6 ms·

In bullet-points: - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) - Percentage of people that get side-effec

In bullet-points: - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health: LDL "large particle -- bad" cholesterol is not actually measured, but estimated. The current formula is: (total cholesterol - HDL - triglycerides)/5 which is liable to under-report true LDL levels. Estimation also has the drawback of being unable to tell how much of each "bad" particle is actually in your blood (chylomicrons vs VLDL vs LDL etc.) -- muddying your actual risk profile. Likewise, no LDL "content" tests are performed to measure how much cholesterol each LDL is actually carrying. So yes, statins will lower these numbers, but the methodology around these numbers is flawed, and only loosely correlated with cardiovascular health

haldujai 3y ago
What patient population are you talking about? Statins have excellent evidence behind them. > - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) It depends what your baseline risk is and what time point you're looking at. > - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic This is just completely false, even from 2013 data[0] (which overestimates diabetes) but is better addressed in a subsequent review [1]. The side effects, if they do happen, are also self-limiting and stop with cessation or changing agents. > - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health ... and only loosely correlated with cardiovascular health See reference [1] and [2]. [0]https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ https://thennt.com/nnt/statins-for-heart-disease-prevention-... [1]https://www.thelancet.com/article/S0140-6736(16)31357-5/fulltext https://www.thelancet.com/article/S0140-6736(16)31357-5/full... [2]https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fulltext https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fullt...
- rgbgraph 3y ago
  All adult patient populations: those without a history of cardiovascular events, and those with. Baseline risk is something like ~35% for men, and ~20% women. Time point is from 50 to 75 years of age. Statins -- at most -- reduce your absolute risk from 35% to 33% (for men) and from 20% to 18% (for women). If you do not smoke, your absolute risk drops by ~7%, from 35% to 28%. If you're diabetic, your risk jumps an absolute ~30% to 65%. See: https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.548206 https://www.ahajournals.org/doi/full/10.1161/circulationaha.... (table 2 & table 3). --- Your article has this caveat: "Virtually all of the major statin studies were paid for and conducted by their respective pharmaceutical company. A long history of misrepresentation of data and occasionally fraudulent reporting of data suggests that these results are often much more optimistic than subsequent data produced by researchers and parties that do not have a financial stake in the results." Ignoring that, 2% (absolute) of the population on statins develop diabetes and 10% (absolute) develop muscle pain/rhabdo (in one experiment). This is also ignoring all of the serious adverse events from gen-1 and gen-2 statins. As a whole, they on average achieve a 1.2% reduction in absolute mortality (all-cause or only from heart disease?). While I have just read it, I'm going to discount [1], because of what's inside "Declaration of interests." And on principle, I'm not going to read [2], unless you quote the relevant sections (as is good form when referencing).
  - haldujai 3y ago
    As stated thennt is from 2013, many statin trials have come out since. 2% diabetes is overstated as in link 1 except you discount it because of declared disclosures despite the fact that it’s one of the most highly cited papers on the subject in the last 10 years and the study was a review. You also discount a well respected guideline on lipids out of principle. Then you cite unrelated data from 2006 as a good reference for an unknown reason? Finally, you disregard the opinions of a Cochrane review in an unrelated patient population which directly contradicts your misinterpretation of the data (clearly have no concept of NNT/NNH as you just make capricious interpretations of ARR) yet cite yourself as more of an expert than the Cochrane authors. For what it’s worth since you focus on conflicts it’s to my financial benefit if you don’t take your statins (and pharma pays me nothing), so by all means skip the statin at your own risk. This really doesn’t seem like an open discussion so I’ll stop engaging. But you’re spreading misinformation for any reader, statins save lives.
nradov 3y ago
There are multiple different statins. The latest research indicates that some are more effective than you indicate, with a lower rate of serious side effects. https://peterattiamd.com/johnkastelein/ https://peterattiamd.com/johnkastelein/
- rgbgraph 3y ago
  I had an inkling I should have ended one of the points with that line of thought. However, I haven't seen any research that shows more than minor absolute risk changes, regardless of statin -- they're the wrong drugs for the job.
  - haldujai 3y ago
    Do you have a single citation to back this claim up? Unless you’re talking about prophylactic statins in patients with no known risk factors (I.e. primary prevention which is not standard of care) this is complete misinformation.
    - rgbgraph 3y ago
      Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, vol. 2021, no. 9, 2013, https://doi.org/10.1002/14651858.cd004816.pub5 https://doi.org/10.1002/14651858.cd004816.pub5. Page 11. If you have an account at Cochrane: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004816.pub5/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... If not, just get it from LibGen with: 10.1002/14651858.CD004816.pub5
      - sohex 3y ago
        The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to these low risk groups." And as haldujai mentioned this is explicitly regarding their use for primary prevention, not with regards to usage for secondary prevention which has strong supporting evidence.

