring statins--those doctors
either perform (or at least should perform) creatinine blood tests for
monitoring statins. As you know, muscle problems are one of the known
statin side effects and the creantine blood test is one method of checking
for that statin side effect.
|
No, this is incorrect.
First, a creatinine measurement is a test of kidney function and no one
recommends performing this in people on statins. You are confusing this
with a creatine kinase (CK) test, a muscle enzyme test.
Second, routine measurements of CK are not needed in asymptomatic
patients on statins, (and, additionally, unlike liver function tests,
such tests are not recommended by the US FDA prescribing information).
I am not confusing the two tests. I suggest that you download this report:
http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm.
The report clearly states that Rhabdo can be caused by statins and that
serum creatinine levels can be altered by that disease. Various other
blood and urine tests are mentioned in that report. I was discussing not
what doctors do but instead what I believe doctors should do to monitor
their statin patients. I
also believe they should do blood tests for CK and CPK.
If they fail to do it, those patients that develop Rhabdo should sue them.
They could use the blood tests as proof that those tests mentioned above
were not done. My doctor done those tests.
Jason |
|
| Back to top |
|
|
Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
|
| Posted: Mon May 29, 2006 3:15 am Post subject:
Re: Statins and muscle damage
|
|
|
In article <1148868097.679979.110770@38g2000cwa.googlegroups.com>, "Andrew
B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote:
eml wrote:
| Quote: | David Rind wrote:
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
the following may interest those responding to this OP:
"Statins may alter the response of muscle to exercise stress by
altering the action of the UPP, protein folding, and catabolism,
disrupting the balance between protein degradation and repair. "
Atherosclerosis and Lipoproteins
Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal
Muscle With Exercise and Statins
Maria L. Urso; Priscilla M. Clarkson; Dustin Hittel; Eric P. Hoffman;
Paul D. Thompson
From the Department of Exercise Science (M.L.U., P.M.C.), University of
Massachusetts, Amherst, Mass; the Division of Cardiology (P.D.T.),
Henry Low Heart Center, Hartford Hospital, Hartford, Conn; and the
Research Center for Genetic Medicine (D.H., E.P.H.), Children's
National Medical Center, Washington DC.
Objective- Statins are safe medications but have side effects
including myalgia and rhabdomyolysis. How statins provoke muscle damage
is not known, but this effect is exacerbated by exercise.
Methods and Results- Healthy subjects took Atorvastatin (80 mg/daily)
or placebo for 4 weeks. Biopsies of both vastus lateralis muscles were
performed 8 hours after eccentric exercise (known to result in muscle
soreness and damage) of the left leg at baseline and the right leg
after statin/placebo treatment. Gene expression was determined using
Affymetrix GeneChips, and selected genes confirmed by polymerase chain
reaction (qRT-PCR). Atorvastatin had little effect on gene expression
at rest. When combined with exercise, 56 genes were differentially
expressed with 18% involved in the ubiquitin proteasome pathway (UPP)
and 20% involved in protein folding and catabolism, and apoptosis.
Conclusion- This is the first investigation to our knowledge to
implicate involvement of the UPP in skeletal muscle in response to
combined exercise and statin treatment, possibly explaining the onset
of myalgia with exertion. Statins may alter the response of muscle to
exercise stress by altering the action of the UPP, protein folding, and
catabolism, disrupting the balance between protein degradation and
repair.
Statins are safe medications but have side effects including myalgia
and rhabdomyolysis. How statins provoke muscle damage is not known, but
this effect is exacerbated by exercise. This is the first investigation
to our knowledge to implicate involvement of the UPP in skeletal muscle
in response to combined exercise and statin treatment, possibly
explaining the onset of myalgia with exertion. Statins may alter the
response of muscle to exercise stress by altering the action of the
UPP, protein folding, and catabolism, disrupting the balance between
protein degradation and repair.
|
Yes, I am familiar with the concerns about long term statin use.
Again, the goal is to eventually get folks off the statins and this
happens for most when they become lean and trim.
Prayerfully in Christ's amazing love,
Andrew
http://tinyurl.com/jjl29
Andrew,
As usual, you are 100% correct.
