Statins in the Drinking Water? - Packer

Statins in the Drinking Water?

by Milton Packer, MedPage Today

"Universal treatment for people at minimal risk means that a physician would need to treat more than 100 patients for 10 years to obtain an extra year of good health in one person. This marginal improvement does not meet most current standards for cost-effectiveness. The benefit is so small that it disappears if quality of life were even slightly diminished by the need to remember to take the drug daily."

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"Treating every middle-aged person with a statin is the polar opposite of precision medicine.

Confused? You should not be. It is medicine that has gone insane."

Read the complete article here.

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid?

J Eval Clin Pract. 2012 Feb;18(1):159-68. doi: 10.1111/j.1365-2753.2011.01767.x. Epub 2011 Sep 25.

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study.

Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L.

Source

Research Unit of General Practice, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. halfdanpe@gmail.com

Abstract

RATIONALE, AIMS AND OBJECTIVES:

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline.

METHODS:

We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total).

RESULTS:

Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) . Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern.

CONCLUSION:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.
© 2011 Blackwell Publishing Ltd.

Comment in

• J Eval Clin Pract. 2012 Feb;18(1):169; author reply 170-1.

PMID:

21951982

[PubMed - in process]

PMCID:

PMC3303886

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Read the article here.

Wisdom from The British Medical Journal blogger

BMJ's Ten Commandments for the Ideal Physician

The British Medical Journal's great blogger Richard Lehman has published the following Ten Commandments for excellent clinical practice. These are great rules of thumb for any savvy health care practitioner--but they do require that wee bit of extra work to truly understand the statistics behind the medical literature.

 

The New Therapeutics: Ten Commandments

• Thou shalt treat according to level of risk rather than level of risk factor.
• Thou shalt exercise caution when adding drugs to existing polypharmacy.
• Thou shalt consider benefits of drugs as proven only by hard endpoint studies.
• Thou shalt not bow down to surrogate endpoints, for these are but graven images.
• Thou shalt not worship Treatment Targets, for these are but the creations of Committees.
• Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.
• Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.
• Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.
• Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
• Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.

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http://carlatpsychiatry.blogspot.com/2012/01/bmjs-ten-commandments-for-ideal.html

Wheat Belly

Tom Naughton just reviewed the book Wheat Belly by Dr. William R. Davis cardiologist. See that review here.

I just received my Kindle e-book copy and will read it soon.

I stopped consuming wheat products about two years ago at the recommendation of Dr Davis for the treatment of lipid disorders (it has a dramatic effect on small LDL) )and heart disease. Since I have a history of CAD that has resulted in 6 heart attacks I am of course interested in finally doing something to reduce the progression of plaque growth. The only advice I have received previous to this is to reduce my serum cholesterol i.e. take a statin and eat a low fat diet. But in the process of doing that I had my first four heart attacks. I treated that 'risk factor' (cholesterol) over the course of many years and while doing so had my first 4 heart attacks. Clearly it was not attacking the disease, only a non-significant risk factor in my case.

I am now following the Track Your Plaque regimen of measuring plaque using a heart scan, advanced lipid testing (VAP NMR, Berkley) , treating lipid disorders shown to be correctable in clinical trials and observations, following the TYP diet and monitoring blood glucose levels. I have only been on board fully with this approach since Feb 2011 so it is a work in progress.

I first began learning about this approach to actually treat the disease rather than a single risk factor back in 2006 or so but it took my skeptical self a while to become convinced. After all it was not exactly Main Stream Medicine. Was it quackery or something more. It took a couple more heart attacks and the realization that MSM had not served me well other than to patch the damage but not to treat the disease, to push me over the edge. I began blogging some of what I was finding in early 2007 to, if you will, document and share my findings, and keep track of what I think is Credible Evidence leading me to where I am now.

The Kindle version of Wheat Belly is only ten bucks. It is not the whole answer, but it does, I think, point to what is a significant piece of the puzzle.

Thanks Tom for the review.