Re: Statin drugs lower heart attack death-study - 2nd article
- From: "Bill" <xxx@xxxxx>
- Date: Wed, 31 Aug 2005 04:05:22 GMT
"Sharon Hope" <shope@xxxxxxxx> wrote in message
news:b8qdnTp0MM7ptIjeRVn-uw@xxxxxxxxxxxxxx
>
> "Bill" <xxx@xxxxx> wrote in message
> news:0k9Re.3667$oJ2.254@xxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>>
>> "Sharon Hope" <shope@xxxxxxxx> wrote in message
>> news:X8SdnUp_ga3UjIjeRVn-hg@xxxxxxxxxxxxxx
>>> No bias here: "Importantly, why weren't 100% of patients who just had a
>>> heart attack being discharged with a statin? Again, there are large
>>> treatment gaps where we know statins should be used, and they should be
>>> used here."
>>>
>>> So said lead investigator Dr Gregg Fonarow.
>>>
>>
>> I think that is the standard of care.
>>
>>> No possibility this kind of bias spilled over into his choice of
>>> statistics to use in the old anecdotal data?
>>>
>>
>> What does that mean? He counted the number of people who died.
>>
>>
>>> Oh, wait, here's a surprise: "Fonarow has consulted and done research for
>>> Merck & Co, Pfizer, and Bristol-Myers Squibb."
>>>
>>> That loud silence we
>>
>> I think that's pretty much you
>>
>>
>>> hear is Bill not demanding a "gold standard placebo controlled trial" and
>>> not disparaging this as untrustworthy anecdotal observations, started from
>>> a biased standpoint. I guess if the results fit with the statin-zealot
>>> belief system....
>>>
>>
>> You keep seeing boggy men.
>>
>> Actually, I thought I mentioned I was surprised at the outcome, but these
>> were not started from a biased standpoint and are not anecdotal - they are
>> from a controlled trial.
>
> A "Controlled Trial"???
>
> "Known as an observational study, the new research relies on an analysis of
> previously collected data. The gold standard for drug tests are
> placebo-controlled clinical trials." (LA Times article, link provided in
> other posts)
>
> OBSERVATIONAL STUDY of stale information, it is definitely NOT a "controlled
> trial." Why would you persist in pretending it is?
>
I agree. I misspoke. It was an observational study - but done in a disaplined
way.
However, you missed every thing else
I'll restate the issues and replace controlled trial.
> No bias here: "Importantly, why weren't 100% of patients who just had a
> heart attack being discharged with a statin? Again, there are large
> treatment gaps where we know statins should be used, and they should be
> used here."
>
> So said lead investigator Dr Gregg Fonarow.
>
I think that is the standard of care.
> No possibility this kind of bias spilled over into his choice of statistics
> to use in the old anecdotal data?
>
What does that mean? He counted the number of people who died.
> Oh, wait, here's a surprise: "Fonarow has consulted and done research for
> Merck & Co, Pfizer, and Bristol-Myers Squibb."
>
> That loud silence we
I think that's pretty much you
> hear is Bill not demanding a "gold standard placebo controlled trial" and
> not disparaging this as untrustworthy anecdotal observations, started from a
> biased standpoint. I guess if the results fit with the statin-zealot belief
> system....
>
You keep seeing boggy men.
Actually, I thought I mentioned I was surprised at the outcome, but these were
not started from a biased standpoint and are not anecdotal - they are from a
study that reviewed records. So why do you think one should call them
anecdotal?
Bill
> You call reading through "data from 174,635 heart attacks compiled as part
> of a national registry from July 2000 to January 2002" a "CONTROLLED
> TRIAL"?????????
>
> What controls were in effect for the recorded data from 2000 to 2002 nation
> wide?
>
> What controls failed in the data collection that compelled the author to be
> sure it is "*Adjusted for covariates and propensity score"?
>
> This was NOT a "Controlled Trial" - why are you pretending that it was?
> Misrepresentation!
>
>
>
>>So why do you think one should call them anecdotal?
>>
>> Bill
>>
>>>
>>> "Bill" <xxx@xxxxx> wrote in message
>>> news:VW3Re.1167$nB6.388@xxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>>>> Here is a second article on the same subject. They claim to have adjusted
>>>> for confounding factors. And, again, such a dramatic lower of the death
>>>> rate during the in-hospital stay after giving a statin to someone who had
>>>> never had one was surprising to me.
