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Worried about taking statins? Here’s what you need to know

After last week’s controversial Catalyst program on the ABC, some people may be wondering whether they should stop taking statins to lower their cholesterol. But before making such a decision, read this…

People who are questioning whether to continue taking statins should talk to a doctor. Hilke Kurzke

After last week’s controversial Catalyst program on the ABC, some people may be wondering whether they should stop taking statins to lower their cholesterol. But before making such a decision, read this article and discuss your risk of heart disease or stroke with a doctor.

About 2.6 million Australians take statins. And a recent analysis of Australian data found that over-treatment of people at low risk is more common than under-treatment of people at high risk.

This is problematic but it doesn’t reflect a problem with the statins. Rather, it shows that people may not be appropriately informed about who benefits from taking this medicine.

What the trials say

While Catalyst highlighted that most of the major trials for statins have been funded by the pharmaceutical industry, it didn’t explain their overall results.

A collaboration funded by the UK Medical Research Council, British Heart Foundation and Cancer Research UK (the Cholesterol Treatment Triallists Collaboration), brought together data from 26 trials involving 170,000 patients, to better understand what the trials found.

What they discovered was the results are remarkably consistent: they show statins reduce the risk of heart attack or stroke by about 20%. This is true whether you’ve had a heart attack or stroke in the past or not.

There were fewer women in the trials, so the numbers for women are less precise but they’re approximately the same as the overall numbers.

If your risk of having a heart attack or stroke over the next five years is 30%, taking statins will reduce it to 24%. If it’s 10%, your risk is reduced to 8%. Obviously, the benefit is greater if your initial risk is higher (we’ll come back to how to work this out later).

Heart attacks and strokes are serious events that most people want to avoid, and there’s clear, solid evidence that statins reduce the chance of having one.

But like all drugs, statins also have side effects and the Catalyst program was correct in pointing out that these were probably underestimated in the trials. There are good reasons for this.

Trials often exclude people with early side effects, the elderly and people with other conditions, such as kidney disease. It would be unethical to continue giving a new drug to someone if they are experiencing side effects and do not wish to continue, so participants can withdraw from the trial at any time.

The age group and medical conditions for clinical trials are specified so it can identify the effect of the drug on the target group for treatment. But the side effects of statins have been investigated in many other studies and populations outside of those trials, and continue to be monitored.

The most common side effects are fatigue, exercise intolerance, cataracts, and sometimes, memory loss. On the other hand, statins may protect people from small strokes that could cause dementia. This is why the decision to take statins has to be a balance between their benefits and risks.

Who should take statins

In Australia, the National Heart Foundation, Kidney Health Australia, Diabetes Australia, and the National Stroke Foundation (the National Vascular Disease Prevention Alliance) have weighed up the benefits and risks of drugs to lower cholesterol.

The decision to take statins should not be based on someone’s cholesterol level alone unless it’s unusually high. Divine Harvester/Flickr

They recommend medication for people who have a high absolute risk, which is more than a 15% chance of having a heart attack or stroke over the next five years.

The absolute risk of heart attack or stroke is calculated by using all the major factors that predict risk – age (it gets more likely as you get older), sex (males are at higher risk), blood pressure, and cholesterol. Whether someone smokes or has diabetes also strongly impacts their risk profile.

Medication may also be considered for people at moderate risk (10% to 15%), who haven’t been able to reduce their risk with diet and exercise. Or if they have a strong family history of heart disease.

The decision to take statins should not be based on someone’s cholesterol level alone unless it’s unusually high. If you are between 35 and 74 years of age, and know your blood pressure and cholesterol level, you can calculate your own risk here.

The advantage of this approach (using absolute risk as the guide) is that people at high risk of heart attack or stroke who have normal cholesterol levels can still reduce their risk by taking statins.

At the same time, people with mildly elevated cholesterol levels who have no other risk factors (and are therefore unlikely to benefit) don’t need to take them.

