Re: One more safe alternative to statins


"Juhana Harju" <shantigiri@xxxxxxxxxxxxx> wrote in message
news:3g2he7Fa7ihlU1@xxxxxxxxxxxxxxxxx
> Bill wrote:
> :: "Juhana Harju" <shantigiri@xxxxxxxxxxxxx> wrote in message
> :: news:3g2bqqFa8nunU1@xxxxxxxxxxxxxxxxx
> ::: Jim Chinnis wrote:
> ::::: Susan <nevermind@xxxxxxxxxx> wrote in part:
> :::::
> :::::: We know that pantethine is safer than statins, and as effective
> :::::: without risk.
> :::::
> ::::: It would take thousand of patients to demonstrate statistically
> ::::: significant reductions in mortality. To my knowledge, those
> ::::: studies have not been done usining pantethine. Neither have the
> ::::: necessary studies been done to show whether pantethine reduces
> ::::: second heart attacks, strokes, etc.
> :::::
> ::::: Large retrospective studies have linked statins to increased risk
> ::::: of polyneuropathy and decreased risks of cancer. Have there been
> ::::: any large retrospective sties of pantethine and polyneuropathy or
> ::::: cancer?
> :::::
> ::::: Aren't the kinds of data that have been assembled for and against
> ::::: statins mostly missing on pantethine?
> :::
> ::: In women and in elder people statins do not lower all-cause
> ::: mortality, which is after all what really counts.
> ::
> :: The following paper suggests that is not true in the elderly with
> :: CAD. What evidence do you have that it is true?
>
> I would like to question the whole policy of trying to reduce cholesterol in
> the elderly population (people over 70 years). The Honolulu Heart Program
> study below shows that cholesterol is positively associated with higher
> survival in elderly populations. I think that adopting a Mediterranean diet
> (especially fish oils) would be much more successful approach than statins.
> Remember that in the Lyon Heart Study was achieved a remarkable 50-70%
> reduction in all-cause and cardiovascular mortality by relatively simple
> dietary changes. The Mediterraean diet is also very palatable - so the
> patient compliance to the diet should be very good. At the moment that diet
> is not actively promoted by the health care system.
>
> From other approaches the mortality reduction achieved by *policosanol* in
> the elderly population seems to be far better than what is achieved by
> statins. See my policosanol tolerability post but also the comment by Thomas
> Carter in the sci.life-extension to the same study:
>
> http://groups-beta.google.com/group/sci.life-extension/msg/71e415eb0ffecfb5?hl=fi
>
>

First, this really does not address the issue. You claimed the statins do not
improve all cause mortality in the elderly. I provided a study that shows it
does at least for those with CAD - which is the group statins are usually
prescribed to. You need to provided a study to show this is untrue. (The cause
for improvement could be something unrelated to cholesterol.)

Second it is not relevant whether anything else might, in your opinion, work
better. You would have to show that people will stick to a Mediterranean diet,
for example, and show this through a study vs. statins.

Third the study you quote is limited to Japanese/American men. It is known
that Asians respond differently to statins than those of European origin. So I
do not think you can generalize from this.

