PMR and Heart
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my very astute GP suggested that since I didn't like statins based on my risk factors I should take some tests. I didn't have symptoms but outcome has been a coronary stent to unblock an artery. In my mind the difference between "public health" and "individual health".
I've found (even though it was never lost) a 2014 paper that suggests a 2.5 times greater risk of vascular events (heart / stroke) in patients with PMR than normal. Keele University paper using the UK General Practice Research Database. I guess its easy to find anything on the internet to support one's beliefs. So I'm wary. The suggestion of increased risk is consistent with my simple perception that I exercise much less than I did without PMR and lack of exercise is accepted as increasing the coronary risk. My simplistic interpretation of the conclusions in the paper is that the inflammation plays a role.
Something about the way the statistics have been exposed in the paper caught my attention in a way the statistics used for coronary risk factors in general didn't. Perhaps the tightness in the connection between the statistics and the narrative, I could follow and reproduce the argument. Even a chart that included the 95% confidence limits (my industrial experience says I need those limits). The equivalent chart for the general coronary risk factors (age, cholesterol, smoking, etc) has eluded me which contributed to my scepticism.
The coronary rehab is excellent. While the staff are allowing for the PMR there's seemingly nothing explicit in any of the materials (principally of Heart Foundation origin) that relate to any uncontrollables apart from diabetes. Very difficult of course with a group where everyone probably has different complications.
Of course resolving my conflict between "exercise reduces risk of heart attack" and "exercise increases PMR pain" and "pred side effects reduce my effectiveness and are unhealthy" and "inflammation is bad" is an interesting challenge. One that we all face in various ways. I have a feeling of more than one rock and many hard places to choose from. :-)
Some days I wish it would all go away, but the wishing well is dry so I just have to get on with it and remain positive. So far so good. And knowledge is power - even if I did gather it after my "coronary event".
0 likes, 22 replies
EileenH julian.
Posted
Macas02 - I've mentioned my a/f in another response. My cardiologist is quite sure mine is due to the PMR. It certainly isn't due to the pred, the episodes that I didn't recognise for what they were only happened after PMR started. It wasn't diagnosed for 5 years and when I returned to the GP he was as flummoxed about the palpitations as he was about the PMR symptoms. I asked some rheumies about increased incidence of a/f in PMR (it is acknowledged in RA) and got the fluff answer of "but they are things that happen in the same age group". Very likely, but that wasn't what I asked, I asked was the incidence higher in people with PMR/GCA. My anecdotal viewing of it that they are - judging by the number I meet on the forums at least.
Patients with GCA should be monitored for development of aortic aneurysm according to the BSR guidelines. In her book about PMR Kate Gilbert alleges it isn't done because "it would worry the patients too much as nothing can be done"! Which is tosh of the first order - 10 years ago maybe, these days they have stents of all sizes.
Julian - it isn't exercise per se that is bad in PMR, it is trying to rush things and do too much, especially in the early stages. Once you have got the inflammation under control it is a different matter and you can start to build up the amount slowly - you have to increase slowly but you can increase a lot. I have built up from barely 10 mins 3 years ago to being able to do 3 or 4 hours now if I need to, as long as we find a convenient cafe/restaurant half way!
julian. EileenH
Posted
I have a sneaking suspicion that the PMR masked the heart problem. I wasn't aware of any symptoms. Over time the fatigue and stiffness from overdoing the exercise reduced the norm to something I accepted as being PMR normal. General decay. I'm enjoying the gym, though very wary of pushing the boundaries and causing a flare, also reluctant to consider increased pred.
julian. EileenH
Posted
the paper was unusual in discussing both the relative - for example 3 x at 6 months after diagnosis - and absolute - for example 47.6 vascular events per 1000 person years 6 months after diagnosis vs 14.6 without PMR.
The point at which absolute risk is significant is always interesting. I figure that if the risk is significant enough to treat more than half the US population with statins the increased risk is probably more significant. But then I didn't take statins as I considered the absolute risk (without consideration of PMR) to be small.
I'm wary of papers where the relative risk is used for the headlines and the absolute risk is not exposed, hidden, or obfuscated.
EileenH julian.
Posted
Maybe not - there is the confounder of Big Pharma's profits and which publications were funded by them.
Apart from any other consideration, the claims were based on figures obtained by combining results from males and females which show an overall benefit. However, if you take them separately it can be seen that for women who have not yet had a cardiovascular event there is no benefit from taking statins. But that rules out nearly half their target population.
julian. EileenH
Posted
What caught my attention was what I thought was the high quality of the research and the paper. It appeared the statistics were completely exposed, internally consistent, and supported the narrative. An objective report. It was representative of the sort of technical report I used to aspire to write. Independent of whether it was medical, metallurgical, electronic or whatever.
I noticed it in contrast to what seems to have become the norm for research papers of selective reporting, sponsorship, hype, self-promotion, obfuscation, funding, and often an agenda. As part of "critical thinking" I mentally reduce the credibility of such papers.
IMO papers associated with drug studies are in a land of their own. Sometimes bordering on Nephelokokkygia.
My bit about "half the US population" was a bit tongue in cheek. Public health gone mad and I can't imagine why they haven't got round to adding statins to the water supply like fluoride. As you point out Eileen, the statistics were reported very selectively, which immediately implies flim flam to me.
Which is why I didn't take statins and did take tests. My individual health not dubious statistics based public health.
julian.
Posted
julian. EileenH
Posted