Study: Cholesterol Drugs Underprescribed

[CindySue48]

Study: Cholesterol Drugs Underprescribed

By JUSTIN M. NORTON, Associated Press Writer Mon May 30, 8:28 PM ET

SAN FRANCISCO - Cholesterol-lowering drugs known as statins that can help prevent heart disease are still underprescribed for many at-risk patients, according to a new study.
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Research by the Stanford School of Medicine concludes that doctors should aggressively examine patients with a moderate to high risk of heart disease to see if such drugs are appropriate. The study was released Monday in the online journal Public Library of Science Medicine.

"Only 50 percent of high-risk patients who visit doctors receive statins," said study author Dr. Jun Ma, a research associate at the Stanford Prevention Research Center. "People may die prematurely because of inadequate treatment. And people who should receive these drugs but don't are put at greater risk of heart disease."

Heart disease is one of the nation's leading killers, along with cancer. Each year, more than half a million people die from the disease.

Statins — along with blood-pressure medicines like beta blockers — are critical because they reduce risk factors that cause heart disease. Statins cut cholesterol production in the liver and boost the organ's ability to remove a "bad" cholesterol known as LDL.

The study also called for a renewed emphasis on how lifestyle factors, including exercise and diet, can reduce heart disease risks. Cholesterol checks are also important for adults.

Dr. Randall Stafford, associate professor of medicine at the Stanford Prevention Research Center and senior author of the study, said risk-lowering lifestyle changes are still overlooked.

"The problem is that we have not been effective at turning this evidence into practice," he said.

The study is apparently the first to examine how statin therapy varies according to the risk of heart disease among U.S. outpatients.

Researchers examined two national databases that track outpatient visits to hospitals and physicians between 1992 and 2002, and medications prescribed or renewed during the visits.

The researchers compared results with the number of patients who had been diagnosed with high cholesterol levels and varying degrees of risk for heart disease.

Among patients with high cholesterol in moderate and high-risk groups, researchers found fewer than half of patient visits in 2002 ended with a statin recommendation. Use of these drugs overall grew during the decade, but doctors said the drugs were still underused, in particular among moderate-risk patients.

"If compared to the number of patients who would benefit from these drugs, the degree of increase is less than what we'd expect," Ma said.

The study was funded by Merck Co., which manufactures statins Zocor and Mevacor, and by the Agency for Healthcare Research and Quality.

Dr. Kanu Chatterjee, a cardiologist and medical professor at the University of California, San Francisco, agreed with the findings. He said earlier studies have documented how statins are underused among blacks in the United States and among Europeans.

"There is no question that statins show a tremendous benefit in reducing the rates of heart attack and potentially the risk of strokes," said Chatterjee, who was not involved with the study.

OK....I'm gonna sit back and read the comments as they arrive. I gotta put some ice on my chin.....I bruised it when my jaw hit the floor!

Do you think it might be some conspiracy to reduce the population?

___

[322432]

I studied there in the 60's; but you can be sure that Stanford will get nothing more from me. Of course, they don't need it with Merck's funding. I'm ashamed.

[Kristine]

Here's a link (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020149) to a synopsis of the 'study'. So Merck paid for this doctor to analyze statin prescribing patterns, and the results are... *drumroll* ... not enough statins are being doled out!

I know I shouldn't be surprised, but "chin on floor" was pretty much my reaction, too. http://instagiber.net/smiliesdotcom/otn/angry/plthumbsdown.gif

[TBoneMitch]

If we were to believe what these «health» professionals are saying, we may come to believe that heart disease is caused by a statin deficiency in the human body.

Pure hogwash, fueled by pharmaceutical propaganda!

An interesting link:

www.lipitor.com

It is the official site for Pfizer's lipitor drug.
If you go at the bottom of the home page, you get the following disclaimer, lost in the marketing hype:

«It has not been shown to prevent heart disease or heart attacks»

Which puts some perspective to the reporter's claim that statins «prevent heart disease».

[Dodger]

I expected the analysis to have actually looked at the health status (death rate) between those given statins and those not within a comparable 'risk' category.

Instead all they analysed was how to increase drug sales.

[Nancy LC]

I think its the plan to "fix" social security. Kill off everyone at around age 50 with drugs they don't need.

[ojoj]

This sums it up beautifully!


http://www.thincs.org/Malcolm3.htm#jan16

Jo

[Rain1272]

This is insane. The drug companies must be stopped. How can a place such as Stanford continue to disseminate this type of propaganda with a clear conscience. Are we really that much about the almighty dollar? I feel like that exercise/diet guru from years ago and want to run around yelling "STOP THE MADNESS!!"

