'Statins' - nothing but slow poison?

[casebro]

The death rate from cardiovascular disease has decreased by 31% over the last decade.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6021a6.htm?s_cid=mm6021a6_x

Linda

And in the mean time smoking use by adults has plummeted, and angiolasties and CABGs have skyrocketed.

We can't give lipid tech all of the credit.

But here is another reality- how much has the average life span gone up in that concurrent time? Most of us don't know what we will die from. We do want to live longer. So how much longer has the 10 years of progress given the average person?

With all of the progress in the ensuing time, from 1960 to 2010, fifty years during which we have reached the pinnacle of medical care, we added 10 years. At 2010 spending, the costs over a lifetime will be about $650,000. Or $65,000 per QALY. Can we do that? Will society go bankrupt? Or will it be a growth sector of the economy? I don't know.

 

[Skeptic Ginger]

The results should always show up if the studies are properly done -- unless the medication or procedure proves to be ineffective.
Your example (comparing age specific mortality rates of those receiving flu vaccine vs. a proper control group who do not) must be flawed unless such vaccines are ineffective. We are dealing with mathematics here -- not medicine!

You are so convinced that good research leads to valid results you are missing the imperfection in the real world. Not every study is a randomized placebo controlled prospective study with a sufficient sample size carried out over a sufficient period of time. Not every study has a large enough sample size. Not every study is carried out over the ideal time frame. Not every study controls for all variables, sometimes there are unexpected variables not accounted for in the study. And when meta analyses are done, the inclusion/exclusion criteria are not always specifically concerned with every outcome measure.

And yet, the "conclusions" are still summed up in the study. Limitations are noted if the study is properly done as you say. So if the correct conclusion is, "there was no statistically significant difference in all cause mortality", but the limitations of the study are disclosed noting those results are tentative, and someone only reads the conclusion, they might mistakenly believe the study actually supported that outcome as valid. In reality the study noted that outcome was not valid, only tentatively suggested. If all you read is the conclusion and you don't look at the details, such as the noted limitations, you would likely believe the study supported an outcome it did not support.


I understand what you are saying. But I also know medical research. It is not that uncommon to find specific outcome measures not supporting all the conclusions. You have to look at more than just the conclusions noted in the abstract to weigh the validity of the conclusions. You often need a broader underlying understanding of the study subject to interpret research results. You can't just read the summary and expect to accurately size up the meaning of the results.

 

[casebro]

Taking the flu vaccine example above, the flu mostly kills the old and infirm. "Decrepit" is the term my sister the MICU RN with the master degree uses. So, real world, preventing the flu amongst the decrepit will only delay the end for a short time. Not only would this barely show in vaccine mortality studies, it won't show at all if the study concentrates on a younger patient pool- those who seldom die of the flu.

Same concept would apply to Statins. Most heart attack victims are in their 60-70s. But the typical 5 years study starts with an average age of 55. NOT the group where heart attacks happen to most of us. So is the study data pertinent?

 

[theprestige]

My own, first-hand experience of statins;

Actually, your entire anecdote describes a second-hand experience with statins.

 

[Perpetual Student]

I am not suggesting doing "properly done" studies is easy. Sorry if I have given that impression. I know that confounding factors, unexpected variables, inaccurate reporting, small sample size, etc. etc. and, most importantly, expense make all such studies very difficult to design and execute.
Consider, in contrast, the actuarial study done in the fifties concerning smokers vs. non-smokers mortality ratios (age bracket specific). The data was massive and the study was extremely well funded (The insurance industry was highly motivated.). The results were unambiguous and devastating for any claim that smoking was harmless. The mortality ratios (by cause of death and age brackets) showed huge differences between smokers and non-smokers for many diseases.
On the other hand, I don't understand why such a mortality study for the flu vaccine would be so difficult. Constructing a control group with similar demographics for vaccine and non-vaccine receivers should be fairly straightforward. The data base is enormous and the results should be easily detected. The comment above that "the flu mostly kills the old and infirm --the 'decrepit'" is nonsensical. Someone, who is otherwise healthy, getting the flu between, say, age 70 and 75 would be more at risk to croak compared to his counterpart who does not get the flu because he is protected by vaccination. That age group (70 - 75) in the US consists of some 8 million people, so the data is certainly available and ample. It would appear that the motivation to spend the required money is lacking.