Jason |
|
| Back to top |
|
|
David Rind
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 205
|
| Posted: Mon May 29, 2006 3:50 am Post subject:
Re: Statins and muscle damage
|
|
|
Jason Johnson wrote:
| Quote: | I am not confusing the two tests.
|
I've reread your prior post, and I don't believe you. At the very least,
you were not comprehending that a creatinine test is a kidney function test.
As mentioned previously, this is not a report. It is an entry in a
medical dictionary about rhabdo. I looked at it weeks ago when you
suggested I read it.
| Quote: | The report clearly states that Rhabdo can be caused by statins and that
serum creatinine levels can be altered by that disease.
|
Both those statements are true. However no one who knows what they are
talking about thinks doctors should monitor creatinine levels to screen
for statin muscle toxicity.
| Quote: | Various other
blood and urine tests are mentioned in that report. I was discussing not
what doctors do but instead what I believe doctors should do to monitor
their statin patients. I
also believe they should do blood tests for CK and CPK.
|
Since you are not confusing tests, why don't you explain the difference
between a CK test and a CPK test.
| Quote: | If they fail to do it, those patients that develop Rhabdo should sue them.
They could use the blood tests as proof that those tests mentioned above
were not done. My doctor done those tests.
|
I'm sure your expert opinion will be very useful to those planning to sue.
I'll give up at this thread after one last attempt, since apparently all
efforts to get you to post actual evidence rather than your own personal
opinion have failed.
I posted a citation to an article showing that there is little or no
utility in checking screening liver function tests or muscle enzyme
tests in patients on statins. The FDA does not recommend screening
muscle enzyme tests in patients on statins. Why are you so sure of your
own opinion that doctors should monitor those tests?
--
David Rind
drind@caregroup.harvard.edu |
|
| Back to top |
|
|
Andrew B. Chung, MD/PhD
medicine forum Guru
Joined: 25 Mar 2005
Posts: 8540
|
| Posted: Mon May 29, 2006 7:18 am Post subject:
Re: Statins and muscle damage
|
|
|
Jason Johnson wrote:
| Quote: | In article <1148868097.679979.110770@38g2000cwa.googlegroups.com>, "Andrew
B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote:
eml wrote:
David Rind wrote:
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
the following may interest those responding to this OP:
"Statins may alter the response of muscle to exercise stress by
altering the action of the UPP, protein folding, and catabolism,
disrupting the balance between protein degradation and repair. "
Atherosclerosis and Lipoproteins
Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal
Muscle With Exercise and Statins
Maria L. Urso; Priscilla M. Clarkson; Dustin Hittel; Eric P. Hoffman;
Paul D. Thompson
From the Department of Exercise Science (M.L.U., P.M.C.), University of
Massachusetts, Amherst, Mass; the Division of Cardiology (P.D.T.),
Henry Low Heart Center, Hartford Hospital, Hartford, Conn; and the
Research Center for Genetic Medicine (D.H., E.P.H.), Children's
National Medical Center, Washington DC.
Objective- Statins are safe medications but have side effects
including myalgia and rhabdomyolysis. How statins provoke muscle damage
is not known, but this effect is exacerbated by exercise.
Methods and Results- Healthy subjects took Atorvastatin (80 mg/daily)
or placebo for 4 weeks. Biopsies of both vastus lateralis muscles were
performed 8 hours after eccentric exercise (known to result in muscle
soreness and damage) of the left leg at baseline and the right leg
after statin/placebo treatment. Gene expression was determined using
Affymetrix GeneChips, and selected genes confirmed by polymerase chain
reaction (qRT-PCR). Atorvastatin had little effect on gene expression
at rest. When combined with exercise, 56 genes were differentially
expressed with 18% involved in the ubiquitin proteasome pathway (UPP)
and 20% involved in protein folding and catabolism, and apoptosis.
Conclusion- This is the first investigation to our knowledge to
implicate involvement of the UPP in skeletal muscle in response to
combined exercise and statin treatment, possibly explaining the onset
of myalgia with exertion. Statins may alter the response of muscle to
exercise stress by altering the action of the UPP, protein folding, and
catabolism, disrupting the balance between protein degradation and
repair.