Cholesterol isn't the sole problem. Inflammation is. Even I, though I am not a doctor, know that total cholesterol numbers shouldn't be the sole factor in determining cardiac/stroke risks. Where is the push to have homocystine levels baseline and monitored? How many of you who have had their doctor say..."hmmm your cholesterol numbers aren't too good" have that followed up by the dr saying "lets check your homocystine to get a more accurate picture" I venture to guess there are few of you. I know mine didn't. I also know that mine never once suggested that there are potentially irreversible side effects and some of those side effects could be reduced by taking CoQ10. I find it quite sad and rather disturbing that I know more about this particular issue than my own physician does.

I agree with you Cindy, that it is a conspiracy but one that is between the doctors and pharmaceutical companies. Pharmaceutical companies push Dr's to prescribe the statins with financial incentives when they do. Dr's prescribe the statins which cause major, often irreversible and life threating side effects, which in turn require more medications to take care of, which further line the pockets of the pharmaceutical companies.

The only thing that will stop this is for the public to become aware, more educated, more vocal, take back control of their health and demand that their physicians be accountable to them rather than the pharmaceutical reps. Ultimately, the loudest voice will be those raised together in, sadly, lawsuits. It is when this effects the physicians bottom line that they will finally wake up and stop this. Until then it is up to each of us to be personally responsible for our healthcare, study and learn and refuse poor advice and treatment.

www.statinalert.org
http://www.freewebs.com/stopped_our_statins/researchdocuments.htm
http://www.theomnivore.com/
http://health.groups.yahoo.com/group/Stopped_Our_Statins/

[GeoUSA]

The more I read, the more I think that cholesterol is not part of the heart disease problem at all. Someone recently posted an article by Ron Rosedale, M.D. in which he indicated the whole idea of HDL/LDL -- good/bad cholesterol is wrong, that the body NEEDS a good amount of cholesterol, and that in itself explains why the body not only makes cholesterol, but returns it to the liver for storage.

I know that two years on Lipitor triggered loss of a good amount of muscle, joint pain, and memory problems for me. At least Crestor is receiving bad press now -- can it be that much longer before the other statins do too?

[Groggy60]

On the positive side, 50% of people that Merck thinks should be taking their drug, are not getting it from their doctor. Perhaps all doctors are not the saps you suppose they are while becoming better informed. Just as we read this in disbelief, I am sure there are many doctors will too.

Hopefully, next year a similiar study will say that 60% of the people that "need" the drug are not getting it.

[tie_guy]

Before I discovered LC diets I had high cholesterol so my doctor perscribed Liptor. At the time I knew I was supposed to take it but something just didn't feel right. Part of it was that after I found I had high cholesterol I did what I was supposed to: eliminate red meat and all forms of cholesterol in my diet. Of course that didn't work and this set off my BS detector. Then I went online to do research to convince myself to take the drugs. No matter how much I looked I couldn't find a study that said that statins would be safe and effective at making my life longer (I don't care about anything else.)

Then I took a closer look at the Lipitor commercial. At the time the adverstising campaign involved a person who did an insane amount of exercising and ate all of the "right" food and yet still had high cholesterol. This comfirmed what I already knew. You can eat "right" and still not effect your cholesterol. Then the real important information came up -- the fine print. This time I took the time to read the fine print in the ad and discovered that they admitted that lipitor has not been proven to reduce your risk of heart attacks or strokes. So wait a minute! Lipitor had not been proven to stop me from getting a heart attack (I could give a rats butt about my cholesterol numbers, I am sure that people have written entire PHD thesis on the differences between blood chemisty in different people and that those papers a real page turners) all I care about is the length and quality of my life. And as far as I could (and can tell now) lipitor may not make me live longer but it is quite possible that it could cause liver problems (and now I see muscle problems, heart problems and yes even death.) If you perscribe a drug that hasn't been proven safe and effective at making my life longer than I am sorry but you are not a scientist. Taking drugs without proving they work? What is this the 1700's?

So I never could bring myself to refil that perscription more than a few times. Good thing I discoverd LC diets and what they do to your cholesterol numbers. Now I no longer "need" to take lipitor. Not that I care but it was freaking my wife and mom out that I wasn't taking the drugs I "needed."

