Re: Woman and statins - A good debate

In article <f352rh$3h4$1@xxxxxxxxxxxxxxxxx>,
David Rind <drind@xxxxxxxxxxxxxxxxxxxxx> wrote:

bigvince wrote:
On May 22, 9:56 pm, Jim Chinnis <jchin...@xxxxxxxxxxxxxxxx> wrote:

Jim Chinnis <jchin...@xxxxxxxxxxxxxxxx> wrote in part:


I don't do homework for people except when I have things at hand. I'll
follow up when i have my resources available. You want evidence that
statins
reduce coronary artery disease events in primary prevention?!

Actually, here's a very recent met-analysis:

+ Arch Intern Med. 2006 Nov 27;166(21):2307-13. Related Articles, Links
+
+
+Primary prevention of cardiovascular diseases with statin therapy: a
meta-analysis of randomized controlled trials.
+
+Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK.
+
+Department of Medicine, University of Toronto, Toronto, Ontario.
+
+BACKGROUND: While the role of hydroxymethyl glutaryl coenzyme A reductase
inhibitors (statins) in secondary prevention of cardiovascular (CV) events
and mortality is established, their value for primary prevention is less
clear. To clarify the role of statins for patients without CV disease, we
performed a meta-analysis of randomized controlled trials (RCTs). METHODS:
MEDLINE, EMBASE, Cochrane Collaboration, and American College of Physicians
Journal Club databases were searched for RCTs published between 1966 and
June 2005. We included RCTs with follow-up of 1 year or longer, more than
100 major CV events, and 80% or more of the population without CV disease.
From each trial, demographic data, lipid profile, CV outcomes, mortality,
and adverse outcomes were recorded. Summary relative risk (RR) ratios with
95% confidence intervals (CIs) were calculated using a random effects
model.
RESULTS: Seven trials with 42,848 patients were included. Ninety percent
had
no history of CV disease. Mean follow-up was 4.3 years. Statin therapy
reduced the RR of major coronary events, major cerebrovascular events, and
revascularizations by 29.2% (95% CI, 16.7%-39.8%) (P<.001), 14.4% (95% CI,
2.8%-24.6%) (P = .02), and 33.8% (95% CI, 19.6%-45.5%) (P<.001),
respectively. Statins produced a nonsignificant 22.6% RR reduction in
coronary heart disease mortality (95% CI, 0.56-1.08) (P = .13). No
significant reduction in overall mortality (RR, 0.92 [95% CI, 0.84-1.01])
(P
= .09) or increases in cancer or levels of liver enzymes or creatine kinase
were observed. CONCLUSION: In patients without CV disease, statin therapy
decreases the incidence of major coronary and cerebrovascular events and
revascularizations but not coronary heart disease or overall mortality.

Note the following: "Statin therapy reduced the RR of major coronary
events,
major cerebrovascular events, and revascularizations by 29.2% (95% CI,
16.7%-39.8%) (P<.001), 14.4% (95% CI, 2.8%-24.6%) (P = .02), and 33.8% (95%
CI, 19.6%-45.5%) (P<.001), respectively."
--
Jim Chinnis Warrenton, Virginia, USA


And studies HAVE shown event reductions in primary prevention. Let's
stop
beating this dead horse.


There are some interesting issues here, but I don't think relative vs
absolute numbers or the difficulty of establishing mortality benefits
in
primary prevention are two of them.
--
Jim Chinnis Warrenton, Virginia, USA


Jim earlier you wrote "There are some interesting issues here, but I
don't think relative vs
absolute numbers or the difficulty of establishing mortality benefits
in
primary prevention are two of them.
Then you cite a meta- analysis that concludes "CONCLUSION: In
patients without CV disease, statin therapy
decreases the incidence of major coronary and cerebrovascular events
and
revascularizations but not coronary heart disease or overall
mortality." I question the fact that statins reduce mortality you
say thats not an issue and cite a study that concludes that statins do
not reduce the incidence of all cause mortality. The article
starts......BACKGROUND: While the role of hydroxymethyl glutaryl
coenzyme A reductase
inhibitors (statins) in secondary prevention of cardiovascular (CV)
events
and mortality is established, their value for primary prevention is"
less "
clear." . Jim this is the question that: if I understand you
correctly , your position is that there effectiveness in primary
prevention has been established. The authors of this and it is the
study you presented find it " less clear'. that's why they did the
analysis.
Jim and I do not want to beat a dead horse
.................but.......,,,,,,1. This study and you presented it
found no decrease in mortality with statin therapy.................2
.Included people with a history of heart disease up 10% there are
other issues . But my question is how can you say " establishing
mortality benefits in
primary prevention " is not worthy of discussion then cite a study
that concludes statin offer no reduction in "coronary heart disease or
overall mortality." to prove your point. Thanks . Vince

This meta-analysis has two major problems.

First, the main cause of it finding such a small effect on all-cause
mortality (RRR 8%) was inclusion of the large and badly flawed ALLHAT
trial. Take a look at what the estimated RRR would be if ALLHAT were
excluded and you'll see that the point estimate would be similar to the
RRR in all-cause mortality seen in secondary prevention with statins.

Second, it had no basis to conclude that statins do not decrease
coronary heart disease mortality. The meta-analysis found a point
estimate RRR of 23% for CHD mortality. That this was not statistically
significant is likely a power issue. It certainly isn't evidence of an
absence of benefit, and that RRR is very similar to what is seen in
secondary prevention with statins.

Using statins for primary prevention typically results in such small
absolute risk reductions that they are often clinically unimportant. But
my read of the evidence is that whether in primary or secondary
prevention statins have pretty similar relative risk reductions over a
wide range of baseline risks.

So your father and mother in law with no heart issues were told to
consider Statins at age 60 +- 10. What would suggest?

Can you answer in less then 10 words?

Bill that values David's words.

--

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