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MedicalJOBS NEWS REVIEW 17 of cholesterol metabolism in 1964 .
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MedicalJOBS NEWS REVIEW 17 of cholesterol metabolism in 1964 .
This may be why Dr Endo missed out , Professor Nicholls suggests .
“[ Dr Endo ’ s death in June ] is truly a significant death in the field , if you think of the millions of people who have used these agents and the stents and bypass operations and heart attacks and deaths that have been avoided by using these agents .
“ It ’ s hard to find someone who has had a greater impact in medicine ,” he says .
Statin sceptics
But these drugs have not been without controversy .
Right up until the 1980s , the role of lowering cholesterol in CVD was debated , Professor Nicholls says .
“ Not all the medical professions were on board with the concept of lowering cholesterol as a way to prevent CVD .
“ There were a lot of cholesterol sceptics inside the medical community … this included high-profile people who were very vocal , and the public opposition probably delayed the opportunity to start moving this field forward by about 10 years .”
A trial known as ‘ 4S ’ published in 1994 provided “ massive validation ” of the role of statins in preventing CVD , he says . It was followed by several landmark trials showing statin benefits in various populations , and showing that higher doses of statins could be beneficial to take cholesterol levels to lower levels .
However , in 2002 , there was another setback when cerivastatin was voluntarily withdrawn from sale worldwide by sponsor Bayer due to reports of its association with severe and life-threatening rhabdomyolysis , at a rate up to 80 times higher than that for any other statin .
In the UK , questions about statin use arose again in 2013 , when two articles published in The BMJ suggested that statin benefits may be outweighed by the risk of side effects in people not at high risk .
And in Australia , ABC TV program Catalyst also aired a two-part series in 2013 questioning links between cholesterol and heart disease and suggesting the benefits of statins for preventing CVD had been oversold .
That program , fronted by journalist Dr Maryanne Demasi , who has a PhD in medical research , was condemned , not least by ABC presenter Dr Norman Swan , who said it misrepresented scientific evidence and scared people away from prescribed medications .
It was withdrawn by the broadcaster .
Researchers subsequently found it led to a significant
drop in statin dispensing , which may have resulted in up to 2900 preventable , potentially fatal , heart attacks and strokes over the ensuing five years .
However , despite statins remaining a mainstay of secondary prevention of CVD and being recommended by all international guidelines for people with established atherosclerotic CVD , Professor Garry Jennings says they are still underused .
‘ There were a lot of sceptics .’
“ Studies indicate significant gaps in adherence and treatment , suggesting more Australians could benefit from statin therapy , especially after major cardiovascular events ,” the Heart Foundation chief medical adviser says .
“ They could also perhaps be better targeted with anecdotal and other evidence of their use in people with low cardiovascular risk .”
Nevertheless , Dr Endo ’ s legacy continues to impact lives globally .
Back in 1964 , when presenting the Nobel prize to Bloch and Lynen , Rector Sten Friberg of Sweden ’ s Karolinska Institute commented that we could “ look forward to a time when mankind will not only live under vastly improved conditions but will itself be better ”.
Dr Endo was able to say in 2010 that this time had “ been truly realised ”, thanks to the contribution of statins , which were being taken by 30 million people worldwide and had extended the lives of millions .
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MINIMUM PRODUCT INFORMATION EpiPen ® Adrenaline Auto-Injector 0.3mg / 0.3mL EpiPen ® Jr . Adrenaline Auto-Injector 0.15mg / 0.3mL . The following are not a complete listing : Indications : For the emergency treatment of anaphylaxis ( acute severe allergic reaction ) due to insect stings or bites , foods , drugs or other allergens . Contraindications : Contraindications are relative , as this product is intended for use in life-threatening emergencies . Certain arrhythmias , cerebral arteriosclerosis , vasopressor drug contraindication , shock ( except anaphylactic shock ), certain types of general anaesthesia . Precautions : Sulfite allergy , intravenous administration , ventricular fibrillation , prefibrillatory rhythm , tachycardia , myocardial infarction , cardiovascular disease , organic heart disease , cardiac dilation , cerebral arteriosclerosis , prostatic hypertrophy , elderly , individuals with diabetes , hypertension , narrow angle glaucoma , hyperthyroidism , organic brain damage , psychoneurosis , phenothiazine-induced circulatory collapse , Parkinsonism . Avoid injection into hands , feet , ears , nose , buttocks , genitalia . Use in Pregnancy : Pregnancy Category A . Excreted in breast milk . Use with caution when maternal blood pressure is in excess of 130 / 80 . Interactions : CNS medicines , alpha and beta adrenergic blockers , some general anaesthetics , hypoglycaemic agents . Adverse Effects : Anxiety , restlessness , tachycardia , respiratory difficulty , tremor , weakness , dizziness , headache , dyspnoea , cold extremities , pallor , sweating , nausea , vomiting , sleeplessness , hallucinations , flushing of face and skin . Psychomotor agitation , disorientation , impaired memory , potentially fatal ventricular arrhythmias , severe hypertension which may lead to cerebral haemorrhage and pulmonary oedema . Angina may occur in patients with CAD . Dosage : Single intramuscular injection into anterolateral aspect of thigh , repeat as directed if symptoms recur or have not subsided . Adults ≥30kg : EpiPen ® Auto-Injector ( 0.3mg adrenaline ) Children 15 – 30kg : EpiPen ® Jr . Auto-Injector ( 0.15mg adrenaline ). The prescribing physician may choose to prescribe more or less than this amount ; please refer to relevant guidelines .
Dr Maryanne Demasi ( PhD ) on ABC ’ s Catalyst .