I am convinced that the lipitor cure is much worse than the disease. Heart attacks and strokes are the number one killer in america -- killing about 50% of us. Think about that: flip a coin, if it comes up heads you will die of a heart disease; tails and you will die of something else (cancer probably.) It is true that most of these deaths from heart attacks occur late in life and that these people really die of old age, but still. I wonder how much real research isn't done on heart disease because we already have the problem "solved" in the form of diet and statins.

[CindySue48]

If we were to believe what these «health» professionals are saying, we may come to believe that heart disease is caused by a statin deficiency in the human body.

Pure hogwash, fueled by pharmaceutical propaganda!

An interesting link:

www.lipitor.com

It is the official site for Pfizer's lipitor drug.
If you go at the bottom of the home page, you get the following disclaimer, lost in the marketing hype:

«It has not been shown to prevent heart disease or heart attacks»

Which puts some perspective to the reporter's claim that statins «prevent heart disease».


You know? The disclaimer on the website sounds exactly like the speil they give (softly) in the commercial.....except they don't say the "It has not been shown to prevent heart disease or heart attacks"

[CindySue48]

I think its the plan to "fix" social security. Kill off everyone at around age 50 with drugs they don't need.

I tell ya, I keep looking over my shoulder! :lol:

[Lisa N]

The study was funded by Merck Co.,

'Nuff said. :agree:

[VALEWIS]

Colpo just quoted a lit review in which it was shown that n-3 fatty acids (fish oil, folks) is better than statins in reducing mortality risk. See below.

Val

Effect of different antilipidemic agents and diets on mortality: a systematic review.

Studer M, Briel M, Leimenstoll B, Glass TR, Bucher HC.

Basel Institute for Clinical Epidemiology, University Hospital Basel, CH-4031 Basel, Switzerland.

BACKGROUND: Guidelines for the prevention and treatment of hyperlipidemia are often based on trials using combined clinical end points. Mortality data are the most reliable data to assess efficacy of interventions. We aimed to assess efficacy and safety of different lipid-lowering interventions based on mortality data. METHODS: We conducted a systematic search of randomized controlled trials published up to June 2003, comparing any lipid-lowering intervention with placebo or usual diet with respect to mortality. Outcome measures were mortality from all, cardiac, and noncardiovascular causes. RESULTS: A total of 97 studies met eligibility criteria, with 137,140 individuals in intervention and 138,976 individuals in control groups. Compared with control groups, risk ratios for overall mortality were 0.87 for statins (95% confidence interval [CI], 0.81-0.94), 1.00 for fibrates (95% CI, 0.91-1.11), 0.84 for resins (95% CI, 0.66-1.08), 0.96 for niacin (95% CI, 0.86-1.08), 0.77 for n-3 fatty acids (95% CI, 0.63-0.94), and 0.97 for diet (95% CI, 0.91-1.04). Compared with control groups, risk ratios for cardiac mortality indicated benefit from statins (0.78; 95% CI, 0.72-0.84), resins (0.70; 95% CI, 0.50-0.99) and n-3 fatty acids (0.68; 95% CI, 0.52-0.90). Risk ratios for noncardiovascular mortality of any intervention indicated no association when compared with control groups, with the exception of fibrates (risk ratio, 1.13; 95% CI, 1.01-1.27). CONCLUSIONS: Statins and n-3 fatty acids are the most favorable lipid-lowering interventions with reduced risks of overall and cardiac mortality. Any potential reduction in cardiac mortality from fibrates is offset by an increased risk of death from noncardiovascular causes.

[TBoneMitch]

Good one from Colpo again.
However, call me a cynic but I wouldn't expect these results to be reported into hysterical articles urging people to take fish oil!

[acohn]

What is a risk ratio, and how is it derived? Why is a lower number better?

[mcsblues]

What is a risk ratio, and how is it derived? Why is a lower number better?
This might help;

"HOW RISKY IS A RISK?

An analysis that will make it easier for you to hack your way through the misinformation that spews forth from the great medical research machine


by Malcolm Kendrick MD

I have only just recovered from the idea that everyone in the whole world over the age of fifty-five should spend the rest of their lives on six different medications, all stuck together in one great big pill. You may have seen the non-story about the non-existent polypill peddled in the British Medical Journal (BMJ). I was stimulated to look again at the concept of risk.

The authors of the madcap polypill article in the BMJ made the claim that taking their polypill would reduce the risk of dying of coronary heart disease (CHD) by 80%. Whether or not you believe their figures — and I don’t — I sense that this figure of 80% would be taken by most people to mean that eighty out of one hundred people would be saved from death.