 

[fls]

But by it's very nature, isn't the PAR ignoring the biggest risk factor in the "unexposed population"?

No. A PAR can be calculated for any risk factor. In this case, they were focussing on modifiable factors. Using the numbers from the article (unadjusted) and population stats gives a PAR of 21% for male sex and 32% for age greater than 40.

I suspect that to be age. They left it out. I'm thinking it would be the only risk factor in the unexposed group. With such a high risk factor that all others are greatly discounted. Hey, look, the total risk factors is 255% ? Sorry, can't reduce risk factors by more than 100% EVAR. That is math.

You are thinking of something else. PAR's aren't additive.

Then also, stated as "increased risk" instead of "comparative risk" means that the 54% lipid number is exaggerated when the important point is that cutting cholesterol would cut the risk by 35%.

You do not understand the numbers or concepts you are referring to.

Linda

 

[fls]

And in the mean time smoking use by adults has plummeted, and angiolasties and CABGs have skyrocketed.

We can't give lipid tech all of the credit.

I didn't. I was just pointing out that your statement was dead wrong.

Linda

 

[Beerina]

Hmm... Funny how "Big Pharma" is pushing statins.

That would be why my GP in a rationalisation drive for the NHS switched me from Crestor (tm) to Simvastatin (Generic)...

Simvastatin costs 90p for a 28 day supply to the NHS. I can see "Big Pharma" creaming in the profits here. I wonder how much a Homeopath would charge for 1 months treatment of sugar pills? Probably a lot more than the Crestor (tm) I switched from which being in patent was costing the NHS £30.00 for a 28 day supply.

I was also taking escitalopram (Cipralex (tm)) which is the active enantiomer of citalopram. Cipralex 20mg costs £25.50 for a 28 day supply. I was switched over to the original citalopram which merely meant my tablet is bigger (40mg) however it costs the NHS just £1.37 for the exact same thing.

So much for "Big Pharma" and statins.

BTW, I have taken these for over 4 years now and have no ill effects whatsover.

Ya know what? I've got news for you, £30.00 for a month's supply of a fairly new, useful drug isn't a bad deal. Oh, sure, if you can get roughly equivalent from a generic or other drug, much more cheaply, go for it.

But £30.00? BFD. Every person should budget several times that for new drugs per month.

 

[fls]

I am not suggesting doing "properly done" studies is easy. Sorry if I have given that impression. I know that confounding factors, unexpected variables, inaccurate reporting, small sample size, etc. etc. and, most importantly, expense make all such studies very difficult to design and execute.
Consider, in contrast, the actuarial study done in the fifties concerning smokers vs. non-smokers mortality ratios (age bracket specific). The data was massive and the study was extremely well funded (The insurance industry was highly motivated.). The results were unambiguous and devastating for any claim that smoking was harmless. The mortality ratios (by cause of death and age brackets) showed huge differences between smokers and non-smokers for many diseases.
On the other hand, I don't understand why such a mortality study for the flu vaccine would be so difficult. Constructing a control group with similar demographics for vaccine and non-vaccine receivers should be fairly straightforward. The data base is enormous and the results should be easily detected. The comment above that "the flu mostly kills the old and infirm --the 'decrepit'" is nonsensical. Someone, who is otherwise healthy, getting the flu between, say, age 70 and 75 would be more at risk to croak compared to his counterpart who does not get the flu because he is protected by vaccination. That age group (70 - 75) in the US consists of some 8 million people, so the data is certainly available and ample. It would appear that the motivation to spend the required money is lacking.

