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Rapid Responses: Rapid Responses published:
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Informed consent?
- Joan McClusky (17 May 2007)
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Statins decrease lifestyle changes
- Sukhbindar S Sibia (19 May 2007)
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Crp levels and Hypercholesterolemia
- Daniel A. Lahana (11 August 2009)
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Joan McClusky, Medical writer New York, NY 10003
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Malcolm Kendrick's take on the issue of offering statins to women to reduce cardiovascular risk--"no" due to lack of proven effectiveness-- might be supported further by an aspect of preventive medicine that is often overlooked--that of informed consent. To give women drugs that many studies have shown to be of no benefit in reducing mortality or even coronary heart disease is--at best--a clinical trial. And positions itself in direct opposition to such advice as "don't get a broken leg fixed, you'll have a crook leg." Before we start putting statins in the the public well, it might be a good idea to develop a simple patient sheet that explains what the overall findings are, the risks of side effects, other treatment alternatives, and let the patient decide. This would make a fascinating study, and could also do something to reduce the demands of the "worried well." Competing interests: None declared |
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Sukhbindar S Sibia, Consultant Physician Sibia Medical Centre, B/XIX-568 A, Civil Lines, Ludhiana - 141001 India
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It is difficult enough to motivate patients (and non patients) to undergo lifestyle changes for prevention of cardiac and many other diseases. Giving them Statins (to men or women) gives them another excuse to avoid the changes. The side effects of statins and other drugs are better known to the doctors than the patients. Most patients attribute the side effects of statins to decreased cholesterol and dont even report it to the attending physician - a dangerous trend. Like minimal invasive surgery it is time to move towards minimum intake medicines. Dr.Sibia, info@sssibia.com Competing interests: None declared |
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Daniel A. Lahana, Physician Beverly Hills 90210
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In my medical practice I used persistently elevated C-reactive protein and low Hdl levels as a good guide in my efforts to isolate a sub-class of patients that may warrant treatment with statins . I don't know whether the series of patients that were quoted in the articles mentioned by Dr's grundy and Kendricks (that did not have altered effects on survival or major changes in the coronary heart disease outlook) , were chosen also on the basis of having low HDL and high risk elevations of C-reactive proteins .If this was not used in the inclusion criteria for those studies,then are we missing a sub-class of patients that will benefit from statin therapy ? Daniel A. Lahana M.D.
Competing interests: None declared |
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