>>>>
>>>> Bill
>>>>
>>>> ______________
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> Early statin use in acute MI reduces the risk of in-hospital mortality
>>>> and other complications
>>>>
>>>> Aug 29, 2005 Michael O'Riordan
>>>>
>>>> Los Angeles, CA - An analysis of the large National Registry of
>>>> Myocardial Infarction (NRMI) database has shown that statin therapy
>>>> administered to acute MI patients within the first 24 hours of
>>>> hospitalization significantly reduces the risk of in-hospital mortality
>>>> and other complications [1]. Based on this early cardioprotective effect
>>>> of statins, as well as other studies showing the benefit of early statin
>>>> treatment, researchers suggest that early statin therapy should be the
>>>> standard of care for acute MI patients.
>>>>
>>>> "Since we already have in the national guidelines that patients should be
>>>> treated with statins before discharge, I think that in the present
>>>> context this observational data can be enough to say, although we don't
>>>> have a randomized control trial, this should become the standard of
>>>> care," lead investigator Dr Gregg Fonarow (University of California, Los
>>>> Angeles) told heartwire. "We do believe that this is something that
>>>> should be considered a routine recommendation in the same way that we
>>>> give early aspirin or beta-blocker therapy to acute MI patients."
>>>>
>>>> The results of the study are published in the August 29, 2005 issue of
>>>> the American Journal of Cardiology.
>>>>
>>>>
>>>>
>>>> Majority of patients not started within 24 hours
>>>> In some early experimental animal models, researchers have demonstrated
>>>> that statins can significantly decrease reperfusion injury and limit MI
>>>> size. According to Fonarow, this led his group to hypothesize that acute
>>>> MI patients treated earlywithin 24 hours of hospitalizationwould have
>>>> lower in-hospital morbidity and mortality risks than patients not treated
>>>> with statins or those in whom statin therapy was discontinued.
>>>>
>>>> Using data from the NRMI 4, a prospective, observational database of
>>>> consecutive patients admitted with acute MI to participating hospitals in
>>>> the US, they included 174 635 patients in the analysis. Patients were
>>>> categorized into four groups based on whether statin treatment was
>>>> provided before the index hospitalization and whether statin therapy was
>>>> administered within the first 24 hours:
>>>>
>>>> a.. Patients were classified as continued if they were receiving a
>>>> statin before hospitalization and were administered a statin within 24
>>>> hours (n=17 118).
>>>> b.. Newly started patients were not on statin therapy before acute MI
>>>> hospitalization but were administered a statin within 24 hours (n=21
>>>> 978).
>>>> c.. Discontinued patients were previously taking a statin but were not
>>>> given the agent within 24 hours of hospitalization (n=9 411).
>>>> d.. The not-started patients were not taking a statin before the acute
>>>> MI and were not treated with statin therapy within 24 hours of
>>>> hospitalization (n=126 128).
>>>> New or continued treatment with a statin in the first 24 hours was
>>>> associated with a decreased risk of death compared with no statin use. In
>>>> contrast, patients who had been treated with a statin before
>>>> hospitalization but whose therapy was discontinued derived no associated
>>>> protective effect and had a slightly higher risk of in-hospital
>>>> mortality. After adjustment for potential confounding demographic,
>>>> clinical, hospital, prehospital, and in-hospital variables and propensity
>>>> score, patients who continued or were newly started on statin therapy
>>>> continued to have a significantly decreased risk of in-hospital
>>>> mortality.
>>>>
>>>> In-hospital mortality by statin use
>>>>
>>>>
>>>> Primary end point
>>>> Continued statin therapy (n=17 118)
>>>> Newly started statin therapy (n=21 978)
>>>> No statin therapy before hospitalization, not treated with
>>>> statin therapy within 24 hours of hospitalization (n=126 128)
>>>> Discontinued statin therapy (n= 9411)
>>>>
>>>> In-hospital mortality (%)
>>>> 5.3
>>>> 4.0
>>>> 15.4
>>>> 16.5
>>>>
>>>>
>>>>
>>>>
>>>> In-hospital mortality by statin-therapy groups
>>>>
>>>>
>>>> Statin therapy groups
>>>> Odds ratio (95% CI)*
>>>>
>>>> Patients newly started on statins within 24 hours of
>>>> hospitalization vs those with no statin treatment before or after MI
>>>> 0.62 (0.57-0.67)
>>>>
>>>> Patients continuing with statins within 24 hours of
>>>> hospitalization vs those with no statin treatment before or after MI
>>>> 0.58 (0.54-0.63)
>>>>
>>>> Patients discontinuing statin therapy vs those with no statin
>>>> treatment before or after MI
>>>> 1.12 (1.05-1.20)
>>>>
>>>>
>>>>
>>>>
>>>> *Adjusted for covariates and propensity score
>>>>
>>>> To download tables as slides, click on slide logo below
>>>>
>>>> "The findings support the experimental data, as the benefit likely has to
>>>> do with immediately raising nitric oxide and having an important acute
>>>> anti-inflammatory effect in the ischemic myocardium, as well as having a
>>>> direct cellular protective effect," explained Fonarow. "Here we see, in
>>>> patients treated within the first 24 hours with statins, in-hospital
>>>> mortality rates were substantially lower than in those who were not, and
>>>> they also had other lower outcomes that correlate with cardioprotective
>>>> effects. Patients treated early had a lower risk of cardiogenic shock,
>>>> developing ventricular fibrillation, having cardiac rupture, and having
>>>> acute pulmonary edema and heart failure."
