Comments on: Statin guidelines we love to hate – and the docs who write them

By: Health Research Report

Health Research Report — Sat, 16 Aug 2014 01:45:40 +0000

[…] Statin guidelines we love to hate – and the docs who write them (ethicalnag.org) […]

By: Karen Johnson

Karen Johnson — Thu, 03 Jul 2014 02:22:53 +0000

Before taking the statin, analyze why you probably had the heart attack. Were you over stressed? If so statin drugs will not reduce your stress. Were you overworked… statins don’t reduce this as well. Consider that approx 100 people need to take statins over a five year period for one person to benefit. While approx 50% stop talking them due to side effects.

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By: Carolyn Thomas

Carolyn Thomas — Thu, 21 Nov 2013 20:20:10 +0000

Dave, you and I share very similar concerns about our statin prescriptions, and even a similar 5-year time span since our cardiac events. Like you, I was also prescribed a statin in hospital following my MI (Crestor 20 mg). Like you, I’ve read all the studies suggesting that statins for secondary prevention in patients like us show good outcomes (and really, what all patients care about more than hitting a specific intermediate endpoint like a lower LDL #, e.g. will this help prevent another heart attack?) Yet what I’ve learned (and written about here, here, here, here) about pervasive drug research practices like selective outcome reporting, data mining, publication bias, medical ghostwriting, marketing-based medicine, blahblahblah leaves me highly skeptical of even the most well-publicized of studies.

Like you, I eat healthy and exercise every day. Your comment re ‘optimal’ LDL numbers, however, is just what the new guidelines are telling us we can forget about! What’s a poor patient to believe when all is said and done?!

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By: Dave Wyman

Dave Wyman — Thu, 21 Nov 2013 19:56:18 +0000

I’ve enjoyed your posts on this issue.

You’ve had a heart attack. Do you take a statin? And what dosage?

I’ve had a heart attack, too. I’ve gone back and forth in the intervening five years about whether or not I should take my current cardiologist-recommended statin. He’s never told me how much statin I should take; he just tells me any amount will help stave off another heart attack. I’m currently on a low dose – 10mg – regimen, because I think a low dose is as effective and much safer than a high dose.

I’m 65. I eat healthy foods, I exercise a lot. I’ve passed my stress test and my cardiologist tells me I can run a marathon (I do ride my bike 100 miles in a day a couple of times a year).

However, I also have heart disease, as did my father, not to mention my heart attack. So my cardiologist would like me to take a statin. Statistics from studies I’ve seen seem to show the risk of all-cause mortality is lowered by about a 1/3 for those who take statins, compared to those who with heart disease who don’t take statins. So taking a statin seems reasonable. (By the way, off of statins, I have very good cholesterol/triglyceride readings. There is some tenuous evidence, though, that heart disease can be reversed with low LDL, so for now I’m willing to get closer to that optimal LDL number).

Furthermore, even though exercise and healthy eating might be better at protecting me from a heart attack than a statin, what’s wrong with adding protection, if that’s what a statin can do? After all, we don’t say, if we drive a car, that we won’t worry about tire pressure or if the engine has enough oil or if the brakes work, just because we wear seat belts. All the protective measure we take when we drive a car, from wearing seat belts to basic maintenance, add up to a better chance of surviving an accident.

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By: Carolyn Thomas

Carolyn Thomas — Thu, 21 Nov 2013 13:03:26 +0000

Agreed. And this particular risk calculator seems especially flawed – as Michael O’Riordan of TheHeart.Org asked out loud at the American Heart Association scientific meetings in Dallas this week: “How do you have a serious discussion about the patient’s risk if the risk calculator doesn’t accurately calculate risk?”

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By: Dr. Joe Kosterich

Dr. Joe Kosterich — Thu, 21 Nov 2013 05:03:07 +0000

A real can of worms was opened the day medicine went from treating what is there (illness) to treating what might happen one day. Risk calculators are crystal balls dressed up as science.

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By: Carolyn Thomas

Carolyn Thomas — Thu, 21 Nov 2013 02:12:52 +0000

I got 7.5%

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By: sciencepharmer

sciencepharmer — Thu, 21 Nov 2013 01:05:48 +0000

“Just for fun, CNN’s Elizabeth Cohen said when she used the risk calculator, putting in a 60-year-old man with normal cholesterol levels of 100 LDL (“bad” cholesterol) and 45 HDL (“good” cholesterol) and no risk factors – normal blood pressure, no diabetes and a non-smoker”. Have YOU used the calculator yourself? This description gives a risk of 1%.

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By: Carolyn Thomas

Carolyn Thomas — Wed, 20 Nov 2013 19:53:24 +0000

Thanks Allison – that’s a fair question. A review in Lancet of the effect of clinical guidelines on medical practice found that of 59 studies, all but 4 detected “significant improvements in the process of care” after the introduction of guidelines. Of course, I guess that brings up the definition of “improvement”. According to these new guidelines, improvement could be millions more people eventually taking statins.

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By: Allison

Allison — Wed, 20 Nov 2013 16:45:06 +0000

This is an excellent summation of the problem with the guidelines. I heard an interview with one of the people on the panel on NPR, didn’t catch his name. He kept admitting that most of panel had ties to big pharma, but that they didn’t vote. Right, they only sat in on the meetings for years and colored the thinking of everyone there. This is disturbing on so many levels.

Will the new guidelines become the new standard of care?

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