Re: Bad lab reports


"Michelle C." <michelle_of_the_desert@xxxxxxxxxxx> wrote in message
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GysdeJongh wrote:
"Michelle C" <bookbug_35@xxxxxxxxx> wrote in message
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I have to agree with Susan and Nicky on the statins:
From this article:

http://discovermagazine.com/2008/jul/20-wonder-drugs-that-can-kill/article_view?b_start:int=0&-C=

Hi Michelle,
I found the original article in The Lancet.Here is an abstract :

Abramson J, Wright JM.
Are lipid-lowering guidelines evidence-based? Lancet 2007; 369:168?69.

doi:10.1016/S0140-6736(07)60084-1
Comment
J Abramson and JM Wright
Harvard Medical School, Cambridge, Massachusetts, USA
Department of Anesthesiology, Pharmacology & Therapeutics and Medicine,
University of British Columbia, Vancouver, BC, Canada
Available online 18 January 2007

The last major revision of the US guidelines, in 2001,1 increased the
number of Americans for whom statins are recommended from 13 million to
36 million, most of whom do not yet have but are estimated to be at
moderately elevated risk of developing coronary heart disease.In support
of statin therapy for the primary prevention of this disease in women and
people aged over 65 years, the guidelines cite seven and nine randomised
trials, respectively. Yet not one of the studies provides such
evidence.For adults aged between 30 and 80 years old who already have
occlusive vascular disease, statins confer a total and cardiovascular
mortality benefit and are not controversial.The controversy involves this
question: which people without evident occlusive vascular disease (true
primary prevention) should be offered statins? With about three-quarters
of those taking statins in this category, the answer has huge economic
and health implications.In formulating recommendations for primary
prevention, why do authors of guidelines not rely on the data that
already exist from the primary prevention trials?

We have pooled the data from all eight randomised trials that compared
statins with placebo in primary prevention populations at increased
risk.Our analysis suggests that lipid-lowering statins should not be
prescribed for true primary prevention in women of any age or for men
older than 69 years. High-risk men aged 30?69 years should be advised
that about 50 patients need to be treated for 5 years to prevent one
event. In our experience, many men presented with this evidence do not
choose to take a statin, especially when informed of the potential
benefits of lifestyle modification on cardiovascular risk and overall
health.8 This approach, based on the best available evidence in the
appropriate population, would lead to statins being used by a much
smaller proportion of the overall population than recommended by any of
the guidelines.

Why the disagreement? The current guidelines are based on the assumption
that cardiovascular risk is a continuum and that evidence of benefit in
people with occlusive vascular disease (secondary prevention) can be
extrapolated to primary prevention populations.This assumption, plus the
assumption that cardiovascular risk can be accurately predicted, leads to
the recommendation that a substantial proportion of the healthy
population should be placed on statin therapy.

There was a lot of comment on this article in later issues .... :)
The subject still has a lot of controversies.I have read it all.I don't
see a clear cut message
I decided, long ago, that I will not use statins.Mainly because one of
the side effects : Muscle pain.As one of the critics also remarks : T2
patients have to exercise to manage their condition.If you give them
statins they won't be able to exercise nough.They will have a lower lipid
level and still die sooner ... :( I completely agree with this mans
analysis of the problem.

As always : Ymmv
Everybody has to decide for himself what his conclusion will be on the
(limited) available evidence ... :)

hth
Gys


Hi Gys,

Thanks for finding the original article. VERY interesting. I will be
saving a copy.

Me? Being a woman without heart disease, I cannot justify a statin. There
are other considerations besides the muscle pain too. Due to the statins
anti-inflammatory effects, which means they damp down the immune system,
they increase the risk of cancer. Then there are the anecdotal stories
about associations between statins and memory impairment.

Yes, it is a YMMV thing, but it's disheartening that most people do not
have all the facts.

Memory impairment? I wonder if that's why...that's why... Uh... What was
I saying?


.

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    ... Yet not one of the studies provides such evidence.For adults aged between 30 and 80 years old who already have occlusive vascular disease, statins confer a total and cardiovascular mortality benefit and are not controversial.The controversy involves this question: which people without evident occlusive vascular disease (true primary prevention) should be offered statins? ... In our experience, many men presented with this evidence do not choose to take a statin, especially when informed of the potential benefits of lifestyle modification on cardiovascular risk and overall health.8 This approach, based on the best available evidence in the appropriate population, would lead to statins being used by a much smaller proportion of the overall population than recommended by any of the guidelines. ... Thanks for finding the original article. ...
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