Deans' stroke musings: Tackling over-prescription needs to start with statins

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, January 5, 2012

Tackling over-prescription needs to start with statins

More controversy on statins. A letter to the editor of Irish Medical Times. Your doctor should be up-to-date on all these so start asking him/her questions and if necessary make them uncomfortable.
Ask about statins making you stupid here:http://oc1dean.blogspot.com/2011/06/do-statins-make-you-stupid.html
The over-prescription here:http://www.imt.ie/opinion/2012/01/tackling-over-prescription-needs-to-start-with-statins.html
Your correspondent Dr Bernard Ruane (‘Over-prescribing must be tackled in new economic era’ http://bit.ly/vUxqB6, Irish Medical Times, 02.12.11, ) raises concerns about the overprescribing of drugs for several groups of patients.

His concern for the elderly, and those resident in frail care centres, is justifiable and deserves the attention of every prescribing practitioner.
The large numbers of elderly persons who are routinely prescribed statins for perceived ‘high cholesterol’ has long been a deep concern of mine, and should be the concern of every doctor responsible for their care and well-being.
Contrary to the conventional dogma, high cholesterol is not a risk factor for cardiovascular disease or stroke in these persons and critical evidence shows that higher cholesterol levels may predict longevity, rather than mortality, in the elderly.
Dr Ruane quotes the fear of litigation as a reason for not withholding statins in the care of the elderly. There is no sound basis for this fear, since I believe the weight of evidence supports the protective role of cholesterol in the elderly, who are otherwise at risk of succumbing to infections of the respiratory or gastrointestinal tract.
Hospital-admitted patients are especially vulnerable to such infections, often with a poor outcome. Studies will show that higher cholesterol levels afford protection and for every 1mMol/L increase in cholesterol, there is a corresponding decrease of 15 per cent in mortality.
One study shows that total cholesterol levels below 5.5mMol/L in the over-80s shortened their lives significantly, while another study, looking at more than 30,000 residents in acute care units, found that hospitalised people over the age of 65 years recovered faster if their cholesterol levels were high.
Cholesterol is vital for human health and survival, at all stages of life, and especially for the elderly, who are at risk of succumbing to infection or heart failure.
Coupled with the lack of benefit of cholesterol lowering is the added danger of harm to the CNS and musculoskeletal system, and the depletion of ubiquinol (CoQ10), a key mitochondrial nutrient in ATP production, followed by a greater risk of cardiomyopathy or heart failure.
Further risks to the elderly of non-essential medication are the cumulative effects of drugs metabolised via the CYP3A4 pathway, shared by certain popular statins.
Critical-care literature provides strong evidence for a survival advantage associated with high cholesterol levels in critically-ill people, heart failure patients and the elderly.
The conventional view (based on guidelines which I believe are not evidence based) that high cholesterol levels are associated with increased risk of dying is not based on scientific evidence and represents a paradigm that is in urgent need of review.