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  #1   ^
Old Mon, Sep-11-17, 03:52
teaser's Avatar
teaser teaser is offline
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Plan: ketosis/IF
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Default statins vs. heart disease death

https://www.sciencedaily.com/releas...70906170427.htm

Quote:
Statins reduce deaths from coronary heart disease by 28 per cent in men, according to longest ever study

The study, by Imperial College London and University of Glasgow, focused on men with high levels of 'bad' cholesterol and no other risk factors or signs of heart disease.

Previous research has shown the benefit of statins for reducing high cholesterol and heart disease risk amongst different patient populations. However, until now there has been no conclusive evidence from trials for current guidelines on statin usage for people with very high levels of low density lipoprotein (LDL) cholesterol (above 190mg/dL) and no established heart disease.

After studying mortality over a 20-year period, researchers led by Professor Kausik Ray at Imperial showed that 40mg daily of pravastatin, a relatively weak type of statin, reduced deaths from heart disease in participants by more than a quarter.

Senior author Professor Ray from Imperial's School of Public Health said: "For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy except for very high LDL levels. This legitimises current guidelines which recommend treating this population with statins."

In addition, the findings challenge current approaches on treating younger patients with LDL elevations with a 'watch and wait' approach. Instead, the authors say even those with slightly elevated cholesterol are at higher long term risk of heart disease, and that the accumulation of modest LDL reductions over time will translate into large mortality benefits.

Professor Ray added: "Our findings provide the first trial-based evidence to support the guidelines for treating patients with LDL above 190mg/dL and no signs of heart disease. They also suggest that we should consider prescribing statins more readily for those with elevated cholesterol levels above 155 mg/dl and who also appear otherwise healthy."

The paper is published in the journal Circulation. It follows on from a five-year 1995 study in which researchers observed the long-term effects of statins on patients involved in the West of Scotland Coronary Prevention Study (WOSCOPS) trial. The researchers took into account the original five-year study and followed the patients for a further 15 years.

The WOSCOPS study provided the first conclusive evidence that treating high LDL in men with pravastatin for five years significantly reduces the risk of heart attack or death from heart disease compared with placebo. Statins were subsequently established as the standard treatment for primary prevention in people with elevated cholesterol levels.

Now, researchers have completed analyses of the 15-year follow up of 5,529 men, including 2,560 with LDL cholesterol above 190 mg/dL of the original 6,595, chosen because they had no evidence of heart disease at the beginning of the present study.

Participants were aged 45-64 years. During the five-year initial trial they were given pravastatin or placebo. Once the trial ended the participants returned to their primary care physicians, and an additional 15-year period of follow-up ensued.

The 5,529 men were split into two groups: those with 'elevated' LDL (between 155 and 190mg/dL) and those with 'very high' LDL (above 190mg/dL). The standard 'ideal' level of LDL for high risk patients is below 100mg/dL, but this varies depending on individual risk factors.

The researchers found that giving pravastatin to men with 'very high' LDL reduced twenty year mortality rates by 18 per cent. Statins also reduced the overall risk of death by coronary heart disease by 28 per cent, and reduced the risk of death by other cardiovascular disease by 25 per cent among those with very high LDL cholesterol.

The 15-year follow up also meant the researchers could compare patients' original predicted risk of heart disease with actual observed risk. According to the risk equations to for cardiovascular disease, 67 per cent of patients included in the WOSCOPS trial with LDL above 190mg/dL would have less than a 7.5 per cent risk of heart disease by year ten, and thus would not have been treated with statins based on that risk. However, the present study shows that in fact, this group actually had a 7.5 per cent risk by year five, and meaning their ten year risk was 15 per cent. Following statin therapy, this group's ten year risk was reduced compared with those that were given placebo during the trial.

The authors say today's findings provide the first direct randomised trial evidence to confirm that current guidelines should stand as they are for those with very high LDL, and those with LDL levels above the 190mg/dL threshold should be considered for statin therapy without risk assessment, as the LDL elevation provides enough risk on its own.

Professor Ray said: "This is the strongest evidence yet that statins reduce the risk of heart disease and death in men with high LDL. Our study lends support to LDL's status as a major driver of heart disease risk, and suggests that even modest LDL reductions might offer significant mortality benefits in the long-term. Our analysis firmly establishes that controlling LDL over time translates to fewer deaths in this population."


http://circ.ahajournals.org/content...NAHA.117.027966

Quote:
Abstract

Background—Patients with primary elevations of LDL-C ≥190 mg/dL are at a higher risk of atherosclerotic cardiovascular disease as a result of long-term exposure to markedly elevated LDL-C levels. Therefore, initiation of statin therapy is recommended for these individuals. However, there is a lack of randomised trial evidence supporting these recommendations in primary prevention. In the present analysis we provide hitherto unpublished data on the cardiovascular effects of LDL-C lowering among a primary prevention population with LDL-C ≥190 mg/dL.

