Posts Tagged ‘lipid’

Guest Post: Fighting Fat with Drugs – Is it Worth It?

Wednesday, July 14th, 2010

It’s no longer a trivial issue over which kids get bullied in the school playground or which adults get teased about at the office; today, obesity is an epidemic of oversized proportions. It’s a chronic disease, one that 12 million Americans are suffering from, and because of this, illness is on the rise. Diabetes, heart disease, strokes, cancer, and various other diseases are on the prowl and sending healthcare costs shooting through the roof. And while anyone with plain common sense knows that the best and safest way to fight obesity is to eat a healthy diet and get regular exercise over the course of your life, most people tend to resort to shortcuts and seek remedy in anti-obesity drugs.

To be fair, some people do need extra help since diet and exercise alone cannot do much to help them reduce because they are abnormally obese. And so weight loss pills help them control and/or suppress their appetite or prevent their bodies from digesting the fat in the food they eat. But a recent study conducted by Brazilian and Canadian researchers and published in the British Medical Journal states that even the long term use of weight loss pills contributes only to a minor reduction in weight, an average of less than 11 pounds.

And when we take into consideration the number of side effects that these pills cause – the anti-obesity drug orlistat which is supposed to boost weight loss by preventing your body from digesting fats causes digestive side effects even as it promotes only an average weight loss of 7 pounds; sibutramine and rimonabant which suppress or interrupt neural signals to disguise hunger pangs and food cravings reduce weight by an average of 9 pounds, but at the cost of insomnia, high blood pressure, an elevated pulse rate, and nausea. Rimonabant has also been known to cause anxiety and depression and other mood disorders and is as of now not approved for sale by the FDA.

On the bright side however, the drugs did serve to improve cardiovascular health and prevent and/or control diabetes, hypertension, and cholesterol, the killer diseases that attack overweight people. But then again, with most weight loss drugs being available OTC, we must ask ourselves the question – is it ok to tempt and even court the disease just because we perceive that the cure is just a pill away? And are we fooling ourselves into believing that it is ok to be overweight because anti-obesity medicines are now available even without a prescription?

The truth cannot be written more clearly on the wall – we are a nation plagued by obesity; we invite disease with open arms because of our irresponsible lifestyles, a callous attitude towards exercise, and an overindulgence of food. And because of this, our healthcare costs are spiraling out of control. It’s time we stopped depending on pills and medicines as the panacea to cure all our ills and start looking at their source instead; it’s time we bring up our children to respect and safeguard their health instead of encouraging their sedentary lifestyles and feeding them with junk food; and it’s time we started giving good health the deference it deserves – we don’t have to place it on a pedestal, it’s enough that we acknowledge its importance in our lives.

(This article is contributed by Susan White, who regularly writes on the subject of online radiology technician schools. She invites your questions, comments at her email address: susan.white33@gmail.com)

Review: Muscle pain due to statins

Friday, July 3rd, 2009

Statins are probably the best medications to reduce cholesterol level and also have associated anti-inflammatory activities. Both these properties lead to a marked decrease in atherosclerosis and related diseases.

Muscle pain is quite common in people (up to 10%) who take one of the several statins for lowering their cholesterol levels. However, there is no strict consensus on how to define, diagnose and manage such muscle pains.

The Annals of Internal Medicine recently published an excellent review on “Statin related myopathy.” Here is a brief summary of the article.