Statins are safe medications but have side effects including myalgia
and rhabdomyolysis. How statins provoke muscle damage is not known, but
this effect is exacerbated by exercise. This is the first investigation
to our knowledge to implicate involvement of the UPP in skeletal muscle
in response to combined exercise and statin treatment, possibly
explaining the onset of myalgia with exertion. Statins may alter the
response of muscle to exercise stress by altering the action of the
UPP, protein folding, and catabolism, disrupting the balance between
protein degradation and repair.
Yes, I am familiar with the concerns about long term statin use.
Again, the goal is to eventually get folks off the statins and this
happens for most when they become lean and trim.
Andrew,
As usual, you are 100% correct.
Jason
|
All glory and praise belongs to GOD, Whom I love with all my being.
Many thanks to GOD for your kind heart.
Prayerfully in Christ's amazing love,
Andrew
http://tinyurl.com/jjl29 |
|
| Back to top |
|
|
Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
|
| Posted: Mon May 29, 2006 6:14 pm Post subject:
Re: Statins and muscle damage
|
|
|
In article <1148887080.982841.82370@j55g2000cwa.googlegroups.com>, "Andrew
B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote:
Jason Johnson wrote:
| Quote: | In article <1148868097.679979.110770@38g2000cwa.googlegroups.com>, "Andrew
B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote:
eml wrote:
David Rind wrote:
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
the following may interest those responding to this OP:
"Statins may alter the response of muscle to exercise stress by
altering the action of the UPP, protein folding, and catabolism,
disrupting the balance between protein degradation and repair. "
Atherosclerosis and Lipoproteins
Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal
Muscle With Exercise and Statins
Maria L. Urso; Priscilla M. Clarkson; Dustin Hittel; Eric P. Hoffman;
Paul D. Thompson
From the Department of Exercise Science (M.L.U., P.M.C.), University of
Massachusetts, Amherst, Mass; the Division of Cardiology (P.D.T.),
Henry Low Heart Center, Hartford Hospital, Hartford, Conn; and the
Research Center for Genetic Medicine (D.H., E.P.H.), Children's
National Medical Center, Washington DC.
Objective- Statins are safe medications but have side effects
including myalgia and rhabdomyolysis. How statins provoke muscle damage
is not known, but this effect is exacerbated by exercise.
Methods and Results- Healthy subjects took Atorvastatin (80 mg/daily)
or placebo for 4 weeks. Biopsies of both vastus lateralis muscles were
performed 8 hours after eccentric exercise (known to result in muscle
soreness and damage) of the left leg at baseline and the right leg
after statin/placebo treatment. Gene expression was determined using
Affymetrix GeneChips, and selected genes confirmed by polymerase chain
reaction (qRT-PCR). Atorvastatin had little effect on gene expression
at rest. When combined with exercise, 56 genes were differentially
expressed with 18% involved in the ubiquitin proteasome pathway (UPP)
and 20% involved in protein folding and catabolism, and apoptosis.
Conclusion- This is the first investigation to our knowledge to
implicate involvement of the UPP in skeletal muscle in response to
combined exercise and statin treatment, possibly explaining the onset
of myalgia with exertion. Statins may alter the response of muscle to
exercise stress by altering the action of the UPP, protein folding, and
catabolism, disrupting the balance between protein degradation and
repair.
Statins are safe medications but have side effects including myalgia
and rhabdomyolysis. How statins provoke muscle damage is not known, but
this effect is exacerbated by exercise. This is the first investigation
to our knowledge to implicate involvement of the UPP in skeletal muscle
in response to combined exercise and statin treatment, possibly
explaining the onset of myalgia with exertion. Statins may alter the
response of muscle to exercise stress by altering the action of the
UPP, protein folding, and catabolism, disrupting the balance between
protein degradation and repair.
Yes, I am familiar with the concerns about long term statin use.
Again, the goal is to eventually get folks off the statins and this
happens for most when they become lean and trim.
Andrew,
As usual, you are 100% correct.
Jason
|
All glory and praise belongs to GOD, Whom I love with all my being.
Many thanks to GOD for your kind heart.
Prayerfully in Christ's amazing love,
Andrew
http://tinyurl.com/jjl29
Andrew,
Do you think that GP doctors should or should not conduct serum creatinine
and CPK tests on their patients that take statins to determine whether the
patients are or are not developing Rhabdomyolysis? I once read an article
that was written by the wife of man that developed statin induced Rhabdo.
