Thursday, December 12, 2013

More harm than Good? Statins, Acid Blockers (PPIs) and ARBs for blood pressure/ Pamela Weintraub

Pam Weintraub, editor of Discover Magazine, has an in-depth piece on problems with commonly used drugs on the ExperienceLife website.  

The acid blockers (proton pump inhibitors like Prilosec or Nexium), sold over-the-counter or by prescription, can cause a variety of problems from long-term use.  Getting off them can be a challenge, because a hyperacidity rebound often occurs.  This necessitates taking an antacid like Mylanta frequently, for up to 2 weeks.  After that, the stomach stops producing excess acid.

PPIs can, in fact, effectively treat some noninfectious ulcers and severe cases of reflux, but it’s increasingly clear that long-term use can be dangerous, according to a series of studies published last year:
Research from the National Institutes of Health, published in Current Gastroenterology Reports, shows that long-term use of PPIs can limit the body’s absorption of essential nutrients, including calcium, magnesium, iron and vitamin B12, which require gastric acid to be absorbed. Risks include not just osteoporosis, but also anemia, fatigue, seizures and cardiac events.
  • The Annals of Internal Medicine
  •  reports that long-term use of proton pump inhibitors increases cardiovascular risk for those already suffering myocardial infarction or stroke.
  • The Archives of Internal Medicine
  •  reveals that PPIs substantially increase the risk of infection from a particularly hardy bacteria called Clostridium difficile. The study also linked long-term PPI usage with spine, lower arm and total fractures in postmenopausal women. Perhaps even more alarming was the finding that as many as 69 percent of people taking PPIs don’t need them to effectively treat their symptoms.
The ARBs (angiotensin receptor blockers, like Cozaar) are used because they were thought to cause less side effects than some other antihypertensives.  But they have not been shown to save lives, so is the reduction in blood pressure of any benefit?  
Wright especially takes issue with marketing efforts to push ARBs rather than the less-expensive ACE inhibitors. The drug companies claim their studies showed better health outcomes with ARBs, he says, but recent research challenges that claim. A 2010 study published in The Lancet Oncology, for instance, reported an increase in cancer diagnoses among ARB users. Other side effects include headache, dizziness, lightheadedness, nasal congestion, back and leg pain, and diarrhea.
You have already heard about statins for cholesterol lowering.  It is not at all clear that lowering cholesterol, which they do well, is why they may benefit heart disease.
If you’ve been prescribed the drugs prophylactically, it may be time to talk with your doctor about getting off statins entirely. According to internist and clinical pharmacologist James M. Wright, MD, PhD, professor at the University of British Columbia, statins have no proven net health benefit as a preventive. As managing director and chair of the Therapeutics Initiative, a group that evaluates drug studies in Canada, Wright is an expert on meta-analyses — the large “studies of studies” — that take every last bit of data into account. His latest review of the data — and the most comprehensive to date — was published in the Therapeutics Letter in 2010: “Statins do not have a proven net health benefit in primary prevention populations,” he wrote, adding that the “claimed mortality benefit” for this group is “more likely a measure of bias than a real effect.”

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