Side Effects: Heartburn Drugs and Statin

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Side Effect Linked to Heartburn Drugs

 Canadian researchers have found that older people taking acid suppressing drugs such as esomeprazole, lansoprazole and omeprazole are at higher risk for kidney failure.  The scientists used medication and hospitalization records of nearly 600,000 senior citizens in Ontario between 2002 and 2011. Approximately half of these people were taking proton pump inhibitors like Nexium or Prilosec, while the other half were not. Although hospitalization for kidney injury was uncommon, occurring in less than 1 percent of those in the study, it was still more than twice as likely among people on the heartburn medicines.  This is not the only potentially serious side effect these drugs have been linked to. Other complications include osteoporosis and bone fracture as well as pneumonia and C diff intestinal infections.        

-from The People's Pharmacy April 23, 2015  

New Statin Study Confirms Link to Diabetes

Do statins raise blood sugar and increase the risk of diabetes? A new study says the risk of diabetes is substantially greater than previously reported.  Statin-type cholesterol-lowering drugs like atorvastatin, lovastatin and simvastatin are supposed to prevent heart attacks and strokes. New research from Finland suggests that such drugs may increase the risk of developing type 2 diabetes by 46 percent, a condition that is strongly linked to heart attacks and strokes. What gives?

For over a decade, there have been indications that statins could trigger diabetes in people with normal blood sugar and make control of diabetes more challenging in people who already had the disease.  In 2008 a study called JUPITER (New England Journal of Medicine, Nov. 8, 2008) revealed a link between rosuvastatin (Crestor) and type 2 diabetes. Nowhere in the abstract or the conclusions was there mention of this connection. That is what busy doctors often look at rather than read the entire article.  If, however, you took the time to actually review the full results you discovered that although the authors downplayed the risk of elevated blood sugar they admitted that, "Nevertheless, physician-reported diabetes was more frequent in the rosuvastatin group (270 reports of diabetes, vs. 216 in the placebo group..." And in the discussion the authors admitted that: 

 "We did detect a small but significant increase in the rate of physician-reported diabetes with rosuvastatin, as well as a small, though significant, increase in the median value of glycated hemoglobin [HbA1c]. Increases in glucose and glycated hemoglobin levels, the incidence of newly diagnosed diabetes, and worsening glycemic [blood sugar] control have been reported in previous trials of pravastatin, simvastatin, and atorvastatin. However, systematic protocol-specified measurements showed no significant difference between our two study groups in fasting blood glucose levels or glycosuria during the follow-up period. Therefore, although the increase in the rate of physician-reported diabetes in the rosuvastatin group could reflect the play of chance, further study is needed before any causative effect can be established or refuted."

 Granted, this is doctorspeak and somewhat hard to decipher. Their analysis seems to be attempting to downplay the risk. The seeds of doubt are planted with the phrase "could reflect the play of chance." And indeed some cardiologists choose to either ignore or minimize the connection between rosuvastatin (and other statins) and diabetes. The American College of Cardiology (ACC), the American Heart Association (AHA) and the American Diabetes Association have all come out strongly in favor of statin therapy. In fact the ACC and the AHA published a "Risk Calculator" that pretty much requires all physicians to prescribe a statin to anyone with diabetes.  When asked whether statins might trigger diabetes or make it worse, cardiologists typically respond that it is nothing to worry about and that the benefits of statins far outweigh any risks. The most recent study tracked 8,749 Finnish men between the ages of 45 and 73. None had diabetes at the start of the trial. They were followed for nearly six years. After all the technical analysis, here is what was found at the bottom line:   "In our study statin therapy was associated with a higher risk of diabetes (46%) than previously reported."  Wow. There is no longer any doubt that statin-type cholesterol-lowering drugs like atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor) and simvastatin (Zocor) can trigger diabetes. And based on the Finnish trial, these drugs also make it harder to control blood sugar. Perhaps most convincing, the higher the dose, the worse the problem. In other words, a dose-related problem usually signals that the adverse effect is caused by the drugs and is not merely "chance." 

--Drugs can certainly have some very positive effects, and they can play a key role in people's lives as they struggle with health issues. And no one should ever stop any medication without consulting with the prescribing physician. That is certainly the case in this situation.  But we so easily forget that, no matter how "safe" a drug is declared to be, it alters our normal physiology and comes with side effects (more people die every year from taking aspirin than heroin, for example).  Granted, it seems easier to take a pill than to adjust our lifestyle to deal with issues such as blood sugar, cholesterol levels, or excess stomach acid, but these latest studies are another reminder that choosing to do so comes with its own price.  Before getting committed to a drug regimen, find out if there are healthier alternatives.  Or if you're on meds, work with your physician to see  if there's anything you can do to get off.

 

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