Soltalk February 2020 | Page 42

HealthTalk
Doctor’s notes
Dr Rik Heymans is a general practitioner in Nerja and writes
on developments in the world of medicine
therapies in cardiovascular medicine, with evidence from
hundreds of clinical trials, including >25 large cardiovascular
outcomes trials in the Cholesterol Treatment Trialists (CTT)
collaboration. Benefit is seen for reducing myocardial
infarction (MI), stroke, need for revascularization,
cardiovascular (CV) death, and total mortality. The benefits are
seen in those with prior CV events (i.e. secondary prevention)
and even in primary prevention. Benefit is seen across all
subgroups, without any statistical interaction, including by age.
How many steps?
To do steps, or not? And how many steps, that is the question.
10,000 seems a lot for people who have busy life, but do not
necessarily walk up and down the whole time. Yet this magical
number has been embedded in our consciousness, and not
reaching this goal may saddle some with a guilty conscience…
This goal of 10,000 steps/d is commonly believed by the
public to be necessary for health, but this number has limited
scientific basis. Furthermore, how to cram in my steps after a
full day’s work can seem a daunting task. So researchers started
looking at this! In a study of 16,741 women with a mean age of
72 years, the amount of steps per day were measured by a
pedometer. Women who averaged approximately 4400 steps/d
had significantly lower mortality rates during a follow-up of
4.3 years compared with the least active women who took
approximately 2700 steps/d; as more steps per day were
accumulated, mortality rates progressively decreased before
levelling at approximately 7500 steps/d. The conclusion? More
steps taken per day are associated with lower mortality rates
until approximately 7500 steps/d. where the benefits do not
increase further.
As for all medicines, statins do have side effects, most
prominent of which is myalgia (muscle ache). Other side
effects have been suggested, such as dementia, but refuted in
large randomized trials. The cost of statins used to be an issue,
but now they are almost all generic and widely available for
very low cost. Thus, a careful assessment of benefit vs. risk is
very favourable on the usual metrics of CV events prevented
vs. side effects. Yet somehow, despite wide use and acceptance
in medicine, based on hard research, there is still sometimes
scepticism and resistance to the use of these agents by many
patients and even some medical professionals. Some have
claimed that statins do not work in women for primary
prevention, yet multiple meta-analyses document that they
significantly reduce CV death, MI, stroke, and need for
revascularization.
Lipid lowering statins
Lipid lowering with statins is one of the most beneficial
The media have also joined in with this, with stories citing
those who claim limited benefits of statins. Books have been
written on the ‘cholesterol hoax’ and describe a large
conspiracy of companies trying to sell these drugs without
merit. In the current environment with many claiming ‘Fake
News’ in politics, these types of conspiracy stories thrive on the
Internet.
Another group in which questions have been raised is the
elderly. Here, there are some reasons to raise the question. Is it
worth using a long-term preventive therapy in someone who is
>75 years—meaning: would they live long enough to see any of
the benefit? An important contribution to this discussion
comes in the new analysis in this issue of the European Heart
Journal by Giral and colleagues. They conducted an
observational analysis with careful statistical adjustments,
looking at a 'natural experiment' comparing patients who had
their statins stopped vs. those who continued. They found
consistently that those who stopped had higher rates of
hospitalization for CV events, i.e. ~20–30% higher (Take home
figure). This is consistent with what one would expect from the
benefit of statins. These data are similar to those published
from a nationwide cohort from Denmark. So, the take-home
message would be: if indicated and prescribed, regardless of
the subgroup you belong to, you should take the medication.
The former US President Bill Clinton actually experienced this
first hand: as he did rehab for his knee, he exercised and lost
weight, so he stopped his statin, but a few months later
developed unstable angina and required coronary bypass
surgery. Like him or not, you would not want to follow him in
this matter…
© Dr RIK HEYMANS
c/ Angustias 24, Nerja
Tel: [phone]
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