What are longer-term adherence levels to statin therapy?
What is the likely adherence level to gene therapy?
Not that this is happening in any time soon.
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This is true. However, it’s not relevant to people like “us” who are proactive, happy to take the medications, and it’s part of our daily lives.
It does boggle my narrow mind that people are prescribed an important medication like a statin, and then half of them won’t even bother taking it. To me, that just shows the general level of health education is overall pretty low -and there I blame both the doctors and the patients. I would like to believe that most patients, with a quick explanation of how plaque forms, the area-under-the-curve, and the MoA of statins, ezetimibe, PCSK9i etc would be pretty happy to take the pills. But I guess most of them are told “your cholesterol is high. take these pills every day” and not much else.
Gene therapy is cool. I wouldn’t be the first in line to take it though, since the statin/zetia/Repatha thing is so well proven already for the endpoints I actually care about.
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@relaxedmeatball I’m an example of what you suspect.
I’ve been to five different cardiologists over the last few decades. Some were very bad, some respected, and one so highly regarded that strings were pulled to get me in. The result… not one had ever explained anything to me. Nothing, never. I had to learn from podcasts.
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And, thankfully, you had a) the curiosity to seek out information for yourself, and b) the fortune not to get sucked down an online rabbit hole of cholesterol and statin denialism. I honestly feel sorry for the lay patient now because there’s so much mixed information online and all of it can sound credible. It’s almost just a matter of luck as to which thing the algorithm feeds you IMO.
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Yes, docs in general do not educate patients. This is due to many reasons, primarily lack of time (average length of visits is ridiculously short as the number of patients is high). But, sad to say, many patients have no interest either - “just give me a pill, doc” - and so most doc don’t bother initiating such conversations. That said, I have found - I don’t know how typical this is - that if you display a genuinely high level of knowledge yourself and engage the specialist with incisive questions, they tend to be enthusiastic conversationalists, eager to bounce ideas and appreciative of the interaction with an engaged patient. I’ve had this experience repeatedly, where they’d extend the visit way beyond normal. At least that’s been my experience at a teaching institution where I go for my appointments (UCLA). Sadly it is also true, that some docs, especially overwhelmed and harried general practitioners don’t have all that much knowledge to share, usually limiting themselves to whatever the standard of care and drug inserts say.
That being so, the obligation to educate rests on the patient. It’s their health at stake. Lack of time is an issue. How many people have the luxury to spend hours upon hours reading the literature when that’s not their job or area of competence and their time is already claimed by other obligations. Unless you already have a great interest in this area and it’s your hobby, it’s not surprising that people don’t know how to find reliable information and tell the difference from misinformation spewed by grifters (and many of these grifters are MDs on social media making bank).
It starts at school. Primary education is at a very low level when it comes to basic biology and human physiology is virtually absent for most kids. Education in this area - as frankly in every area - is abysmal. As a result most people don’t have the foundation on which to build more knowledge.
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and in related news…
Broken hearts mended? Rapamycin shows promise preventing feline HCM pathology
By now you may have learned about the anti-aging drug rapamycin and its success in preventing the cardiac muscle thickening characteristic of hypertrophic cardiomyopathy (HCM) in cats. FDA approval and a new study are paving the way toward making rapamycin the key to ending this heartbreaking disease.
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Not sure if this is the best place to post this, but, here you go. I’ve had a few CT scans, so I’m crossing my fingers.
Sorry, I don’t know how to gift an Apple News story, but I’ll paste a key part of the article from the SF Chronicle here:
Based on the 93 million CTs performed on 60 million patients in 2023, an estimated 103,000 future cancers are projected to occur — three to four times more than previous studies have found. This study included more detailed data about the types of scans, and doses of radiation used in those scans, than previous analyses.
CTs are an important tool for assessing many conditions, including whether patients need emergency surgery after car accidents and falls, and to see whether some cancer treatments are working. But the technology is overused in other instances, Smith-Bindman said, such as when it’s used to diagnose a suspected pulmonary embolism, or a blood clot in the lungs, in a patient who’s at low risk for an embolism.
The use of CTs has risen about 30% since 2007, which has led to a significant number of increased projected future cancers, the researchers said.
