More on Statins

[LimieJosh]

Below is a link to a new piece of original research published in this week’s JAMA on theoretical effectiveness of the full implementation of the most recent cholesterol guidelines for preventing CVD from the American College of Cardiology/American Heart Association.

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Their conclusion states

Conclusions Implementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin‐eligible adults could achieve ≈78% of the Healthy People 2020ASCVD prevention goal. Most of the benefit is attained by individuals with 10‐yearASCVD risk ≥7.5%.

Yay, statins. Let’s all remember to ask your Dr if Statins are right for you. Right? Well, the numbers they present are worth fleshing out in a way that means something to non-scientists.

Using NHANES date the authors estimated there are 44.8 million adults (21-79 years) in the US who are “statin eligible” but not currently taking them. If all were treated with statins according to these guidelines it would prevent nearly 250,000 events (fatal and non-fatal) per year. Over the ten year period (typically how these things are assessed) that is 2.5 million events. That comes out to one event prevented over a ten year period for under 6% of the treated population. Put another way 42 million people could take the statins and not have a single event prevented over the 10 year period.

They also present sub-group analysis of those more amenable to benefit, those with a ten year risk of an event of greater than 7.5%. They estimate this group numbers 32.2 million in the US and appropriate treatment would prevent 218,000 events per year. This they present as the most positive outcome, yet the same calculations show this is not even 7% of the sub population, and leaves 30 million of this 32.2 million sub population of moderately increased risk people with no measurable benefit.

This ostensibly, according to the authors, supports the drive to expand statin usage to try and reduce cardiac events and help meet the Healthy People 2020 targets. I am less sure.

[Mark Rippetoe]

Interesting, the way statistics can be represented.

[tertius]

Below is a link to a new piece of original research published in this week’s JAMA on theoretical effectiveness of the full implementation of the most recent cholesterol guidelines for preventing CVD from the American College of Cardiology/American Heart Association.

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Their conclusion states


Yay, statins. Let’s all remember to ask your Dr if Statins are right for you. Right? Well, the numbers they present are worth fleshing out in a way that means something to non-scientists.

Using NHANES date the authors estimated there are 44.8 million adults (21-79 years) in the US who are “statin eligible” but not currently taking them. If all were treated with statins according to these guidelines it would prevent nearly 250,000 events (fatal and non-fatal) per year. Over the ten year period (typically how these things are assessed) that is 2.5 million events. That comes out to one event prevented over a ten year period for under 6% of the treated population. Put another way 42 million people could take the statins and not have a single event prevented over the 10 year period.

They also present sub-group analysis of those more amenable to benefit, those with a ten year risk of an event of greater than 7.5%. They estimate this group numbers 32.2 million in the US and appropriate treatment would prevent 218,000 events per year. This they present as the most positive outcome, yet the same calculations show this is not even 7% of the sub population, and leaves 30 million of this 32.2 million sub population of moderately increased risk people with no measurable benefit.

This ostensibly, according to the authors, supports the drive to expand statin usage to try and reduce cardiac events and help meet the Healthy People 2020 targets. I am less sure.

In other words, roughly six or seven percent of people who could take the drugs would garner some benefit from doing so.

That seems like a very... let's call it "marginal", effect. In terms of raw numbers, yes, 250K events prevented is non-trivial, sure.
Economically there's probably some real savings to the emergency health system to be had there, though the cost of the drugs themselves might well outweigh that considerably.

But what percentage of that population will experience negative side-effects from the same drugs, over the same period of time?
What is the clinical, quality of life, and economic significance of those negative side-effects, compared to the possible benefit?

More pointedly, what other interventions might provide benefit to more than 7% of the at-risk population?

[Elephant]

If I'm reading correctly, the paper assumes that lowering cholesterol will reduce ASCVD events (heart attacks, strokes, etc.). It's not the paper's empirically derived conclusion, it's an assumption. See the section "Estimated Decline in ASCVD10 With Statin Therapy".

I don't believe it's controversial that statins reduced cholesterol. What's controversial is whether reducing cholesterol with statins will actually improve health by reducing the risk of ASCVD events.

[Giri Kotte]

If I'm reading correctly, the paper assumes that lowering cholesterol will reduce ASCVD events (heart attacks, strokes, etc.). It's not the paper's empirically derived conclusion, it's an assumption. See the section "Estimated Decline in ASCVD10 With Statin Therapy".

I don't believe it's controversial that statins reduced cholesterol. What's controversial is whether reducing cholesterol with statins will actually improve health by reducing the risk of ASCVD events.

So, blood cholesterol levels do not show any significant correlation to incidence of ASCVD?

[Daniel Cavallari]

Seeing this type of article makes me curious to know if the authors are either dumb or malicious. I suspect the latter.

I ask myself the same of all leftists I meet.

[LimieJosh]

If I'm reading correctly, the paper assumes that lowering cholesterol will reduce ASCVD events (heart attacks, strokes, etc.). It's not the paper's empirically derived conclusion, it's an assumption.

It's not an assumption, it's a conclusion derived from the data. However, what this paper demonstrates is how small a percentage of people experience this benefit, even among the population that is recommended to need the drug.

[Elephant]

So, blood cholesterol levels do not show any significant correlation to incidence of ASCVD?

For example, http://startingstrength.com/resource...-guidance.html, particularly Sully's posts.

[Yonason Herschlag]

Most people produce four times more cholesterol in their liver than they ingest with their food. HMG-CoA reductase is a liver enzyme that is responsible for producing cholesterol. Statins are a drug that lowers LDL cholesterol levels by inhibiting the enzyme HMG-CoA reductase. However, statins carry with them many known and unknown side effects harming health (e.g., diabetes and muscle deterioration ). Using them should only be considered as a last resort.

Insulin increases the enzyme HMG-CoA reductase. People who suffer from insulin resistance will naturally produce and release more insulin to lower blood sugar levels (and the higher insulin levels increase HMG-CoA reductase, increasing LDL cholesterol).

There is a science to improving insulin sensitivity and maintaining proper blood sugar levels with less insulin; this is done by diet, exercise, and a specific type of daily intermittent fasting (easier than it sounds). By following the protocol one will have lower blood sugar levels, reduced body fat, and lower LDL cholesterol levels.

[Mike C]

What do we do if we have super high cholesterol. 300+?