Re: Lisinopril?

Your conclusion ("all risk no benefit") seems to contradict, or at best incompletely represent, the study whose abstract you posted, which states "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 study DOES question the use of statins as a PREVENTIVE.

"Susan" <susan@xxxxxxxxxxxx> wrote in message news:8n70t3FlsaU1@xxxxxxxxxxxxxxxxxxxxx
x-no-archive: yes

Statins are contraindicated in women and the elderly for primary prevention; all risk no benefit:


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

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.