Re: dueling studies on statins
- From: "TC" <tunderbar@xxxxxxxxxxx>
- Date: 28 Nov 2006 13:46:43 -0800
TC wrote:
http://www.forbes.com/forbeslife/health/feeds/hscout/2006/11/28/hscout536300.html
Statins Cut Risk of Heart Attack, Stroke in Those Without Heart Disease
11.28.06, 12:00 AM ET
TUESDAY, Nov. 28 (HealthDay News) -- There are clear medical benefits
for prescribing cholesterol-reducing statin drugs for people who don't
have cardiovascular disease but are at moderate risk of heart attack,
stroke or other events, new research indicates.
An analysis of studies that included more than 48,000 people supports
current guidelines about who should get statins, said study lead author
Dr. Niteesh K. Choudhry, an associate physician at Brigham and Women's
Hospital, in Boston.
Those guidelines state that "those at highest risk even without known
cardiovascular disease should get statins," Choudhry said. "They
suggest that people at moderate risk, they may also benefit."
There are clear benefits for people at moderate risk due to such
conditions as diabetes or high blood pressure, in addition to high
blood cholesterol, the analysis found. The incidence of major
cardiovascular events such as heart attack was 29 percent lower for
those who took a statin rather than a placebo, an inactive substance,
and a 14 percent reduction in strokes over an average of 4.3 years.
Statin therapy did not reduce the death rate in the trials, "likely
because of the relatively low risk of mortality in this patient
population and insufficient length of follow-up," the report said.
The study was published in the Nov. 27 issue of the Archives of
Internal Medicine.
The cost of statin treatment must also be considered against the
benefits, Choudhry said. If the 23 million Americans at moderate risk
of cardiovascular disease were treated for 4.3 years, an estimated
85,800 strokes and 383,000 major coronary events would be prevented --
but the cost would be at least $40 billion.
"Whether those at moderate risk should be getting statins is a matter
of cost-benefit analysis, whether the bang for the buck is worth it,"
he said.
Dr. Christopher P. Cannon, a cardiologist at Brigham and Women's who
was not involved with the study, has no doubts that the benefits of
statin therapy outweigh the costs.
Who is this Dr. Christopher P. Cannon who is so sold on statins? (Pun
intended):
Chistopher P. Cannon, M.D., F.A.C.C., Associate Professor of Medicine,
Harvard Medical School, Boston, MA. Received research funding from
AstraZeneca, Bristol-Myers Squibb, Merck & Co., and Sanofi-Synthelabo
Inc.; consultant for Aventis, Best Med, Bristol-Myers Squibb,
GlaxoSmithKline, Guilford Pharmaceuticals Inc., Ingenixo, Merck & Co.,
Millennium Pharmaceuticals, NCME, Sanofi-Synthelabo Inc., and Vertex
Pharmaceuticals. (http://www.medscape.com/viewprogram/3779_authors;
accessed 7/28/05) Contributing editor, Theheart.org, an on-line
resource owned and produced by Conceptis Technologies, which provides
advice to medical professionals on heart disease; has stock options in
Conceptis Technologies.
(http://www.theheart.org/viewAboutUs.do#sponsors; accessed 5/4/05)
Co-author on "Addition of Clopidogrel to Aspirin and Fibrinolytic
Therapy for Myocardial Infarction with ST-Segment Elevation," which
is supported in part by Sanofi-Aventis and Bristol-Myers Squibb. (N
Engl J Med. 2005 Mar 9; [Epub ahead of print].) Received research grant
support from Bristol-Myers Squibb, Merck, and Sanofi-Synthelabo through
the Department of Medicine of Brigham and Women's Hospital; served as
a consultant to Asahi Chemical Company, Merck, Guilford
Pharmaceuticals, Schering-Plough, Bristol-Myers Squibb, Bayer, Pfizer,
Vertex, Medicines Company, Ortho-Clinical Diagnostics, AstraZeneca, and
GlaxoSmithKline. Served on the speakers' bureaus of Aventis,
Bristol-Myers Squibb, Centocor, Eli Lilly, Genentech, Merck,
Millennium, and Sanofi-Synthelabo; received honoraria for preparation
of educational materials from Best Med, Discovery East, Excerpta
Medica, Medical Decision Point, and NCME (Network for Continuing
Medical Education, a for-profit firm); received honoraria for
preparation of educational materials from Best Med, Discovery East,
Excerpta Medica, Medical Decision Point, and NCME. (N Engl J Med. 2005
Mar 9; [Epub ahead of print].; Chest. 2004;126:167S-71S.) Consultant to
Bristol-Myers Squibb for the Prove It study. (Stolberg, Sheryl Gay and
Gerth, Jeff. "Drug Marketing 101: Proving Our Pill is Better than
Yours," New York Times 12/23/00.) Received research grant support
from Cor Therapeutics and Merck. (JAMA. 2000;283:2941-47.)
Hilarious, if it weren't so tragic.
"The study is very important news for tens of millions of people here
in the United States," Cannon said. "It provides very important
evidence supporting the use of statins to lower cholesterol in people
at moderate risk."
The study shows that a person would have to be treated with a statin
for 4.3 years to prevent one major coronary event, Cannon noted. "That
cost is well within the realm of standard medical practice," he said.
Alternative cholesterol-lowering measures, such as better diet, do not
offer the same clear benefits as statin treatment, Cannon said. "People
take a look at the box of oatmeal in the morning and say, 'Not today,'
" he said.
And the price of statin therapy is coming down, Cannon said.
"Fortunately, statins are available as generics," he said. "That
dramatically reduces the cost of implementing the strategy. Three
statins are now available generically."
The analysis also showed statistically significant benefits of statin
therapy even for people at relatively low risk, Choudhry added. "But
the amount of benefit is small," he said. "The question is, is it worth
it?"
***********
http://www.cbc.ca/health/story/2006/11/27/statins-heart.html
Few benefits of statins for people without heart disease: review
Last Updated: Monday, November 27, 2006 | 4:21 PM ET
CBC News
Cholesterol-lowering drugs slightly reduce the risk of heart attack and
stroke in people with no history of the disease but their overall risk
of death does not fall, a Canadian-led review concludes.
Statins are a bestselling family of drugs that lower levels of
artery-clogging "bad" cholesterol, called LDL or low-density
lipoprotein. The medications are thought to help ward off heart attacks
and strokes.
In Monday's issue of the Archives of Internal Medicine, Dr. Paaladinesh
Thavendiranathan of the University of Toronto and colleagues analyzed
the results of seven previously published clinical trials on the
benefits of statins.
The team concluded statins help lower the risk of heart attacks and
strokes in people at risk from heart disease or high cholesterol. But
for otherwise healthy adults, the benefits are limited.
On average, an adult has a nearly six per cent chance of having a heart
attack or stroke over a 4.3-year period. Statins reduced that risk to
four per cent, the researchers said.
"Therefore, 60 patients would need to be treated for an average of 4.3
years to prevent one major coronary event," Thavendiranathan and
colleagues wrote.
To prevent one stroke, 268 people would need to take statins, and to
prevent one nonfatal heart attack, 61 would need to take the pills.
Rates of death from cardiovascular disease and other causes were about
the same in the statin and control groups.
Statins are expensive and other therapies may work to reduce the risk,
the researchers said in calling for more research to clarify the
cost-effectiveness of statin therapy for people at intermediate risk.
Drug-free ways such as improving your diet and exercising more also
lower blood cholesterol levels, studies show.
**********
Forbes vs CBC News. Black and white. Yin and Yang.
TC
.
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