Yet, that is not what it means at all, for this figure is a relative risk reduction figure. And a relative risk reduction means nothing, by itself. However, because everyone’s eyes glaze over whenever you start talking about statistics, most researchers manage to get away with using relative risk reduction figures when, in reality, they should be shot for doing so.

Now, here’s a challenge. The challenge to make an article about statistics interesting….. Okay, that’s not possible. But maybe a little bit interesting?

When you talk about a risk, you need to know the absolute risk of a thing happening. For example, the risk of getting struck by lightening. I don’t actually know what that risk is, but I would imagine it is about one in five million. But again, that figure means nothing unless you put a time scale on it. Is this a one in five million risk over a hundred years, or one year?

If you don’t put a time scale in, you can claim anything you like. For example ‘The Earth will be hit by a big Asteroid. This is one hundred percent certain — shock claim from Astronomer.’ Read all about it. And of course, this is true. The Earth will be hit by a big Asteroid, sometime in the next three billion years or so. The odds ratio for this event is 1 = 100% certain. I am even willing to take a bet on it.

So, I must define risk in two ways, the possibility of the thing happening, and the time period during which that thing will happen. With lightening strikes, this is about a one in five million risk, over a five year period. Not high.

However, people don’t tend to bend statistics by ignoring the time factor that often. Unless they want money to fund their Asteroid defence system. A snip at five trillion dollars, plus VAT. What generally happens is that people inflate the risk in the following way. For example, the chances of dying of lung cancer, for a non-smoker, are about 0.1%, lifetime risk. If, however, you live with a heavy smoker, your chances will increase to about 0.15%. (These figures are for illustration only).

Now you can report this in two ways. You can state that passive smoking can increase the risk of lung cancer by 0.05% - one in two thousand. Or, you can state that passive smoking increases the risk of lung cancer by fifty per cent. Both figures are correct. If you are an anti-smoking zealot, then I would imagine you would prefer to highlight the second figure. The relative risk figure.

And when it comes to reducing cardiovascular risk, exactly the same procedure is used (in reverse). Let’s say that the chance of dying of CHD over five years, in a healthy fifty-five year-old, is 1%. By reducing this risk to 0.2%, you will have reduced the relative risk of dying of CHD by 80%. In this way a 0.8% absolute risk reduction is hyped up as an 80% reduced risk of dying of CHD. Mangling statistics is easy when you know how. It’s even fun.

Anyway, now you know the difference between a relative risk and an absolute risk, and I hope this makes it easier for you to hack your way through the misinformation that spews forth from the great medical research machine."

http://www.thincs.org/Malcolm.htm#risk

Cheers,


Malcolm

[K Walt]

While the risk ratios in the quoted study are indeed favorable to statins -- and to omega 3's --- the effects are TINY.


Statins have a TINY effect on mortality. Almost immeasurable.

In this sort of study a value of 1.00 shows NO effect. It means your risks ON the drug, are the same as your risk OFF the drug. ON divided by OFF equals 1.00.

If your risk ON the drug is smaller than OFF, the ration -- ON divided by OFF -- becomes less than one. A smaller number, which is supposedly 'good.

However, in this case, the stated effects are MINISCULE. Usually, statisticians would attribute this to mathematical 'noise'.

You wouldn't pay much attention until the risk ration gets down to 0.33 or something.

Here's an explanation of Risk Ratios:


http://www.numberwatch.co.uk/RR.htm

[Abd]

I expected the analysis to have actually looked at the health status (death rate) between those given statins and those not within a comparable 'risk' category.

Instead all they analysed was how to increase drug sales.

Paranoid thought: they *did* look at the death rate, but it showed no improvement from taking statins. So they didn't report it. If it *had* shown an improvement, they'd have reported it. For sure.

The problem is clear in the confused language used. The article uses "risk factor" and "risk" as if they were interchangeable. A "risk factor" is something that has been shown (or is accepted without clear evidence, which is sometimes the case) to be associated with an undesireable outcome like heart disease. A "risk" is something that actually is implicated in causing heart disease. Blood cholesterol is a risk factor, it is commonly claimed (apparently without much evidence). But there is no proof that lowering blood cholesterol actually lowers the risk of heart disease. The statins lower cholesterol (though only a little). Whether or not this actually helps prevent heart disease is unknown, or you can be sure that the drug companies would not have that disclaimer on their web sites.