I'm not sure why you are under the impression that these studies haven't been done. The kind of study you describe is feasible (as you mentioned) and various databases have demonstrated reductions in mortality with influenza vaccination.

http://jid.oxfordjournals.org/content/184/6/665.short
http://jama.ama-assn.org/content/270/16/1956.full.pdf

The main problem with all-cause mortality (other than inappropriate choice of comparison group, as mentioned), is simply that it can be a relatively insensitive measure under conditions where the base rate is low (as is the case with primary prevention). For example, the systematic review of statins referenced earlier showed a reduction in mortality. It just didn't quite reach statistical significance because it was underpowered for that end-point.

Otherwise, it's a good choice. A reduction in mortality from one cause will show up as an overall reduction. There's no reason to think that unrelated causes of death will increase. And it avoids the problem of biases creeping into determination of cause of death. Also, it has the potential to pick up increased mortality which is related to the intervention. Vioxx would be an example of this. If we had only looked at mortality from peptic ulcer disease (which it decreased), we would miss the possibility that mortality from heart disease increased.

Linda

 

[Perpetual Student]

I'm not sure why you are under the impression that these studies haven't been done. The kind of study you describe is feasible (as you mentioned) and various databases have demonstrated reductions in mortality with influenza vaccination.

http://jid.oxfordjournals.org/content/184/6/665.short
http://jama.ama-assn.org/content/270/16/1956.full.pdf

The main problem with all-cause mortality (other than inappropriate choice of comparison group, as mentioned), is simply that it can be a relatively insensitive measure under conditions where the base rate is low (as is the case with primary prevention). For example, the systematic review of statins referenced earlier showed a reduction in mortality. It just didn't quite reach statistical significance because it was underpowered for that end-point.

Otherwise, it's a good choice. A reduction in mortality from one cause will show up as an overall reduction. There's no reason to think that unrelated causes of death will increase. And it avoids the problem of biases creeping into determination of cause of death. Also, it has the potential to pick up increased mortality which is related to the intervention. Vioxx would be an example of this. If we had only looked at mortality from peptic ulcer disease (which it decreased), we would miss the possibility that mortality from heart disease increased.

Linda

Actually, I really had not investigated whether such studies were done. I understood Skeptic Ginger or casebro (because the "decrepit" are involved) to say such studies were ambiguous. In retrospect, perhaps she was talking about statins and casebro was just babbling. In any case, thanks for those links. As I expected, the results of those studies were quite unambiguous.

 

[Perpetual Student]

So, back to my question about simvastatin and Alzheimer's disease. Has anyone here seen the actual study results behind these articles? Boston University FuturePundit Has there been any confirmation? A fifty percent reduction is an amazing and powerful result! What dosages were used?
With a prevalence rate of around 40% at age 85 for Alzheimer's, I would think simvastatin would be prescribed for anyone who reaches some advanced age, like 65 or 70.

 

[Skeptic Ginger]

I am not suggesting doing "properly done" studies is easy. Sorry if I have given that impression. I know that confounding factors, unexpected variables, inaccurate reporting, small sample size, etc. etc. and, most importantly, expense make all such studies very difficult to design and execute.
Consider, in contrast, the actuarial study done in the fifties concerning smokers vs. non-smokers mortality ratios (age bracket specific). The data was massive and the study was extremely well funded (The insurance industry was highly motivated.). The results were unambiguous and devastating for any claim that smoking was harmless. The mortality ratios (by cause of death and age brackets) showed huge differences between smokers and non-smokers for many diseases.
On the other hand, I don't understand why such a mortality study for the flu vaccine would be so difficult. Constructing a control group with similar demographics for vaccine and non-vaccine receivers should be fairly straightforward. The data base is enormous and the results should be easily detected. The comment above that "the flu mostly kills the old and infirm --the 'decrepit'" is nonsensical. Someone, who is otherwise healthy, getting the flu between, say, age 70 and 75 would be more at risk to croak compared to his counterpart who does not get the flu because he is protected by vaccination. That age group (70 - 75) in the US consists of some 8 million people, so the data is certainly available and ample. It would appear that the motivation to spend the required money is lacking.

This is off topic but deserves an answer. Let me see if I can find the discussion in a past thread.

