Documentos de Académico
Documentos de Profesional
Documentos de Cultura
• Name : Prof. DR. Dr. Idrus Alwi SpPD, K-KV, FACC, FESC,
FAPSIC, FINASIM, FACP.
• Current Position : President of Indonesian Society of
Internal Medicine
Prof. Idrus Alwi MD, PhD, FINASIM, FACP, FACC, FESC, FAPSIC
99% or
95% CI
Statin/more Control/less
Group 1 Group 2
Group 3 Group 4
* Subgroup analysis
Stone NJ, et al. J Am Coll Cardiol 2013 Nov 7. Epub ahead of print
New ACC/AHA Guideline:
Which Statin Trials Support Which Groups?
Group 1 Group 2
Trials: Trials:
TNT-Atorva Clinical ASCVD LDL-C ≥190 mg/dL None
IDEAL-Atorva CHD, stroke, and
(~5 mmol/L)
PROVE-IT-Atorva peripheral arterial
disease, all of presumed
SPARCL-Atorva atherosclerotic origin
Group 3 Group 4
Trials: Trials:
CARDS-Atorva Diabetes mellitus ASCVD risk ≥7.5% ASCOT LLA-Atorva
TNT*-Atorva HPS-Simva
HPS*-Simva + age of 40–75 years No diabetes JUPITER-Rosuva
+ LDL-C 70–189 mg/dL + age of 40–75 years
(~1.8–5 mmol/L) + LDL-C 70–189 mg/dL
(~1.8–5 mmol/L)
* Subgroup analysis
Stone NJ, et al. J Am Coll Cardiol 2013 Nov 7. Epub ahead of print
Statin Issue and Safety
• Erectile Dysfunction
• Haemorrhagic Stroke
• Myopathy
• New Onset Diabetes
• Dementia
Are the use of statin can cause
erectile dysfunction?
11
• Based on study conducted by Saltzman Erin
A et al (published in journal urology 2004)
shows that Atorvastatin improve erectile
function in men with hypercholesterolemia
12
13
14
Statins (+/-) sildenafil may improve ED compared with placebo (+/- sildenafil)
Cui Y, J sex Med 2014;11:1367-1375
Conclusion
There is no clear evidence that statin will
cause ED, however ED may be caused by
hypercholesterolemia (atherosclerosis).
16
Are the use of statin associate
with haemorrhagic stroke?
17
Role of lipids in Cerebrovascular
disease
• There are a strong association between
total and LDL cholesterol with ischemic
stroke risk, especially for atherosclerotic
subtype
• Conversely there is an increased risk of
intracerebral hemorrhage at the low end of
spectrum of total and LDL cholesterol level
HPS
GREACE*
MIRACL
KLIS*
LIPID
CARE
4S
AFCAPS
OVERALL (95% Cl) HR 0.90 (0.65-1.22)
Heterogeneity P=.15
24
Some Definitions…
Myalgia:
Muscle symptoms reported by the patient
Myopathy:
Muscle symptoms with CK elevation >10x ULN
Rhabdomyolysis:
Widespread muscle injury with CK >10x ULN and
accompanying organ (renal) damage.
Myoglobinuria/emia feature
• Myalgia, myopathy and, rarely, rhabdomyolysis
have been reported in patients treated with all
statins
RHABDOMYOLYSIS
AERS/ mill Rx
20
15
P<0,01
10
5 P<0,001
P<0,001
0
Rosuvastatin Simvastatin Pravastatin Atorvastatin
Myalgia 2% 3% 2% 3% 3%
Arthralgia 1% 2% 0% 3% 1%
Arthritis 1% 1% 2% 0% <1%
Joint disorder <1% <1% 0% 1% <1%
Myopathy* 0% 0% 0% 0% 0%
* In post-marketing surveillance, rare cases of myopathy and rhabdomyolysis have been reported with atorvastatin
and other statins
Newman CB, Palmer G, Silbershatz H, et al. Safety Of Atorvastatin Derived From Analysis of 44 Completed Trials In 9416
Patients. Am J Cardiol.2003;92:670-676.
Statins & New onset diabetes?
30
http://www.fda.gov/ForConsumers/
ConsumerUpdates/ucm293330.htm
• Statin therapy was associated with a 9% increased risk for incident diabetes, but
this does not show CAUSAL RELATIONSHIP
• This is retrospective data and did not consider number of Diabetes risk factors (such
as BMI, HbA1c, family history, lipid level, BP, etc) for both Statin & Placebo groups.
• Statins might be preferentially used in patients at higher risk of diabetes, thus NOD
might happen in those patients who already have risk factors of developing Diabetes,
not exclusively because of Statin usage itself
Statin use is associated with a modest increase in risk (~10 – 12%) for new onset
od T2DM, compared with placebo or usual care
37
Is Statin cause Memory Loss?
Is Statin cause Memory Loss?