The effect of statins might be (really) small

(Gregory - You can teach an old dog new tricks.) #21

P.S.

Here is one of my favorites when this comes up.

Most Heart Attack Patients’ Cholesterol Levels Did Not Indicate Cardiac Risk

(Bacon is a many-splendoured thing) #22

So of course we need to dose many millions more patients, and get their cholesterol levels even lower, so they won’t have heart attacks. How great! The alternative explanation, that cholesterol has nothing to do with cardiovascular risk, is an obvious non-starter, of course.

ETA: Here are the financial disclosures of the authors, from the full article in Am. Heart J., Jan. 2009:

Financial disclosures:
Amit Sachdeva, MD (none);
Christopher P. Cannon, MD (grants: Accumetrics [San Diego, CA], AstraZeneca [Wilmington, DE], Bristol-Myers Squibb [New York, NY], GlaxoSmithKline [Philadelphia, PA], Merck [Whitehouse Station, NJ], SanofiAventis [Bridgewater, NJ], Schering Plough [Kenilworth, NJ]);
Prakash C. Deedwania, MD (consultant of AstraZeneca and Pfizer [New York, NY]);
Kenneth A. LaBresh, MD (none);
Sidney C. Smith, Jr., MD (none);
David Dai, PhD (employee of Duke Clinical Research Institute [Durham, NC]);
Adrian Hernandez, MD (none);
Gregg C. Fonarow, MD (research from Pfizer and GlaxoSmithKline; consultant and honorarium from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Pfizer, and Schering Plough; and chair of the Get With the Guidelines Steering Committee).

As Upton Sinclair wrote: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

(UsedToBeT2D) #23

I recently started more actively managing my stock portfolio. I am buying more heathcare stock. For obvious reasons.

#24

There is a great talk by Dr Paul Mason on this subject. As usual, he let’s the research do the talking:

Dr. Paul Mason - 'The truth about statins' - YouTube

(Bacon is a many-splendoured thing) #25

A study on familial hypercholesterolaemia that appeared in Medicine, vol. 45, no. 2 (1966), cited by Diamond in the video:

This is a paragraph from the summary of the authors’ conclusions:

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(Bacon is a many-splendoured thing) #26

Interstingly, the study linked in my previous post does not appear in searches on PubMed (U.S. National Institutes of Health site), even though several other articles from the very same issue of the journal do appear. Fortunately, despite its biases, Google was able to turn up a copy.

(Bacon is a many-splendoured thing) #27

From the summary of “Corn Oil in Treatment of Ischaemic Heart Disease,” British Medical Journal, June 12, 1965:

Eighty patients with ischaemic heart disease were allocated randomly to three treatment groups. The first was a control group. The second received a supplement of olive oil with restriction of animal fat. The third received corn oil with restriction of animal fat. The serum-cholesterol levels fell in the corn-oil group, but by the end of two years the proportions of patients remaining alive and free of reinfarction (fatal or non-fatal) were 75 %, 57 %, and 52 % in the three groups respectively. The likelihood that the worse experience of the patients treated with corn oil was due to chance alone was 0.05-0.1. The likelihood that the trial failed by chance to detect a true and important benefit from corn oil was extremely remote. It is concluded that under the circumstances of this trial corn oil cannot be recommended in the treatment of ischaemic heart disease.

This would, I believe, tend to indicate that lowering cholesterol does not have a good effect on cardiovascular risk, since both the oil-eating groups had similar rates of death, and much worse than the rate of death in the control group.

(Bob M) #28

Note too that the other worse group was having…olive oil. That miracle elixir of life doesn’t do so well in an RCT.

(Alec) #29

@OldDog said…

Here is one of my favorites when this comes up.

Most Heart Attack Patients’ Cholesterol Levels Did Not Indicate Cardiac Risk

The actual study summary of results was:

Results: Of 231,986 hospitalizations from 541 hospitals, admission lipid levels were documented in 136,905 (59.0%). Mean lipid levels were LDL 104.9 +/- 39.8, HDL 39.7 +/- 13.2, and triglyceride 161 +/- 128 mg/dL. Low-density lipoprotein cholesterol <70 mg/dL was observed in 17.6% and ideal levels (LDL <70 with HDL > or =60 mg/dL) in only 1.4%. High-density lipoprotein cholesterol was <40 mg/dL in 54.6% of patients. Before admission, only 28,944 (21.1%) patients were receiving lipid-lowering medications. Predictors for higher LDL included female gender, no diabetes, history of hyperlipidemia, no prior lipid-lowering medications, and presenting with acute coronary syndrome. Both LDL and HDL levels declined over time (P < .0001).

My notes

  1. Mean LDL was 105. Below the US national average (116)
  2. No study commentary on the triglyceride average of 161. US average was 110 at the time.
  3. What causes high triglycerides? Carbs. Clear association: carbs, high triglycerides, heart attacks.

There are none so blind as those that will not see.

(Gregory - You can teach an old dog new tricks.) #30

Don’t rule out the possibility that the olive oil they used was the cheap heat extracted stuff, not cold pressed.

I would suspect the difference could be significant.

(Bacon is a many-splendoured thing) #31

In any case, Ravnskov and Diamond have posited that lipids are irrelevant to cardiovascular risk, and that it is the coagulability of the blood that is the main risk factor. They cite a study on families with familial hypercholesterolaemia where the only family members who had cardiovascular problems all had variants of fibrinogen and factor VIII that made their blood far more likely to clot. The people without those variants never developed heart trouble, even though their cholesterol levels were just as high.

The authors of that study, which was done in the nineteen-sixties, observe that their results seemed to disprove the diet-heart hypothesis, which was at that time beginning to be heavily promoted. Guess no one listened, or we wouldn’t be where we are today.