Bill



> Lancet. 2001 Aug 4;358(9279):351-5.
>
> Cholesterol and all-cause mortality in elderly people from the Honolulu
> Heart Program: a cohort study.
>
> Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD.
>
> Clinical Epidemiology and Geriatrics Division, Department of Medicine, John
> A Bums School of Medicine, University of Hawaii at Manoa, 1356 Lusitana
> Street, 7th Floor, Honolulu, HI 96813-2427, USA.
>
> BACKGROUND: A generally held belief is that cholesterol concentrations
> should be kept low to lessen the risk of cardiovascular disease. However,
> studies of the relation between serum cholesterol and all-cause mortality in
> elderly people have shown contrasting results. To investigate these
> discrepancies, we did a longitudinal assessment of changes in both lipid and
> serum cholesterol concentrations over 20 years, and compared them with
> mortality. METHODS: Lipid and serum cholesterol concentrations were measured
> in 3572 Japanese/American men (aged 71-93 years) as part of the Honolulu
> Heart Program. We compared changes in these concentrations over 20 years
> with all-cause mortality using three different Cox proportional hazards
> models. FINDINGS: Mean cholesterol fell significantly with increasing age.
> Age-adjusted mortality rates were 68.3, 48.9, 41.1, and 43.3 for the first
> to fourth quartiles of cholesterol concentrations, respectively. Relative
> risks for mortality were 0.72 (95% CI 0.60-0.87), 0.60 (0.49-0.74), and 0.65
> (0.53-0.80), in the second, third, and fourth quartiles, respectively, with
> quartile 1 as reference. A Cox proportional hazard model assessed changes in
> cholesterol concentrations between examinations three and four. Only the
> group with low cholesterol concentration at both examinations had a
> significant association with mortality (risk ratio 1.64, 95% CI 1.13-2.36).
> INTERPRETATION: We have been unable to explain our results. These data cast
> doubt on the scientific justification for lowering cholesterol to very low
> concentrations (<4.65 mmol/L) in elderly people. PMID: 11502313
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11502313&dopt=Abstract
>
>
> :: See the paragraph that I marked with *****
> ::
> :: Bill
> ::
> :: Evidence-based Management of Coronary Artery Disease in the Elderly
> :: -- Current Perspectives CME
> ::
> ::
> :: Nanette Kass Wenger, MD Tarek Helmy, MD, FACC Amar D. Patel, MD
> :: Stamatios Lerakis, MD, FACC, FASE
> ::
> :: Medscape General Medicine 7(2):, 2005. © 2005 Medscape
> :: [...]
>
> :: *******
> ::
> :: Lipid-lowering agents such as hydroxyl-methylglutaryl coenzyme A
> :: (HMG CoA) reductase inhibitors ("statins") also have survival
> :: benefit in hypercholesterolemic patients with CAD. In the 4S
> :: clinical trial, 2282 of the 4444 patients enrolled were at least 60
> :: years of age and were randomized to either simvastatin or placebo.
> :: The relative risk reduction in death/MI was approximately 30%
> :: compared with placebo at a mean follow-up of 5 years.[18] Treatment
> :: of elderly patients (aged >/= 60 years) with pravastatin with
> :: average cholesterol levels (total cholesterol 209 ± 17 mg/dL,
> :: high-density lipoprotein 39 ± 9 mg/dL, LDL 139 ± 15 mg/dL) in the
> :: Cholesterol and Recurrent Events (CARE) trial revealed a 27%
> :: relative risk reduction compared with placebo and a 26% relative
> :: risk reduction compared with patients aged younger than 60
> :: years.[19] The Long-Term Intervention with Pravastatin in Ischaemic
> :: Disease (LIPID) Study Group demonstrated similar results, in
> :: addition to a reduction in UA events requiring hospitalization (29%
> :: relative risk reduction).[20] Benefit from simvastatin therapy is
> :: maintained in patients 70 years of age or older as evidenced by data
> :: from the Heart Protection Study.[21] The Prospective study of
> :: Pravastatin in the Elderly at Risk (PROSPER) study group
> :: specifically addressed the use of statin therapy in the elderly
> :: population. Approximately 5804 patients (average age 75 years [range
> :: 70-82 years]; 48% men) with a history of, or risk factors for,
> :: vascular disease were randomized to pravastatin 40 mg or placebo and
> :: followed for a mean duration of 3.2 years. Primary end points were
> :: CHD death, nonfatal MI, and stroke.[22] The follow-up data revealed
> :: a significant reduction in the composite primary end point with a
> :: 15% relative risk reduction compared with placebo. However, when
> :: analyzed separately, there was no significant reduction in
> :: cerebrovascular event rates. Further, the incidence of new cancer
> :: diagnoses was higher in the pravastatin group, but no evidence of
> :: heterogeneity of increased risk was observed when comparing these
> :: results with other statin trials. These data suggest benefit for
> :: aggressive lipid lowering in the elderly population. The Fluvastatin
> :: Assessment of the Morbidity/Mortality in the Elderly (FAME) trial
> :: will provide more elderly-specific data.
> :: [...]
>
> ::: There are no reason to use statins in these
> ::: very large population groups. In women, increasing HDL and lowering
> ::: trglyserides is important if you want to lower cardiovascular and
> ::: all-cause mortality. Contary to statins these alternatives are
> ::: better in increasing HDL and decreasing triglyserides, which is
> ::: likely to benefit these large population groups.
>
> --
> Juhana
>
>


.

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