Tuesday, May 22, 2012

More data to recommend putting statins in the drinking water?

There seems to be little controversy regarding treating patients with coronary artery disease with statins,what we call secondary prevention. Primary prevention, treating patients, who have no clinical evidence of heart disease,with statins is another matter being more than a little controversial.

Now we have a new meta-analysis that concluded primary prevention is a good idea. See here for a discussion of that study which reported a reduction in cardio-vascular mortality and all cause mortality in so called low risk patients. On the other hand (clinicians may yearn for the mythical one handed epidemiologist) a large meta-analysis by Dr. K. Ray and colleagues found no benefit in terms of all cause mortality.see here.

A few years ago I felt reasonably confident that I could a)determine a person's cardiac risk with a risk equation and b) advise that person about taking statins to lower his risk. I am much less sure about both those two things now but I still obstinately take pravastatin. In regard to risk equations I said all I can say about that in this several years old post entitled "Individual risk assessment,a peculiar,elusive,ambiguous concept." I would add another modifier, "faith based".

So how good can the risk equations ( yes there are more than one for predicting risk of coronary heart disease events and death ) be when studies perched on the highest rung on the ladder of evidence based medicines give contradictory results?

5 comments:

Michel Accad said...

James, I enjoyed reading your old post from 2007 on the topic of individual risk evaluation.

Cheers,

Michel

Margaret said...

"More data to recommend putting statins in the drinking water?" Looks like not a good idea. I've read lots of articles about statins and most of them have a detailed information about its side effects. I hope they change their mind with their plans. It's not a good idea. For sure many people will protest with this idea.

james gaulte said...

I suspect the question mark after the title did not adequately reflect the sarcasm intended.
James

Roy M. Poses MD said...

It looks like the latest meta-analysis was deliberately designed not to answer the main question, that is, do statins decrease mortality for patients without known underlying coronary disease? Instead, it was designed to answer a question that probably makes no sense: if a patient with no known coronary disease takes statins, and then has a specific decrease in LDL, does such a patient have a lower risk of mortality? See: http://brodyhooked.blogspot.com/2012/05/statins-in-water-supply-continued-why.html

james gaulte said...

Dr.Poses,

Thanks for your comments.I was not aware of Dr. Bordy's critique and he certainly raises an important point.When knowledgeable folks poke around inside the details of meta-analysis often the published results seem to be less black and white than the publication's summary indicates.