 

[Skeptic Ginger]

Actually, I really had not investigated whether such studies were done. I understood Skeptic Ginger or casebro (because the "decrepit" are involved) to say such studies were ambiguous. In retrospect, perhaps she was talking about statins and casebro was just babbling. In any case, thanks for those links. As I expected, the results of those studies were quite unambiguous.

I'm not sure I want to address casebro's nonsense about flu mortality but definitely I don't want to derail the thread off into the flu vaccine research example.

My point was specifically about taking a single result, 'no change in all cause mortality', and without looking at the strength or limitations of that result in that specific study, erroneously proclaiming that single result to be conclusively meaningful.


You want to know how the result can be wrong and I said, sometimes a variable is overlooked. That is the issue that deserves an answer. Let me find the proper thread to discuss it.

 

[Skeptic Ginger]

So, back to my question about simvastatin and Alzheimer's disease. Has anyone here seen the actual study results behind these articles? Boston University FuturePundit Has there been any confirmation? A fifty percent reduction is an amazing and powerful result! What dosages were used?
With a prevalence rate of around 40% at age 85 for Alzheimer's, I would think simvastatin would be prescribed for anyone who reaches some advanced age, like 65 or 70.

Here's the full article:

Simvastatin is associated with a reduced incidence of dementia and Parkinson's disease

 

[fls]

So, back to my question about simvastatin and Alzheimer's disease. Has anyone here seen the actual study results behind these articles? Boston University FuturePundit Has there been any confirmation? A fifty percent reduction is an amazing and powerful result! What dosages were used?
With a prevalence rate of around 40% at age 85 for Alzheimer's, I would think simvastatin would be prescribed for anyone who reaches some advanced age, like 65 or 70.

http://www.ncbi.nlm.nih.gov/pubmed/19370582

Observational studies are notoriously unreliable.

Linda

 

[Perpetual Student]

http://www.ncbi.nlm.nih.gov/pubmed/19370582

Observational studies are notoriously unreliable.

Linda

Amazing! One study shows a fifty percent reduction in Alzheimer's (associated with simvastatin) and the other shows no effect! I can understand how this can happen when we are dealing with a few percentage points, but 50% is beyond credible as an error in such a large study. How can that happen? I would be interested to learn how thoroughly you have studied these papers and what conclusions you have reached, if any.

(On the one hand) From the Boston U. website:

"The researchers examined data from the Decision Support System database of the United States Veterans Affairs Medical System, a database of medical centers throughout the United States which contains diagnostic, pharmaceutical and demographic information on approximately 4.5 millions people.Using three different models for analysis, the researchers examined the effects of three different statins (atorvastatin, lovastatin and simvastatin) and found that simvastatin showed a strong reduction in the incidence of Alzheimer’s disease in each of the models. The data also showed the same statin was associated with a reduced incidence of Parkinson’s disease."

(On the other hand) From the NIH website:

There is good evidence from RCTs that statins given in late life to individuals at risk of vascular disease have no effect in preventing AD or dementia.

 

[Skeptic Ginger]

Amazing! One study shows a fifty percent reduction in Alzheimer's (associated with simvastatin) and the other shows no effect! I can understand how this can happen when we are dealing with a few percentage points, but 50% is beyond credible as an error in such a large study. How can that happen? I would be interested to learn how thoroughly you have studied these papers and what conclusions you have reached, if any.

(On the one hand) From the Boston U. website:



(On the other hand) From the NIH website:

Such is the nature of medical research.

 

[fls]

Amazing! One study shows a fifty percent reduction in Alzheimer's (associated with simvastatin) and the other shows no effect! I can understand how this can happen when we are dealing with a few percentage points, but 50% is beyond credible as an error in such a large study. How can that happen? I would be interested to learn how thoroughly you have studied these papers and what conclusions you have reached, if any.

(On the one hand) From the Boston U. website:

(On the other hand) From the NIH website:

It's because one study was observational and the other was from randomized, controlled trials. A drop of 50% is actually weak for observational data. It isn't strong until you see 90% or more. It's easy for selection biases or confounding to lead to differences of 50% or less. Those biases are removed (or at least reduced) in RCT's.