haldujai 3y ago

What patient population are you talking about? Statins have excellent evidence behind them. > - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction) It depends what your baseline risk is and what time point you're looking at. > - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic This is just completely false, even from 2013 data[0] (which overestimates diabetes) but is better addressed in a subsequent review [1]. The side effects, if they do happen, are also self-limiting and stop with cessation or changing agents. > - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health ... and only loosely correlated with cardiovascular health See reference [1] and [2]. [0]https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ https://thennt.com/nnt/statins-for-heart-disease-prevention-... [1]https://www.thelancet.com/article/S0140-6736(16)31357-5/fulltext https://www.thelancet.com/article/S0140-6736(16)31357-5/full... [2]https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fulltext https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fullt...

rgbgraph 3y ago
All adult patient populations: those without a history of cardiovascular events, and those with. Baseline risk is something like ~35% for men, and ~20% women. Time point is from 50 to 75 years of age. Statins -- at most -- reduce your absolute risk from 35% to 33% (for men) and from 20% to 18% (for women). If you do not smoke, your absolute risk drops by ~7%, from 35% to 28%. If you're diabetic, your risk jumps an absolute ~30% to 65%. See: https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.548206 https://www.ahajournals.org/doi/full/10.1161/circulationaha.... (table 2 & table 3). --- Your article has this caveat: "Virtually all of the major statin studies were paid for and conducted by their respective pharmaceutical company. A long history of misrepresentation of data and occasionally fraudulent reporting of data suggests that these results are often much more optimistic than subsequent data produced by researchers and parties that do not have a financial stake in the results." Ignoring that, 2% (absolute) of the population on statins develop diabetes and 10% (absolute) develop muscle pain/rhabdo (in one experiment). This is also ignoring all of the serious adverse events from gen-1 and gen-2 statins. As a whole, they on average achieve a 1.2% reduction in absolute mortality (all-cause or only from heart disease?). While I have just read it, I'm going to discount [1], because of what's inside "Declaration of interests." And on principle, I'm not going to read [2], unless you quote the relevant sections (as is good form when referencing).
- haldujai 3y ago
  As stated thennt is from 2013, many statin trials have come out since. 2% diabetes is overstated as in link 1 except you discount it because of declared disclosures despite the fact that it’s one of the most highly cited papers on the subject in the last 10 years and the study was a review. You also discount a well respected guideline on lipids out of principle. Then you cite unrelated data from 2006 as a good reference for an unknown reason? Finally, you disregard the opinions of a Cochrane review in an unrelated patient population which directly contradicts your misinterpretation of the data (clearly have no concept of NNT/NNH as you just make capricious interpretations of ARR) yet cite yourself as more of an expert than the Cochrane authors. For what it’s worth since you focus on conflicts it’s to my financial benefit if you don’t take your statins (and pharma pays me nothing), so by all means skip the statin at your own risk. This really doesn’t seem like an open discussion so I’ll stop engaging. But you’re spreading misinformation for any reader, statins save lives.

nradov 3y ago

There are multiple different statins. The latest research indicates that some are more effective than you indicate, with a lower rate of serious side effects. https://peterattiamd.com/johnkastelein/ https://peterattiamd.com/johnkastelein/

rgbgraph 3y ago
I had an inkling I should have ended one of the points with that line of thought. However, I haven't seen any research that shows more than minor absolute risk changes, regardless of statin -- they're the wrong drugs for the job.
- haldujai 3y ago
  Do you have a single citation to back this claim up? Unless you’re talking about prophylactic statins in patients with no known risk factors (I.e. primary prevention which is not standard of care) this is complete misinformation.
  - rgbgraph 3y ago
    Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, vol. 2021, no. 9, 2013, https://doi.org/10.1002/14651858.cd004816.pub5 https://doi.org/10.1002/14651858.cd004816.pub5. Page 11. If you have an account at Cochrane: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004816.pub5/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... If not, just get it from LibGen with: 10.1002/14651858.CD004816.pub5
    - sohex 3y ago
      The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to these low risk groups." And as haldujai mentioned this is explicitly regarding their use for primary prevention, not with regards to usage for secondary prevention which has strong supporting evidence.