Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Ebrahim and Smith suggest in their letter that myalgia symptoms in patients taking statins or placebo were "indistinguishable" , concluding that statins did not cause myalgia. Their summary appesrs to suppose that statin myalgia is of sudden onset and equally sudden disappearance, as they used a three week swap period.
From my own experience of statin side-effects (N=1) with sequential trials of simvastatin, atorvastatin, rosuvastatin and prvastatin I can assure your correspondents that their conclusion is worthless. While atorvastatin produced side-effects after two days with a polymyalgia pattern of symptoms, all of the others produced effects that came on between 4 and 12 weeks - but more importantly the effects took between four weeks and four years to subside. I have no idea why different statins should behave differently (and I might add that ezetimibe produced similar symptoms); nor have I any other explanation for my symptoms or the fact that with three of the offending drugs my creatine kinase became significantly abnormal. But if my experience is anything to go by the trial quoted is flawed because its timescale is too short.
Of course, the whole debate is informed by the re-analysis of old studies now shown to be flawed, and the growing realisation that sugar, and not cholesterol, is the villain. It is also true that abandoning statin therapy in the millions who are being treated for something they don't have would go a long way to helping the NHS through its current financial meltdown.
Competing interests:
I have suffered significant statin side-effects
Re: N-of-1 approach to determine when adverse effects are caused by statins; rubbish research
Ebrahim and Smith suggest in their letter that myalgia symptoms in patients taking statins or placebo were "indistinguishable" , concluding that statins did not cause myalgia. Their summary appesrs to suppose that statin myalgia is of sudden onset and equally sudden disappearance, as they used a three week swap period.
From my own experience of statin side-effects (N=1) with sequential trials of simvastatin, atorvastatin, rosuvastatin and prvastatin I can assure your correspondents that their conclusion is worthless. While atorvastatin produced side-effects after two days with a polymyalgia pattern of symptoms, all of the others produced effects that came on between 4 and 12 weeks - but more importantly the effects took between four weeks and four years to subside. I have no idea why different statins should behave differently (and I might add that ezetimibe produced similar symptoms); nor have I any other explanation for my symptoms or the fact that with three of the offending drugs my creatine kinase became significantly abnormal. But if my experience is anything to go by the trial quoted is flawed because its timescale is too short.
Of course, the whole debate is informed by the re-analysis of old studies now shown to be flawed, and the growing realisation that sugar, and not cholesterol, is the villain. It is also true that abandoning statin therapy in the millions who are being treated for something they don't have would go a long way to helping the NHS through its current financial meltdown.
Competing interests: I have suffered significant statin side-effects