This is the same drop that we saw for hormonal replacement therapy and heart disease or vitamin E and cancer, both of which later were shown in RCT's to have the opposite effect.

Linda

 

[wolfgirl]

I'm always a little confused by skeptics who refuse to be skeptical of the drug companies. Don't get me wrong; I'm not talking about being skeptical of the science behind pharmaceuticals. But saying I don't trust the drug companies isn't the same as saying I don't trust science. There's a huge profit motive for them to not necessarily always have our best interest at heart.

It just seems as though there are so many cases where the drug companies have either been caught in out-and-out deceipt, deception, hiding negative impacts, etc., or just been mistaken, not learning about a serious side effect until years after the fact. Or the fact that the overprescribing of antibiotics has become a serious problem with the rise of antibiotic-resistant bacteria. In light of those things, is taking a slower approach really such a bad idea?

Now I will take a medication when it seems truly called for. I had a bad case of bronchitis a few years ago and took antibiotics for it. But I won't take a drug just for mild discomfort (didn't take any pain pills for a broken foot, but did for a broken tailbone) or for questionable benefit. I just figure anything that's going into my body and altering its chemistry may also be doing things I'm not so sure about. They almost all have some side effects, some of which can be serious, and many of which may not show up for years, or may not even have been discovered yet.

I read a study just this morning that said something like 50% of Americans have taken at least one prescription medication in the last 30 days. I don't know, that sounds awfully high to me. Are we all really that sick?

I've joked about this often with my doctor, about how the drug companies want everyone to be on something, and he says he can't really disagree. He knows the reps come and push their drugs on him, and he's supposed to push them on me. Or I'm supposed to see the ads for the drugs and beg him for them. Either way, he's supposed to get me on some drugs. (At my last well-woman exam, the foot stirrups had these little fabric covers on them with the name of some drug on them. I joked with him that, what, am I supposed to see that drug name and ask him for that drug while my feet are up in the stirrups? He laughed, took them off, turned them inside out and put them back on.)

Okay, you may now all commence to calling me an ignorant science-denier or a woo.

 

[fls]

I'm always a little confused by skeptics who refuse to be skeptical of the drug companies. Don't get me wrong; I'm not talking about being skeptical of the science behind pharmaceuticals. But saying I don't trust the drug companies isn't the same as saying I don't trust science. There's a huge profit motive for them to not necessarily always have our best interest at heart.

It just seems as though there are so many cases where the drug companies have either been caught in out-and-out deceipt, deception, hiding negative impacts, etc., or just been mistaken, not learning about a serious side effect until years after the fact. Or the fact that the overprescribing of antibiotics has become a serious problem with the rise of antibiotic-resistant bacteria. In light of those things, is taking a slower approach really such a bad idea?

Now I will take a medication when it seems truly called for. I had a bad case of bronchitis a few years ago and took antibiotics for it. But I won't take a drug just for mild discomfort (didn't take any pain pills for a broken foot, but did for a broken tailbone) or for questionable benefit. I just figure anything that's going into my body and altering its chemistry may also be doing things I'm not so sure about. They almost all have some side effects, some of which can be serious, and many of which may not show up for years, or may not even have been discovered yet.

I read a study just this morning that said something like 50% of Americans have taken at least one prescription medication in the last 30 days. I don't know, that sounds awfully high to me. Are we all really that sick?

I've joked about this often with my doctor, about how the drug companies want everyone to be on something, and he says he can't really disagree. He knows the reps come and push their drugs on him, and he's supposed to push them on me. Or I'm supposed to see the ads for the drugs and beg him for them. Either way, he's supposed to get me on some drugs. (At my last well-woman exam, the foot stirrups had these little fabric covers on them with the name of some drug on them. I joked with him that, what, am I supposed to see that drug name and ask him for that drug while my feet are up in the stirrups? He laughed, took them off, turned them inside out and put them back on.)

Okay, you may now all commence to calling me an ignorant science-denier or a woo.

Who are you talking to?

Linda