7th June 2006
I guess some people must choose between having "problems with" statins or having problems with heart disease, heart attacks and an early death.
I consider myself lucky that I have no problems taking a chemical agent that will prolong my life without the disabling effects of progressive heart disease. I'm sorry that others who need these drugs desperately must choose between suffering side effects or sying of heart disease.
Uff Da...Relative vs. Absolute risk: Since heart disease is the major killer in the United States, I think the risk is probably close to 50%. Eliminate that risk and you have taken an ENORMOUS step towards longevity. Lower cancer risk considerably and you've got the battle won. If we were talking about something like Alzheimer's, cirrhosis, or ALS then absolute risk is always negligible but NOT for heart disease...the absolute risk is HUGE!
Why did I list that Medscape link with an overview of THE major statin studies? I think that the weight of evidence that one can glean from:
The Scandinavian Simvastatin Survival Study (4S) established the importance of treating the hypercholesterolemic patient with established cardiovascular heart disease.
The West of Scotland Coronary Prevention Study (WOSCOPS) showed the benefit of treating healthy hypercholesterolemic men who were nevertheless at high risk of developing cardiovascular heart disease in the future. The Cholesterol and Recurrent Events (CARE) study, a secondary prevention trial, proved the benefit of treating patients with myocardial ischemia and cholesterol levels within normal limits.
This conclusion was confirmed by the Long-term Intervention With Pravastatin in Ischemic Disease (LIPID) study, another secondary prevention study that enrolled patients with a wide range of cholesterol levels (4-7 mmol/dL), into which the large majority of patients would belong. The importance of treating patients with established ischemic heart disease (IHD), and those at high risk of developing cardiovascular heart disease, regardless of cholesterol level, was being realized.
The Air Force/Texas Coronary Artery Prevention Study (AFCAPS/TexCAPS) then showed that treatment can reduce adverse cardiovascular events even in the primary prevention of patients with normal cholesterol levels.
The Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering (MIRACL) trial showed that hypocholesterolemic therapy is useful in the setting of an acute coronary syndrome, while the Atorvastatin Versus Revascularisation Treatment (AVERT) study showed that aggressive statin therapy is as good as angioplasty in reducing ischemic cardiac events in patients with stable angina pectoris.
Finally, the Heart Protection Study (HPS) randomized more than 20,000 patients, and the value of statins in reducing adverse cardiovascular events in the high-risk patient, including the elderly, women, and even in those with low cholesterol levels, is beyond doubt.
I can appreciate that one or the other of these major studies might have shortcomings with one or another aspect, but taken together they present a picture of probaly THE MOST studied effect of any scientific process in history: the roll of blood lipid modification on the various manifestations of heart disease!
The power of the studies, taken together, overwhelms me and I am amazed that anyone could take them as a whole and not find the same compelling results.
I consider myself lucky that I have no problems taking a chemical agent that will prolong my life without the disabling effects of progressive heart disease. I'm sorry that others who need these drugs desperately must choose between suffering side effects or sying of heart disease.
Uff Da...Relative vs. Absolute risk: Since heart disease is the major killer in the United States, I think the risk is probably close to 50%. Eliminate that risk and you have taken an ENORMOUS step towards longevity. Lower cancer risk considerably and you've got the battle won. If we were talking about something like Alzheimer's, cirrhosis, or ALS then absolute risk is always negligible but NOT for heart disease...the absolute risk is HUGE!
Why did I list that Medscape link with an overview of THE major statin studies? I think that the weight of evidence that one can glean from:
The Scandinavian Simvastatin Survival Study (4S) established the importance of treating the hypercholesterolemic patient with established cardiovascular heart disease.
The West of Scotland Coronary Prevention Study (WOSCOPS) showed the benefit of treating healthy hypercholesterolemic men who were nevertheless at high risk of developing cardiovascular heart disease in the future. The Cholesterol and Recurrent Events (CARE) study, a secondary prevention trial, proved the benefit of treating patients with myocardial ischemia and cholesterol levels within normal limits.
This conclusion was confirmed by the Long-term Intervention With Pravastatin in Ischemic Disease (LIPID) study, another secondary prevention study that enrolled patients with a wide range of cholesterol levels (4-7 mmol/dL), into which the large majority of patients would belong. The importance of treating patients with established ischemic heart disease (IHD), and those at high risk of developing cardiovascular heart disease, regardless of cholesterol level, was being realized.
The Air Force/Texas Coronary Artery Prevention Study (AFCAPS/TexCAPS) then showed that treatment can reduce adverse cardiovascular events even in the primary prevention of patients with normal cholesterol levels.
The Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering (MIRACL) trial showed that hypocholesterolemic therapy is useful in the setting of an acute coronary syndrome, while the Atorvastatin Versus Revascularisation Treatment (AVERT) study showed that aggressive statin therapy is as good as angioplasty in reducing ischemic cardiac events in patients with stable angina pectoris.
Finally, the Heart Protection Study (HPS) randomized more than 20,000 patients, and the value of statins in reducing adverse cardiovascular events in the high-risk patient, including the elderly, women, and even in those with low cholesterol levels, is beyond doubt.
I can appreciate that one or the other of these major studies might have shortcomings with one or another aspect, but taken together they present a picture of probaly THE MOST studied effect of any scientific process in history: the roll of blood lipid modification on the various manifestations of heart disease!
The power of the studies, taken together, overwhelms me and I am amazed that anyone could take them as a whole and not find the same compelling results.