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What do you think of this latest study.? Even more Statins.!

Answered on August 19, 2014
Created December 03, 2011 at 5:10 AM

Here is a study reported in a respected journal. What do you all PH's think of this?

http://www.nejm.org/doi/full/10.1056/NEJMoa1110874

03fa485bfd54734522755f47a5e6597e

(3944)

on December 03, 2011
at 03:40 PM

Yes, it does seem that statins reduce heart attack mortality in men who have had heart attacks already. But we don't really know why (and we haven't really discussed whether the side effects could be worse than the gain). The sales pitch that they do it by lowering cholesterol is based on faulty logic: we already *know* that heart attacks are caused by high cholesterol, and statins reduce heart attacks, therefore they must reduce cholesterol. But that stubbornly refuses to be borne out by the evidence, since statins don't appear to do that at all. So many are taking them for the wrong reasons.

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6 Answers

7
Bf57bcbdc19d4f1728599053acd020ab

(5043)

on December 03, 2011
at 09:09 AM

They managed to reverse plaque buildup in patients with cardiac disease with a super-aggressive statin regimen. But In the conclusions, they write the following (note the word "suggested" in the first sentence and "theoretically" in the second):

Previous studies have suggested an association between progression rates and cardiovascular outcomes,29,30 but the precise nature of the relationship remains a subject of ongoing research. Theoretically, regression involves reductions of the lipid, inflammatory, and necrotic components of plaque, each of which has been implicated in plaque rupture. Yet intravascular ultrasonography remains a surrogate end point, and a reduction in plaque volume should not be interpreted as equivalent to a clinical benefit in terms of preventing cardiovascular events. Furthermore, the clinical significance of regression or of observed differences in the secondary end point remains to be established. Despite these limitations, we consider the current evidence showing that the growth of atherosclerotic plaques can be reversed to be promising and deserving of further study in clinical trials.

They admit point blank that there is no established link between plaque buildup and cardiovascular events, and that there is no evidence that reducing plaque is significant clinically. But then they say it's promising and should be continued in clinical trials.

This study was just comparing two different statins on LDL and plaque buildup. The research didn't even touch on whether this has any effect on cardiovascular events (e.g. heart attacks). I look at it as fun and games tweaking biomarkers with drugs, but not as something with a take-home clinical implication.

7
25b139cc1954456d9ea469e40f984cd3

on December 03, 2011
at 07:00 AM

I think there is a fly on your forehead. Flies spread diseases, some of which could prove deadly to you. Fortunately, I have a baseball bat with which to hit the fly.

3
3846a3b61bc9051e4baebdef62e58c52

(18635)

on December 03, 2011
at 05:23 AM

I think that there is a ton of money in selling drugs....

After a brief skim, the standards are applied. They find that "even lower levels" than what is currently recommended would be more beneficial. SHOCKER! So we must make the standards lower and sell some more statins easy fix!

Like many of these studies I saw a lot about one particular aspect of health and or disease (cholesterol)....what is the all cause mortality rate when these recommendations are enacted? Sure we can stop people from dropping dead of heart attack, but what about cancer, infection, autoimmune diseases and so on. How was their quality of life affected? Did the patients have more or less energy and stamina with that low of cholestorol? Were they able to care for themselves and function on a day to day basis? Show me an intervention that improves quality of life and all cause mortality and I'm listening.

1
4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 03, 2011
at 02:41 PM

Except in a microcosm of the paleosphere, everyone has acknowledged for a while that statins reduce CVD mortality, at least in a subset of people (like middle-aged men who have already had heart attacks).

The dominant theory (that it is due to LDL lowering or HDL raising) is probably only part (and maybe an inconsequential part) of the story. Statins have other important effects, like increasing LDL receptor function for example.

The fact that statins may be beneficial for some people does NOT prove that the cardiologists were right all along and saturated fat is bad. It just proves that statins seems to work, at least for some people. Combining statins with a high saturated, low polyunsaturated, fat diet (and supplementing with vitamin K2, vitamin D, magnesium, and CoQ10) might be the ticket for some people... For most everyone else, just eat right.

03fa485bfd54734522755f47a5e6597e

(3944)

on December 03, 2011
at 03:40 PM

Yes, it does seem that statins reduce heart attack mortality in men who have had heart attacks already. But we don't really know why (and we haven't really discussed whether the side effects could be worse than the gain). The sales pitch that they do it by lowering cholesterol is based on faulty logic: we already *know* that heart attacks are caused by high cholesterol, and statins reduce heart attacks, therefore they must reduce cholesterol. But that stubbornly refuses to be borne out by the evidence, since statins don't appear to do that at all. So many are taking them for the wrong reasons.

1
77877f762c40637911396daa19b53094

(78467)

on December 03, 2011
at 01:46 PM

Some thing to think about.

0
A1081af52b61372dbb3ed572d88968f4

(425)

on December 03, 2011
at 12:31 PM

Because of the high dose program, it could have been interesting if they had also tested for APOE4 phenotype, conducted periodical cognitive testing, and then run for a longer period than 24 months. Would have liked to seen much deeper investigation of adverse effects (Table 4). FWIW though, I think it's good that they at least made the (big) caveat that reduce plaque volumes do not necessarily imply reduced events - as it shows some bigger picture scientific thinking is still present (even if not holistic).

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