After the demise of cerivastatin I converted 75 patients to other statins using dose-equivalents from published data: It seemed that [I have yet to do formal audit] about 1/3 responded as expected, 1/3 did better than expected and 1/3 did worse...
The other possibility in this case is that the patient is hypertriglyceridemic - and therefore would respond to a fibrate and not a statin.
TIM
**********************************************
Prof. Tim Reynolds,
Clinical Chemistry Department,
Queens Hospital,
Belvedere Rd.,
Burton-on-Trent,
STAFFORDSHIRE,
DE13 0RB,
UK.
tel: 01283 511511 ext. 4035
fax: 01283 593064
email: tim.reynolds@queens,burtonh-tr.wmids.nhs.uk
alternative email for the all too frequent occasions when the NHS email connection doesn't work:
[log in to unmask]
-----Original Message-----
From: p=NHS NATIONAL
INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK;
Sent: 26 February 2002 10:09
To: p=NHS NATIONAL
INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK;
Subject: Re: Statin Resitance
The manufacturers quoted responses to statin treatment are always an
average, and it is usually very difficult to get a straight answer about the
range of response. We all have experience of people who have responded
extraordinarily well to treatment (we tend not to complain about them!) and
those who respond poorly. I am sure concomitant drug treatment is a reason
in some but by no means all of these patients.
Anecdotally, I have also seen several patients who have had a poor response
to a reputedly potent statin e.g. atorvastatin, but had a far better
response to simvastatin, despite them both being metabolised by similar
pathways. Is it tachyphylaxis for some patients but not others?
Eric
----- Original Message -----
From: GARETH DAVIES <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 25, 2002 12:27 PM
Subject: Statin Resitance
> Dear All,
>
> We have been discussing a young (my age - upper 40s) patient with a
> cholesterol greater than 10mmol/l who is prescribed 80mg simvastatin but
his
> cholesterol is not falling by the expected amount. We will be seeing him
to
> ascertain whether he is compliant but a question that was raised concerns
> "resistance" to a statin formulation.
>
> At 80mg, we would expect a raised total CK. The question is: does the
> magnitude of a rasied CK correlate with the magnitude of the effect of the
> treatment on cholesterol levels? ie, is a higher CK associated with a
> diminished cholesterol-lowering effect
>
> I've had a look at PubMed but its difficult to phrase the search
adequately.
> Has anyone come accross any published studies?
>
> Many thanks.
>
> Gareth
>
> Gareth Davies
> Senior Clinical Biochemist
> Wrexham Maelor Hospital
> Wrexham LL13 7TD
> UK
> 01978 725345
>
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