Definition:

There is no consensus definition. Each group (ACC/AHA, FDA etc) have their own definitions. For most clinical purposes the following definitions should be adequate:

Myopathy: Muscle disease with creatine kinase > 10 time upper limit

Rhabdomyolysis: Creatine kinase elevation with end organ damage

Pathophysiology:

Incompletely understood. Proposed mechanisms include:

  1. Decreased cholesterol content of skeletal myocyte membrane leading to instabilty
  2. Depletion of isoprenoids and/or coenzyme Q10
  3. Mitochondrial dysfunction

Risk factors for developing myopathy:

  • Advanced age
  • Smaller body size
  • Multi-system diseases (including hypothyroidism)
  • Alcoholism
  • Major surgery, excess physical activity
  • History of myopathy while on other lipid lowering agent
  • Family history
  • Higher doses of statin
  • Interaction with other drugs leading to increased bio-availability of statins

Clinical Features:

Major site of muscle pain were in the thighs, calves or it was generalized. Pain was described as heaviness, stiffness or cramping and sometimes was associated with exertion. Physical exertion was a common trigger of myalgia. Tendon pain may also be present.

Management:

  • Check creatine kinase (CK) levels in high risk patients
  • If CK levels > 10 times upper limit, stop statin
  • Re-initiate statin with a lower dose once CK levels return to normal
  • Try switching to fluvastain (better tolerated) or rosuvastatin (less interaction with other medications)
  • Atorvastatin and Rosuvastatin have long half life and can be administered on alternate days
  • Trial of other lipid lowering agents (e.g. Bile acid binders, ezetimibe, niacin etc)
  • Co-enzyme Q10 supplementation may tried. No clear benefit but is very safe.

Brand Name Vs Generics

Thursday, September 25th, 2008

This Medco analysis implies that the perceived therapeutic benefit of generics over brand name in the minds of patients may not be that significant as earlier thought.

The analysis also reveals that reaching the Coverage Gap dramatically stimulates the use of generics among all Medicare recipients. During the initial phase of the benefit, when the plan provides drug coverage, one-third of the medications used daily by beneficiaries were generics and two-thirds were brand-name drugs. Once beneficiaries reached the Gap and were responsible for the full cost of the drug, those numbers flip – generic usage rises to 71 percent and brand-name use falls to 29 percent.

Brand Name Lipitor Vs.jpg Generic Simvastatin

What other factors could be playing a role and how do we counteract it?

Reference: Medco, ACP Internist

Statins for Kids

Wednesday, September 24th, 2008

Promote junk food, raise cholesterol levels and then prescribe cholesterol lowering drugs.

This is capitalism at its best. Can we fight it?

So if everybody hates the idea of giving statins to kids…..why don’t we restrict marketing junk food to children, improve the quality of nutrition at school, promote physical activity at school and increase funding for obesity prevention and treatment?

Your Child’s Lunch Box

Junk food and simvastatin for lunch

What’s next?

Hamburger with a topping of statins!

Cheese fortified with statins!

Statin Water!…………..

Video: Reinventing the school lunch

Speaking at the 2007 EG conference, “renegade lunch lady” Ann Cooper talks about the coming revolution in the way kids eat at school — local, sustainable, seasonal and even educational food.


Reference: WSJ Health Blog, NEJM, Pediatrics Journal

Another blow to Vytorin: Now linked to cancer

Tuesday, September 2nd, 2008

In a new article released online (ahead of print) in the New England Journal of Medicine (SEAS Trial), Schering-Plough’s “would be” blockbuster drug ezitimibe (Zetia) has again not only fallen short of it’s expectations, but now may also be linked with increased cancer risk.

In patients taking Vytorin (simvastatin + ezitimibe) there was an increased number of cancers (no particular type) when it was given to try to prevent aortic stenosis (thickening of a valve located in the blood outflow tract in the heart).

Aortic stenosis in elderly is related to atherosclerosis and has many of the same risk factors as for heart attacks. This trial was therefore designed to see if Vytorin could prevent/delay development of aortic stenosis. Unfortunately, Vytorin fell short in this criterion also.

Of note, another article published online, analyzed data from 2 more trials (which are ongoing – SHARP , IMPROVE-IT) in addition to the SEAS trial and concluded that there may not be any relationship of Vytorin with cancer. However, both the other studies are sponsored by Schering-Plough!!!!!

But these articles most likely will drive the nail in the coffin for Vytorin.

Reference: NEJM