He lost the use of his arms, legs and kidneys. I don't understand why at
least some
doctors don't bother to conduct the tests mentioned above to keep people
from developing Rhabdo. --perhaps they feel that since Rhabdo is a rare
disease--they don't have to worry about it.
Jason |
|
| Back to top |
|
|
Jason
medicine forum Guru
Joined: 29 Apr 2005
Posts: 1120
|
| Posted: Mon May 29, 2006 6:31 pm Post subject:
Re: Statins and muscle damage
|
|
|
In article <e5dqub$dnb$1@reader1.panix.com>, David Rind
<drind@caregroup.harvard.edu> wrote:
Jason Johnson wrote:
| Quote: | I am not confusing the two tests.
|
I've reread your prior post, and I don't believe you. At the very least,
you were not comprehending that a creatinine test is a kidney function test.
As mentioned previously, this is not a report. It is an entry in a
medical dictionary about rhabdo. I looked at it weeks ago when you
suggested I read it.
| Quote: | The report clearly states that Rhabdo can be caused by statins and that
serum creatinine levels can be altered by that disease.
|
Both those statements are true. However no one who knows what they are
talking about thinks doctors should monitor creatinine levels to screen
for statin muscle toxicity.
| Quote: | Various other
blood and urine tests are mentioned in that report. I was discussing not
what doctors do but instead what I believe doctors should do to monitor
their statin patients. I
also believe they should do blood tests for CK and CPK.
|
Since you are not confusing tests, why don't you explain the difference
between a CK test and a CPK test.
| Quote: | If they fail to do it, those patients that develop Rhabdo should sue them.
They could use the blood tests as proof that those tests mentioned above
were not done. My doctor done those tests.
|
I'm sure your expert opinion will be very useful to those planning to sue.
I'll give up at this thread after one last attempt, since apparently all
efforts to get you to post actual evidence rather than your own personal
opinion have failed.
I posted a citation to an article showing that there is little or no
utility in checking screening liver function tests or muscle enzyme
tests in patients on statins. The FDA does not recommend screening
muscle enzyme tests in patients on statins. Why are you so sure of your
own opinion that doctors should monitor those tests?
David,
I was stating my opinions and never mentioned medical protocol in my
posts. I made it clear that I was stating my opinions in my posts. You
appeared to assume that I was discussing established medical protocol.
It's my guess that medical protocol will change if the people that develop
Rhabdo begin to file lawsuits since the tests such as serum creatine and
CPK isoenzymes were NOT done. Since you indicated that you read the
Medline Plus Rhabdomyolysis report--you already know that there are
various other blood and urine tests mentioned in that report. The reason
that I have a strong opinion on this subject is because of the article
that I read that was written by the wife of a man that developed statin
induced Rhabdo. He lost the use of his arms, legs and kidneys. That is the
reason that I believe doctors should do everything in their power to keep
any of their patients from developing statin induced Rhabdo. The story may
still be at this site:
http://www.n3inc.com/SmartMoneyReprint_103003Web.pdf
Don't you believe that doctors should screen re: Rhabdo?
Jason |
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Andrew B. Chung, MD/PhD
medicine forum Guru
Joined: 25 Mar 2005
Posts: 8540
|
| Posted: Mon May 29, 2006 7:59 pm Post subject:
Re: Statins and muscle damage
|
|
|
Jason Johnson wrote:
| Quote: | In article <1148887080.982841.82370@j55g2000cwa.googlegroups.com>, "Andrew
B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote:
Jason Johnson wrote:
In article <1148868097.679979.110770@38g2000cwa.googlegroups.com>, "Andrew
B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote:
eml wrote:
David Rind wrote:
A couple of caveats, of course: A. Although there may be no
current injury, the future remains unpredictable, and muscle
symptoms (which are nearly always mild and reversible) may arise
at any time.
the following may interest those responding to this OP:
"Statins may alter the response of muscle to exercise stress by
altering the action of the UPP, protein folding, and catabolism,
disrupting the balance between protein degradation and repair. "
Atherosclerosis and Lipoproteins
Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal
Muscle With Exercise and Statins
Maria L. Urso; Priscilla M. Clarkson; Dustin Hittel; Eric P. Hoffman;
Paul D. Thompson
From the Department of Exercise Science (M.L.U., P.M.C.), University of
Massachusetts, Amherst, Mass; the Division of Cardiology (P.D.T.),
Henry Low Heart Center, Hartford Hospital, Hartford, Conn; and the
Research Center for Genetic Medicine (D.H., E.P.H.), Children's
National Medical Center, Washington DC.