Methods—We aimed to assess the benefits of LDL-C lowering on cardiovascular outcomes among individuals with primary elevations of LDL-C ≥190 mg/dL without pre-exiting vascular disease at baseline. We carried out post-hoc analyses from the West Of Scotland Coronary Prevention Study (WOSCOPS) randomised, placebo-controlled trial, and observational post-trial long-term follow-up, after excluding individuals with evidence of vascular disease at baseline. WOSCOPS enrolled 6595 men aged 45-64 years, who were randomised to pravastatin 40 mg/d or placebo. In the present analyses, 5529 participants without evidence of vascular disease were included, stratified by LDL-C levels into those with LDL-C <190 mg/dL (n=2969; mean LDL-C 178±6 mg/dL) and those with LDL-C ≥190 mg/dL (n=2560; mean LDL-C 206±12 mg/dL).The effect of pravastatin versus placebo on coronary heart disease (CHD) and major adverse cardiovascular events (MACE) were assessed over the 4.9-year randomised-controlled trial phase and on mortality outcomes over a total of 20-years of follow-up.

Results—Among 5529 individuals without vascular disease, pravastatin reduced the risk of CHD by 27% (p=0.002) and MACE by 25% (p=0.004) consistently among those with and without LDL-C ≥190 mg/dL (p-interaction >0.9). Among individuals with LDL-C ≥190 mg/dL, pravastatin reduced the risk of CHD by 27% (p=0.033) and MACE by 25% (p=0.037) during the initial trial phase and the risk of CHD death, cardiovascular death and all-cause mortality by 28% (p=0.020), 25% (p=0.009) and 18% (p=0.004), respectively, over a total of 20-years of follow-up.

Conclusions—The present analyses provide robust novel evidence for the short and long-term benefits of lowering LDL-C for the primary prevention of cardiovascular disease among individuals with primary elevations of LDL-C ≥190 mg/dL.


Okay, so you do a five year study with statins. Over the five years, there's less heart disease. You return patients to their family doctors. The intervention is over.

You now have two groups, one has been established to have a higher rate of heart disease. One thing that's very predictive of future heart disease is pre-existing heart disease. Once you've established these groups, one with higher heart disease than the other--even if the intervention ends, even if their treatment going forward is likely to be roughly the same, the family doctor is likely to put them on statins, not continue their placebo treatment, if that's what they had before. It seems to me that once a group with higher heart disease is established, the probability that that pattern will continue is high. Less cardiovascular disease in five years being followed by less cardiovascular death going forwards isn't really astonishing.
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  #2   ^
Old Mon, Sep-11-17, 06:27
JEY100's Avatar
JEY100 JEY100 is offline
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Study was funded by Sanofi S.A. A French multinational pharmaceutical company and was originally funded by Bristol-Myers Squibb and Sankyo, also producers of statins. Not that I want to delve into it, but believe this is relative risk, though still has an absolute risk of 2%....as long as you can tolerate the side effects for 20 years. And you have to be a man with "very high" LDL.
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  #3   ^
Old Mon, Sep-11-17, 06:37
teaser's Avatar
teaser teaser is offline
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Plan: ketosis/IF
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Thanks Janet. Not shocked. One thing I found funky;

Quote:
"For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy except for very high LDL levels. This legitimises current guidelines which recommend treating this population with statins."


I know it's in his best interest to make the study seem as significant as possible--but in doing so, he's pretty much bashed the idea that outside of this one study, there's much of anything to "legitimize" current statin guidelines. This is actually quite the admission.
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  #4   ^
Old Mon, Sep-11-17, 09:57
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GRB5111 GRB5111 is offline
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What is alarming is that the studies (initial 5-year and subsequent 15-year) are based on the assumption that anyone with LDL-C above 190 mg/dL is at risk. And over time, the level of LDL-C considered dangerous is being lowered. More and more we're learning that LDL-C is not a valid health marker for CHD. Just as we've learned that total cholesterol is no longer a valid health marker. So, you generate data based on a questionable health marker from studies funded by the very pharmaceutical companies who have a vested interest in an outcome for promoting statins. Sorry for stating the obvious, but we live in a crazy world when no one is willing to challenge these findings, other than those of us who have interest in reading and researching this stuff. And the physicians who can prescribe these medications fall in line and continue to do so based on relative risk data. Unbelievable, but true.

Yesterday, I was again in the car listening to Doctor Radio on XM (yes, I am a glutton for punishment), and I heard a cardiologist describing the dangers of high blood pressure and how it causes stroke, heart disease, and other bad health situations, and all I could do is wonder, well, what causes high blood pressure, and isn't it simply another symptom correlated with stroke, heart disease, and other bad health situations? We no longer seek to find the root cause that could be the reason for a variety of symptoms. Again, I'm stating the obvious, but we've lost our ability to think about how all these symptoms being much more frequent and common since the late 1970s came to be. What has changed since then? I believe a few of us know or at least have a reasonable hypothesis.
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  #5   ^
Old Mon, Sep-11-17, 13:14
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JLx JLx is offline
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Quote:
I heard a cardiologist describing the dangers of high blood pressure and how it causes stroke, heart disease, and other bad health situations, and all I could do is wonder, well, what causes high blood pressure, and isn't it simply another symptom correlated with stroke, heart disease, and other bad health situations? We no longer seek to find the root cause that could be the reason for a variety of symptoms.


A friend and I used to walk our dogs together every day and when I moved she said she had to go back on her blood pressure meds because she didn't walk as far or as fast without me. It's too bad that doctors don't "prescribe" a half hour of somewhat brisk walking daily - for various reasons. Simple walking also compared favorably with Zoloft for depression in a Duke University a while back, for instance.

I joined a weight loss group last year and was rather shocked to find that most members do no form of exercise and ALL of them still eat sugar! Including the diabetics.
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