Dr that doesn't believe me

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circular
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Re: Dr that doesn't believe me

Post by circular »

floramaria wrote:In Dr. Bredesen’s book, The End of Alzheimer’s Program he discusses elevated lipids and statins. (pgs 124-127) What he presents supports what you said to your doctor. He states that statins can increase the likelihood of cognitive decline and provides a footnote.
Thank you for sharing that Floramaria. Since I'm interested in Dr. Bredesen's approach, and I am also wading through the statin issue for myself, I finally bought the Kindle version of this book. I'll get to the meat of this in a moment, but first, a technical rant:

The book indicates that it is reference number 87. However, when you click the link '87' it takes you to the end of the Kindle book where you find 'Visit endofalzheimersprogram.com to see every reference in this book'. So I went there, and unless I'm missing something, you cannot view the references sequentially by number. Rather, you need to know the name of the reference to sort the list alphabetically (but clicking on the footnote doesn't provide the information for the footnote so you can do that), or you need to know what chapter you were in and search by chapter. (If I were reading the book I might at least remember what chapter I was in, but I'm not.) By then you've lost your place in the Kindle book (back space takes you through the end matter) and find your way back to figure out what chapter you're in. But rather than page back from where I left off to the beginning of the chapter, I consult the table of contents, but none of the chapter titles are specific to what I was reading, and the beginning page numbers of the chapters don't show there, because the chapter titles are direct links instead. This is already insane. Next I 'back paged' from the statement about statins over 50 pages to finally find which chapter I was in. Then I went back to the website with the references and navigated to that chapter only to find the references not showing in order sequentially, as I would presume they appear within the chapter. So again I found myself paging along, this time through the references for the chapter all out of order.

It's clear—unless I am missing something—that while the book is highly valuable, the Kindle version is useless as a reference for anyone who may want to check references. And this exercise provided yet another example of why it's critical to check references no matter who the writer is … The statement in the book may be accurate, and the source offered to support it may be a good work, but the I would think the additional context that I found provided by the source, and knowledge about the source itself, would interest many readers.

I finally found reference 87 and also located it online: 'US Food and Drug Administration, last modified January 19, 2016: FDA Drug Safety Communication: Important Safety Label Changes to Cholesterol-Lowering Statin Drugs'.

Many people don't put a lot of faith in FDA statements, but apparently Dr. Bredesen does, so the fact that he is referencing the FDA may be important to some people. (I personally don't know enough about the FDA to have an opinion on them as a source.) These seem to be the pertinent paragraphs (I looked for 'cognit' on the page), and it can be noted that this document hasn't been updated since Dr. Bredesen cited it:
Adverse Event Information
Information about the potential for generally non-serious and reversible cognitive side effects (memory loss, confusion, etc.) and reports of increased blood sugar and glycosylated hemoglobin (HbA1c) levels has been added to the statin labels. FDA continues to believe that the cardiovascular benefits of statins outweigh these small increased risks.



Additional Information for Healthcare Professionals

...

There have been rare post-marketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use. These reported symptoms are generally not serious and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks).

Cognitive adverse events

FDA reviewed the AERS database, the published medical literature (case reports and observational studies),4-13 and randomized clinical trials to evaluate the effect of statins on cognition.14-17

The post-marketing adverse event reports generally described individuals over the age of 50 years who experienced notable, but ill-defined memory loss or impairment that was reversible upon discontinuation of statin therapy. Time to onset of the event was highly variable, ranging from one day to years after statin exposure. The cases did not appear to be associated with fixed or progressive dementia, such as Alzheimer’s disease. The review did not reveal an association between the adverse event and the specific statin, the age of the individual, the statin dose, or concomitant medication use.

Data from the observational studies and clinical trials did not suggest that cognitive changes associated with statin use are common or lead to clinically significant cognitive decline.
[Emphasis added]
I have to say, I think Dr. Bredesen's statement in the book may be misinterpreted easily.
Statins can increase the likelihood of cognitive decline. 87
Does he mean to say that statins can increase the likelihood of Alzheimer's, something many readers might conclude based on the title of the book? His reference falls far short of saying that and specifically states that they don't. So I'm thinking he may just be saying to watch for reversible cognitive decline when taking statins and stop them if you experience it, but he stopped short of the whole thought.

True due diligence might call on one to review the references the FDA relied to reach their conclusions. Instead, I went to PubMed and searched 'statins and alzhimer's' since 2016. I can't begin to attend to all 163 results, but there are a couple recent ones that could be of interest, judging by the abstracts. I plan to drop at least one of them into a new post when I get a chance.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Dr that doesn't believe me

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circular wrote:
I have to say, I think Dr. Bredesen's statement in the book may be misinterpreted easily.
Statins can increase the likelihood of cognitive decline. 87
Hi circular, Thanks for the deeper dive. I agree with you about the difficulty of accessing footnotes. They are not included in the print version of the book either, and I looked a long time before someone referred me to the same place you were directed to for the footnotes. At least with the print book I did not have the problem of losing my place.

What you found looking at the footnote is interesting. There may be other studies sited here on ApoE4.Info. Right now I don’t have the time to look into that. If I do find more supporting the correlation between statins and cognitive decline, I’ll post a link.
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circular
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Re: Dr that doesn't believe me

Post by circular »

floramaria wrote: I agree with you about the difficulty of accessing footnotes. They are not included in the print version of the book either …
I think the intention was to make it easy for people to click a direct link from the reference to its location on the web, but called me shocked, flabberghasted, and whatever else you want. That convenience really shouldn't be offered at the expense of professional citation practices. Also, the only reason I could link to them online was that I was using Kindle Cloud reader, which I don't usually use. A Kindle device without web access of that kind wouldn't have worked either. I'm trying hard not to go off on just how this makes me feel.
What you found looking at the footnote is interesting. There may be other studies sited here on ApoE4.Info. Right now I don’t have the time to look into that. If I do find more supporting the correlation between statins and cognitive decline, I’ll post a link.
In case you missed it, here's a link to my recent post about an interesting—if imperfect—paper published in 2020 by Brinton and team about statins and neurodegenerative diseases including AD.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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