Objective- Statins are safe medications but have side effects
including myalgia and rhabdomyolysis. How statins provoke muscle damage
is not known, but this effect is exacerbated by exercise.
Methods and Results- Healthy subjects took Atorvastatin (80 mg/daily)
or placebo for 4 weeks. Biopsies of both vastus lateralis muscles were
performed 8 hours after eccentric exercise (known to result in muscle
soreness and damage) of the left leg at baseline and the right leg
after statin/placebo treatment. Gene expression was determined using
Affymetrix GeneChips, and selected genes confirmed by polymerase chain
reaction (qRT-PCR). Atorvastatin had little effect on gene expression
at rest. When combined with exercise, 56 genes were differentially
expressed with 18% involved in the ubiquitin proteasome pathway (UPP)
and 20% involved in protein folding and catabolism, and apoptosis.
Conclusion- This is the first investigation to our knowledge to
implicate involvement of the UPP in skeletal muscle in response to
combined exercise and statin treatment, possibly explaining the onset
of myalgia with exertion. Statins may alter the response of muscle to
exercise stress by altering the action of the UPP, protein folding, and
catabolism, disrupting the balance between protein degradation and
repair.
Statins are safe medications but have side effects including myalgia
and rhabdomyolysis. How statins provoke muscle damage is not known, but
this effect is exacerbated by exercise. This is the first investigation
to our knowledge to implicate involvement of the UPP in skeletal muscle
in response to combined exercise and statin treatment, possibly
explaining the onset of myalgia with exertion. Statins may alter the
response of muscle to exercise stress by altering the action of the
UPP, protein folding, and catabolism, disrupting the balance between
protein degradation and repair.
Yes, I am familiar with the concerns about long term statin use.
Again, the goal is to eventually get folks off the statins and this
happens for most when they become lean and trim.
Andrew,
As usual, you are 100% correct.
Jason
All glory and praise belongs to GOD, Whom I love with all my being.
Many thanks to GOD for your kind heart.
Andrew,
Do you think that GP doctors should or should not conduct serum creatinine
and CPK tests on their patients that take statins to determine whether the
patients are or are not developing Rhabdomyolysis? I once read an article
that was written by the wife of man that developed statin induced Rhabdo.
He lost the use of his arms, legs and kidneys. I don't understand why at
least some
doctors don't bother to conduct the tests mentioned above to keep people
from developing Rhabdo. --perhaps they feel that since Rhabdo is a rare
disease--they don't have to worry about it.
Jason
|
They should be vigilant about the possibility. They should also be
given the lattitude to decide how to best take care of their patients.
Prayerfully in Christ's amazing love,
Andrew
http://tinyurl.com/jjl29 |
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listener
medicine forum Guru
Joined: 05 May 2005
Posts: 617
|
| Posted: Tue May 30, 2006 1:30 am Post subject:
Re: Statins and muscle damage
|
|
|
jason@nospam.com (Jason Johnson) wrote in news:jason-2905061131290001@66-
52-22-113.lsan.pw-dia.impulse.net:
| Quote: | David,
I was stating my opinions and never mentioned medical protocol in my
posts.
|
Then your posts should be ignored.
L. |
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listener
medicine forum Guru
Joined: 05 May 2005
Posts: 617
|
| Posted: Tue May 30, 2006 1:33 am Post subject:
Re: Statins and muscle damage
|
|
|
jason@nospam.com (Jason Johnson) wrote in news:jason-2905061114300001@66-
52-22-113.lsan.pw-dia.impulse.net:
| Quote: |
Andrew,
Do you think that GP doctors should or should not conduct serum
creatinine
and CPK tests on their patients that take statins to determine whether
the
patients are or are not developing Rhabdomyolysis?
|
Let's see: you want to engage a kook like Dr. Chung yet you insist on being
argumentative and combative with David Rind.
Yep. It's pretty clear.
L. |
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