From the desk of Dr Sam Shohet
BDS MGDS RCS(Eng) LiAc MBAcC ICAK
THE DEFINITIVE TRUTH ABOUT STATINS
A research paper by one of the most revered scientists in the world is so important that I am reproducing it just as it appeared on Synthesis by Dr Jeffrey Bland, a foremost biochemist and innovative thinker:
Lipid-Lowering Guideline Controversy: The Research of Dr. JM Wright
In 2001, when the last major revision of lipid-lowering guidelines took place, the number of Americans for whom statins are recommended increased from 13 million to 36 million, most of whom do not yet have but are estimated to be at moderately elevated risk of developing coronary heart disease. For adults aged between 30 and 80 years old who already have occlusive vascular disease, statins confer a total and cardiovascular mortality benefit and are not controversial. The controversy involves this question:
Without evident occlusive vascular disease (true primary prevention), who should be offered statins?
The answer to this question has huge economic and health implications. Dr JM Wright and his colleague, Dr. J Abramson, pooled the data from eight published randomized trials that compared statins with placebo in primary prevention populations at risk. The analysis was not perfect as the trials were not solely primary prevention (8.5% of patients had occlusive vascular disease at baseline). Dr. Wright and Dr. Abramson used two outcomes to estimate overall benefit (benefit minus harm): total mortality and total serious adverse events (SAEs).
Their analysis suggested that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years.
High-risk men aged 30-69 years should be advised that about 50 patients need to be treated for 5 years to prevent one event. This data, especially when considered in combination with the potential benefits of lifestyle modification on cardiovascular disease and overall health, could lead to statins being used by a much smaller proportion of the overall population than recommended by any of the guidelines, which are based on the assumption that cardiovascular disease risk is a continuum and that evidence of benefit in people with occlusive vascular disease (secondary prevention) can be extrapolated to primary prevention populations.
It is the position of Dr. Wright and Dr. Abramson that the assumption that secondary prevention can be extrapolated to primary prevention in populations is false and that cholesterol treatment guidelines based on this assumption should be revised. Further, in some subgroups statins cause serious unrecognized harm, which negates the benefit when the benefit is small i.e., most primary prevention settings. They call for detailed subgroup data to be made available by the Cholesterol Treatment Trialists (CTT) collaboration so the question of who is being harmed (as well as other hypotheses) can be investigated.
JM Wright, MD, PhD
Departments of Medicine and Anesthesiology, Pharmacology & Therapeutics
University British Columbia Health Sciences
Vancouver
Canada
So what does all this mean?
It means that the wholesale prescribing of statins is an exercise with an eye on profits rather than the provision of health benefits.It means that better results may be obtained by diet and lifestyle changes known to have positive affects on the health of Humankind with absolutely no adverse side effects whatsoever. But then again, where is the gain in that and where are the lifesaving heroes in white coats?
Warm regards,
Sam Shohet