Re: Statins again.
- From: tonyzsims@xxxxxxxxx
- Date: 6 May 2007 06:24:07 -0700
On 7 Apr, 18:01, David Rind <d...@xxxxxxxxxxxxxxxxxxxxx> wrote:
tonyzs...@xxxxxxxxx wrote:
On 6 Apr, 01:58, David Rind <d...@xxxxxxxxxxxxxxxxxxxxx> wrote:
tonyzs...@xxxxxxxxx wrote:
The arguments for an againststatinsmust have been gone over time and
again, both here and elsewhere, but I am still puzzled as to what the
actual evidence is for the claim that they reduce cardiac events and
strokes. All the major studies show that the death rates of those
takingstatinsare virtually the same as control groups not taking
statins. So where in all this is the overwhelming evidence that
statinssaves lives. Can anyone enlighten me?
Tonyz.
That isn't what all the major studies show. If we're talking about
secondary prevention (statinsin people who have already had a
cardiovascular event),statinsreduce further events (including strokes
and heart attacks) by 25-30%, and reduce mortality by 15-20%.
--
David Rind
d...@xxxxxxxxxxxxxxxxxxxxx
In referring to death rate statistics I perhaps used the term 'all
major studies' when I should have said 'most major studies' The
following studies show that the death rates were the same when control
groups were compared to statin takers:2001 MIRACL,2002 ALLHAT,JLIT
2002, ASCOT 2003. These were major studies involving thousands of
patients. I cannot find anything anywhere which shows the reductions
that you mention. Can you cite the sources? The HPS study referred
to by Jim Chinnis does show some reductions, but they are far from
overwhelming.
Here's the abstract from a 2004 meta-analysis (a study that combines the
results of other studies) of the major statin trials in secondary
prevention:
Effectiveness of statin therapy in adults with coronary heart disease.
AU Wilt TJ; Bloomfield HE; MacDonald R; Nelson D; Rutks I; Ho M; Larsen
G; McCall A; Pineros S; Sales A
SO Arch Intern Med 2004 Jul 12;164(13):1427-36.
BACKGROUND: We conducted a meta-analysis of patients with coronary
heart disease (CHD) to determine the effectiveness of statin therapy;
whether effectiveness varied according to patient characteristics,
outcomes, or pretreatment low-density lipoprotein cholesterol (LDL-C)
levels; and the optimal LDL-C goal and the level at which to initiate
statin therapy. METHODS: Randomized trials or systematic reviews for
secondary prevention of CHD with statin therapy published between
January 1966 and December 2002 were identified through MEDLINE and the
Cochrane Library. Studies were included if they randomly assigned adults
with CHD to statin therapy or control, enrolled at least 100 individuals
per arm, reported clinical outcomes and LDL-C levels, and were published
as full studies in English. Two reviewers abstracted data using a
prospectively designed protocol. RESULTS: Twenty-five studies enrolling
69 511 individuals were included. Participants in 19 placebo-controlled
trials had a mean age of 63 years and a mean pretreatment LDL-C level of
149 mg/dL (3.85 mmol/L); 23% were women. Statin therapy reduced CHD
mortality or nonfatal myocardial infarction 25% (relative risk [RR],
0.75; 95% confidence interval [CI], 0.71-0.79), all-cause mortality 16%
(RR, 0.84; 95% CI, 0.79-0.89), and CHD mortality 23% (RR, 0.77; 95% CI,
0.71-0.83). Beneficial effects were seen in women and the elderly. There
were no data to determine whether lowering the LDL-C level to less than
100 mg/dL (<2.59 mmol/L) was superior to lowering it to 100 to 130 mg/dL
(2.59-3.36 mmol/L). Meta-regression analyses revealed risk reductions
for CHD mortality or nonfatal myocardial infarction and major vascular
events across available pretreatment LDL-C levels. CONCLUSION: Statin
therapy reduces mortality and morbidity in adults with CHD, even at
pretreatment LDL-C levels as low as 100 mg/dL (2.59 mmol/L).
The trials you mention have the following issues:
MIRACL: This was a study of 4 days ofstatinsimmediately after an MI,
not a trial of long-term statin therapy for CHD. (That said, earlystatinsdid appear to be beneficial.)
ALLHAT: This trial had major methodologic issues because lots of people
assigned to takestatinsdidn't and lots of people assigned to placebo
ended up takingstatins. (This is a general problem with statin trials
in the past 5-7 years, in that people with CHD typically get statin
therapy whether or not they are assigned it in a randomized trial.)
JLIT: I don't recognize this trial name. Can you post a citation?
ASCOT: This was mostly a primary prevention trial, not a trial in
patients with CHD. (However, it did show a trend toward the same degree
of mortality reduction withstatinsas in the other trials. It just
didn't achieve statistical significance. Absolute benefits withstatins
in primary prevention are very small.)
--
David Rind
d...@xxxxxxxxxxxxxxxxxxxxxx Hide quoted text -
- Show quoted text -
Thank you David for taking the trouble to post details of this meta
analysis. I am sorry not to have acknowldeged this sooner.
One slight difficulty: I have tried to unerth the actual number of
deaths and cardiac events, so that a comparison can be made with
relative reductions and absolute ones. As I cannot gain access to
these data on the internet is it possible for you to provide me with
this information?
.
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