3 ms·

Re: there's robust literature on statins and it's settled. We're not talking about statin studies on CVD patients. We're talking about asymptomatic treatment.

Re: there's robust literature on statins and it's settled. We're not talking about statin studies on CVD patients. We're talking about asymptomatic treatment. I'm not aware of any study that partitioned asymptomatic high-cholesterol individuals on underlying pathology, e.g., by CAC score, and then seeing if statins were of any benefit to the zero score group. That's because we wouldn't treat those individuals. Instead, all studies (used to argue for treatment of asymptomatic high-LDL) I'm aware of lump "high-risk" individuals together, give them all statins, and then say the outcome is improved for the whole group. So on one hand, you argue the OP article is fatally flawed because the low-cholesterol group contains high-risk people given statins. On the other hand, you don't concede that the studies lumping all asymptomatic "high risk" individuals together suffer from the same issue. The EISNER study started with "an older population with baseline risk factors" and found 52% had CAC abnormality. I would be interested to see what percentage of asymptomatic high cholesterol people have CAC zero scores and would be treated with statins anyway under current guidelines.

carbocation 7y ago
There is a categorical difference between the OP, in which failure to account for statins creates the observation, and a clinical trial that successfully reduces mortality even though the event rate in the control arm wasn’t 100%. That difference is so great that there is almost no relationship between those scenarios.
- DocSavage 7y ago
  You don’t know how many people in the low-cholesterol group were on statins in OP article, correct? And despite you completely downplaying it with “the event rate in the control arm wasn’t 100%”, you don’t know how many people in the high-cholesterol group in asymptomatic studies had zero CAC scores (e.g., 50% from EISNER). In both cases you are drawing a conclusion based on incomplete partitioning. There’s also no consideration of non-CVD mortality and especially morbidity in most of these studies. Despite your unequivocal statement that (all) statins are safe, there’s still a lot we don’t know about long-term use including effects on cognition (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830056/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830056/).

carbocation 7y ago

There is a categorical difference between the OP, in which failure to account for statins creates the observation, and a clinical trial that successfully reduces mortality even though the event rate in the control arm wasn’t 100%. That difference is so great that there is almost no relationship between those scenarios.

DocSavage 7y ago
You don’t know how many people in the low-cholesterol group were on statins in OP article, correct? And despite you completely downplaying it with “the event rate in the control arm wasn’t 100%”, you don’t know how many people in the high-cholesterol group in asymptomatic studies had zero CAC scores (e.g., 50% from EISNER). In both cases you are drawing a conclusion based on incomplete partitioning. There’s also no consideration of non-CVD mortality and especially morbidity in most of these studies. Despite your unequivocal statement that (all) statins are safe, there’s still a lot we don’t know about long-term use including effects on cognition (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830056/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830056/).