Sunday, July 11, 2010

One Look At Statin Cost Benefit, Part 4

"The full report looks at both primary prevention against heart disease in men and women under the age of 65 and over the age of 65. And it looks at secondary prevention for men and women who already have heart disease. (Primary prevention is prevention against the development of heart disease in the first place; secondary prevention is prevention against having a heart attack in someone who already has heart disease.)
This post has dragged on long enough, so I’m going to briefly summarize the findings.
In men under 65 with no known heart disease but with risk factors, i.e. LDL of 130 mg/dL or greater, the studies cited showed no difference in all cause mortality. For those men under 65 who had very high LDL levels, the evidence showed that these men might have a slight benefit from taking a statin, but nothing to write home about. Certainly nothing that would justify putting a third of the population on statins.
In women who are under 65 there is virtually no evidence that statins do squat. In fact, the report doesn’t even produce evidence that cholesterol lowering does anything for women. The report states that it bases its rationale for treatment of women on an extrapolation of data from men.
In men and women over 65 the studies cited show no evidence that cholesterol lowering brings about any significant decrease in risk for heart disease. (Remember the 34% of subjects, average age 66.9, in the control group of the PD study mentioned at the start of this post who were on statins. According to the papers cited in this full report, none of those subjects could expect a decreased risk for CHD by taking the statins, but based on this report’s false reporting of the conclusions of these papers, a third of these folks are on statins.)
Men of all ages with diagnosed heart disease were the only group that the studies used in this report show receive an actual benefit from taking statins. And even that is slight.
Women who have heart disease and who take statins have a reduced death rate from heart disease but no decrease in all-cause mortality.
So there you have it. The giant report that, thanks to the executive summary, has driven most physicians in America to prescribe statins to practically everyone who walks through the door shows, when the data is examined, that statins are only really indicated in men who already have heart disease. They don’t do much for anyone else but put them at risk for a host of other problems while running health care costs through the roof for the rest of us.
Who could possibly benefit from this situation? How about the underwriters of the whole scheme: the drug companies and the ‘experts’ on their payroll.
We’ve got a situation where ‘experts’ paid by the drug companies write an executive summary about a report written by ‘experts’ paid by the drug companies, a report that misinterprets (purposefully?) the underlying data to make the case that the drugs made by the drug companies paying the ‘experts’ are under prescribed. Others jump on the bandwagon, making pronouncements, based on this faulty reporting, that almost everyone should be taking these drugs made by the drug companies that underwrote the entire enterprise. One buffoon, cloaked in all the trappings of academia, even made the comment that since statins are so wonderful perhaps they should be added to the drinking water. As a consequence, we’re paying billions of dollars for drugs that don’t particularly work and that cause a number of pretty bad side effects to prevent a disease that can be prevented by fairly simple lifestyle changes. Pitiful.
Is it any wonder that Dr. Weissberg got his panties in a wad when he thought a study might persuade people not to take statins. Based on what you know now, go back and read his comments to the BBC. And get mad."

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