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Just saw this study from over a year ago, related to PCSK9 inhibitors… apologies if its been posted already.
PCSK9 Inhibitors May Affect Lung Function
In the vast number of cases, medication prescribed for high cholesterol does what it promises: significantly lowers the risk of cardiovascular disease, high blood pressure, diabetes, and age-related diseases. It does not cause any other adverse health conditions except diarrhea in some people.
However, lipid-lowering medications that clear cholesterol from the cells – known as PCSK9 inhibitors – could impair lung function and further studies are needed on their long-term side effects, researchers say.
Genetic variants reflecting another cholesterol-lowering medication, statins, were found to correlate with higher BMI and body fat, as well as reduced testosterone. Statins are the most common cholesterol-lowering medication prescribed.
https://scitechdaily.com/new-cholesterol-drugs-could-harm-lungs-warns-groundbreaking-global-study/
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Top level point: This is not a controlled or randomized study
The differences of people in the different groups might be the driver regardless or despite them going to bed at different times
The real question is for a give person or group of people what would time of going to bed would be best… E.g. for someone already going to bed before 10 that might be because they are sick, but if someone goes to bed at 11, would they be better of if they went to bed at 10? this study is not answering that
For example
Participants with an SOT after midnight (n = 31 946) were more likely to be a current smoker and have a history of diabetes or hypertension l
the 11 p.m.–11:59 p.m. group having the lowest sleep irregularity, and the <10 p.m. group the highest sleep irregularity,
Although the findings of this article do not show causality…
Lastly, the small size of the <10 p.m. group compared to the other SOT categories may weaken the conclusion of a U-shaped relationship between SOT and CVD risk.
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Wow… this seems like something we should discuss… 
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Paper:
Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Findings In this risk model, the 93 million CT examinations performed in 62 million patients in 2023 were projected to result in approximately 103 000 future cancers. Although the per-examination cancer risk was higher in children, higher CT utilization among adults accounted for the majority of the projected cancers.
Meaning These findings suggest that if current radiation dosing and utilization practices continue, CT-associated cancers could eventually account for 5% of all new cancer diagnoses annually.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832778
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Asking for a friend ….
What is the preferred statin you recommend for someone who just learned they have high lipids. Maybe there are a couple of preferred options?
Is there any reason not to include ezetimibe?
Thank you.
The safest statins are pitavastatin 2m-4mg once daily, pravastatin 40mg once daily (or 20mg twice daily) and fluvastatin 40-80mg once daily. Always add ezetimibe on top unless you’re allergic to it.
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FWIW, I switched from 10mg/day atorvastatin to 4mg/day pitavastatin. I did a lot of research before I switched. I did that for the following reasons:
1)Pitavastatin has just about the best outcomes as far as MACE goes (Major Adverse Cardiovascular Events)
2)Pitavastatin does not induce new onset diabetes, unlike some other statins. It doesn’t affect glucose control
3)It has very low levels of DDI (Drug Drug Interactions). Very important if you are taking other drugs
4)It does not affect muscles
5)It is not affected by grapefruit and foods that have the same enzyme inhibitors
6)It has a very low number of reported negative effects by users, and a very good safety profile
That said, like any drug, there may be users who have a bad response or are allergic or who would do better on a different statin.
Also compared to some other statins, for example atorvastatin, it has a shorter track record and has been less studied in European populations.
I have been taking it for 6 months now and have had no issues (nor did I have any problems with atorvastatin). I am having a blood lipid panel and other tests within the next two weeks, so I’ll know then what impact it has had.
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Wow, this is great information that I’m happy I can pass on to her. Thank you for listing all the details.
@Virilius thank you, too… looks like she should focus on pitavastatin to begin with.
I agree with you, pitavastatin is great, and I will add that it’s the most potent HDL-C increasing statin. That’s said, I tried different statins and it is definitely not the most potent nor the most cost-effective, even at 4mg a night. My current blood lipids on it with ezetimibe and bempedoic acid on top of that :
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Nobody claimed that pitavastatin is cheap but at the very least it’s one of the most tolerable, moderate-intensity statins on the market.
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Is this one of the drugs available through our India rx connections?
I see she can get it for $52 per month with goodrx, but I wonder if there are less expensive options?