I discussed my last cholesterol test with my doctor (total cholesterol about 330), and he had agreed that I was actually low risk for heart disease. (Not only do I have a mother still kicking at 95, living alone, takes care of herself -- and who has high blood cholesterol -- but I have low triglycerides and good HDL, plus I had a stress test -- excellent -- and to top it off, a cardiac CAT scan. I have low artery blockage, Agatston score of 25, i.e., 75% of asymptomatic men my age have more blockage. I suggested that just to be prudent, perhaps I should see a cardiologist. He said that it would be hard to find one who wouldn't insist on putting me on statins.

The drug propaganda has really worked! The drug companies don't actually lie. They merely manipulate the information so that clueless reporters and others come to the incorrect conclusions that the drug companies want. They might say "risk factor." The reporter hears "risk."

The whole thrust of that study, and the article reporting on it, would be deflated if it was merely mentioned in the article what is mentioned on the drug web sites. After all, it would be much harder to scare more doctors into prescribing statins if they were at the same time reminded that statins aren't known to prevent heart disease. They just lower blood cholesterol. And, quite simply, it is not really known if that is a healthy or unhealthy thing to do. My guess is that it isn't healthy.

Here is a really scary aspect to this:

Because it is "common wisdom" that high cholesterol is high risk for heart disease, and because it is commonly assumed that lowering cholesterol with statins may prevent heart disease, if a doctor *doesn't* prescribe it, and a patient has a heart attack later, there is a risk that he would be sued, because he failed to follow "standard practice."

My doctor said that he hates the system.... he didn't spell it out for me, but he treated my high cholesterol, until we talked, pretty much as an emergency. If he hadn't, he'd have been vulnerable to a lawsuit. How aware was he of this? I'm not sure. But there is pressure on doctors to follow the herd. I think we all need to be aware of this and factor for it when we decide what advice to follow and what to challenge. We need to do our own research.

There is no substitute for being informed.

[Angeline]

Anthony's Colpo take on the subject :

Statins 'Underused', Whines Drug Company-Funded Study

Anthony Colpo,
June 6, 2005

Although the prescription of statins has skyrocketed in the past decade, many patients eligible for statin therapy are still not being prescribed the cholesterol-lowering drugs, according to a recent study.

"Despite significant increases from 1992 to 2002 in use of statins associated with hyperlipidemic patient visits, the magnitude of increases is smaller than expected and the rate of use remains suboptimal according to the best available evidence," write Dr Jun Ma (Stanford University School of Medicine, CA) and colleagues in the June 2005 issue of the Public Library of Science Medicine journal.

The authors analyzed annual data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Using data from 1992 through 2002, they were able to track trends in statin use in the US during ambulatory visits; these were categorized by CHD risk, with or without a diagnosis of hyperlipidemia.



Statins not being pushed aggressively enough,
complain drug
company-funded researchers.


While statin use increased from 1992 to 2002 among moderate- and high-risk patients with hyperlipidemia, just half of these patients were prescribed statins during a consultation with their physician in 2002. Lifestyle counseling regarding diet, exercise, or smoking cessation occurred in only 43% of new and general medical examination visits in 2002 for patients with moderate CHD risk and diagnosed hyperlipidemia.

Ma and colleagues point out that such treatment gaps were observed just one year after the publication of the 2001 NCEP Adult Treatment Panel III recommendations (which just happen to be written by drug company-sponsored researchers). "These obvious treatment gaps are disconcerting, especially in light of the recent [2004] Adult Treatment Panel III update that supports more intensive lipid-lowering drug therapy for patients at high and moderately high risk for a heart attack," write the authors.

Of particular note, the lowest rates of statin use were observed in at-risk younger patients, females, African Americans, and patients cared for by non-cardiologists.

Objective study...or biased, pro-drug nonsense?

The researchers make little mention of the fact that statins have failed to show any mortality benefit in the elderly, males without existing heart disease, and in women with or without CVD.

Despite the researchers' finding that "Lifestyle counseling regarding diet, exercise, or smoking cessation occurred in only 43% of new and general medical examination visits..." they devote the title and bulk of their paper to statin use.

News flash: heart disease occurs--not because of a lack of vitamin 'S' (statins)--but because of sub-optimal nutrition, stress, lack of exercise and exposure to harmful agents such as cigarette smoke.

Of course the fact that the aforementioned study gave little emphasis to this, and instead focused on the alleged 'deficient' pushing of statins by doctors, would have had absolutely nothing to do with the fact that the study was sponsored by an unrestricted grant from Merck, manufacurers of simvastatin (Zocor) and lovastatin (Mevacor), would it?

Gee, of course not…

Reference

Ma J, Sehgal NL, Ayanian JZ, et al. National trends in statin use by coronary heart disease category. PLoS Med 2005; 2: e123.