>>>>
>>>> Fonarow noted that acute MI patients treated with a statin within the
>>>> first 24 hours were more likely to be discharged on statin therapy, which
>>>> is what the guidelines recommend. Those who started statin therapy in the
>>>> hospital within 24 hours or continued therapy were discharged on a statin
>>>> 85% and 91%, respectively, of the time. On the other hand, only 22% of
>>>> the patients not taking a statin before MI and not treated with a statin
>>>> within 24 hours were discharged on a statin.
>>>>
>>>> The study also points to the large treatment gaps in the present-day care
>>>> of acute MI, said Fonarow. The large majority of acute MI patients, many
>>>> who had multiple risk factors and even prior myocardial infarctions, were
>>>> not being treated with a statin before their MI, nor were they discharged
>>>> on a statin.
>>>>
>>>> "Even though it has been recommended in the guidelines that patients
>>>> would benefit from statin therapy, large treatment gaps exist," said
>>>> Fonarow. "The American Heart Association and the American College of
>>>> Cardiology, as well as individual cardiologists, have been trying to
>>>> emphasize the importance of utilizing these agents in patients where
>>>> there is proven benefit. Importantly, why weren't 100% of patients who
>>>> just had a heart attack being discharged with a statin? Again, there are
>>>> large treatment gaps where we know statins should be used, and they
>>>> should be used here."
>>>>
>>>> Fonarow said that the use of statin therapy within the first 24 hours of
>>>> hospitalization has been incorporated into the guidelines at UCLA,
>>>> although this is not the standard of care across the US.
>>>>
>>>> "It is not something that is routinely integrated into practice, but we
>>>> think that this analysis, combined with other prior data, is possibly
>>>> sufficient to where a firm recommendation in the national guidelines is
>>>> warranted," said Fonarow. "Since you're going to using the drug anyway,
>>>> you might as well start it right away, given that there might be an added
>>>> benefit that occurs quite early."
>>>>
>>>>
>>>> Fonarow has consulted and done research for Merck & Co,
>>>> Pfizer, and Bristol-Myers Squibb.
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> Source
>>>>
>>>>
>>>> 1.. Fonarow GC, Wright RS, Spencer FA et al. Effect of
>>>> statin use within the first 24 hours of admission for acute myocardial
>>>> infarction on early morbidity and mortality. Am J Cardiol 2005;
>>>> 96:611-616.
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> Related links
>>>>
>>>>
>>>> "Pervasive" gender disparities in treatment of ACS
>>>> [HeartWire > News; Mar 17, 2005]
>>>>
>>>> Incremental benefits of aspirin, statins, beta blockers, and
>>>> ACE inhibitors in ACS
>>>> [HeartWire > News; Feb 17, 2004]
>>>>
>>>> Early statin use after ACS harmful for those with low
>>>> cholesterol?
>>>> [HeartWire > News; Jun 18, 2002]
>>>>
>>>> PACT: Early start of statin treatment after ACS safe, but
>>>> has limited impact at 30 days
>>>> [HeartWire > News; May 15, 2002]
>>>>
>>>> Statins in hospital only for those without normal
>>>> cholesterol levels, say Swedish researchers
>>>> [HeartWire > News; Jan 25, 2001]
>>>>
>>>> Is MIRACL a miracle or not?
>>>> [HeartWire > News; Nov 17, 2000]
>>>>
>>>> Dramatic increase in use of statins after MI in Germany
>>>> [HeartWire > News; Sep 8, 2000]
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>
>>>
>>
>>
>
>
.
- References:
- Statin drugs lower heart attack death-study
- From: Bill
- Re: Statin drugs lower heart attack death-study - 2nd article
- From: Sharon Hope
- Re: Statin drugs lower heart attack death-study - 2nd article
- From: Bill
- Re: Statin drugs lower heart attack death-study - 2nd article
- From: Sharon Hope
- Statin drugs lower heart attack death-study
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