The balancing game

Regular exercise and a Mediterranean-style diet also lower the risk of heart attack and stroke, and are recommended for everyone, whether they have low, medium, or high risk. But for some people, this is not going to be enough.

The number of deaths from heart disease has fallen dramatically since its peak in the late 1960s and early 1970s. This is partly because of overall improvement of diet, efforts to stop smoking and control blood pressure.

But reducing cholesterol levels through drugs, such as statins, has also played an important role.

People on statins who are now questioning whether to continue take them should talk to a doctor about their absolute risk of heart attack or stroke. This calculation needs to be based on levels of cholesterol and blood pressure before starting medication.

If substantial lifestyle changes have recently been made, it may be appropriate to consider a trial period off statins.

Statins are no magic bullet and people who take them may still have a heart attack or stroke, even though their chance of having one is reduced. And the truth is that if a person has been taking statins and doesn’t have a heart attack or stroke, we can’t tell if that’s because of statins or because they were never going to have one.

The best we can do is use data from trials and other studies to estimate the benefits and risks. Like all medications, statins are not inherently good or bad - whether they help someone depends on whether their likely benefit outweighs their side effects for an individual.

Join the conversation

78 Comments sorted by

  1. Paul Rogers

    Manager

    I asked this on a previous Conversation piece and did not get an answer. Why is physical activity not included in CVD risk calculators? I tried about 5 different calculators (including cvdcheck) and none asked for exercise input.

    Is the data not strong enough? It seems to be. If physical activity is a substantial modifier of risk, and if MDs use standard calculators, then risk will be overestimated -- and perhaps statins over-prescribed.

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    1. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to Paul Rogers

      Hi Paul, physical activity has an indirect effect on CVD risk in these calculators via blood pressure and cholesterol. One problem with accurately quantifying the effect of physical activity is measurement - how do you ask about this in a standardised way? One person's idea of 'vigorous' exercise may be 'moderate' according to another person. However there is a lot of ongoing research into both self-report and objective measures of physical activity, e.g. using pedometers and accelerometers, which can be linked to smartphones for continuous data collection. This will hopefully allow us to incorporate physical activity into future CVD risk models, but it will not necessarily improve the accuracy of the calculators if the other risk factors are still stronger predictors.

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    2. Citizen SG

      Citizen

      In reply to Paul Rogers

      CVD check doesn't calculate risk from diet and family history either. It's a blunt tool.

      The heart foundation primary care guidelines for health care professionals do elaborate on the calculation of absolute risk, however.

      http://www.heartfoundation.org.au/SiteCollectionDocuments/guidelines-Absolute-risk.pdf

      It does seem unlikely that a Gp would prescribe a statin based upon one paramete although it happened to me - even though my absolute risk is very low (obviously as an informed healthcare consumer i declined the offer of a simvastatin prescription).

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    3. Paul Rogers

      Manager

      In reply to Carissa Bonner

      Carissa, yes I understand that exercise can have positive effects on cholesterol and blood pressure, and probably inflammation (hs-CRP), but I suspect that VO2 max is an independent risk modifier; by how much is under evaluation.

      How to quantify physical activity in a questionnaire . . .? I like four of these questions (with choices) in this from a Norwegian Uni:

      How often do you exercise?
      How long is your workout each time?
      How hard do you train?
      What is your resting pulse? (but exclude…

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    4. Paul Rogers

      Manager

      In reply to Richard Hockey

      Richard, thanks, nearly missed your post. That calculator seems much better. Not sure how validated it is, but I like this comment in the instructions:

      "The calculator can be tweaked to take into account concerns that in some populations the Framingham database appears to over-estimate risk. Some studies have suggested Framingham data overestimates CHD risk - a German cohort (50% overestimate) Eur Heart J 2003;24:937-45, British cohort (57% overestimate) BMJ 2003;327:1267, Italian cohort Int J Epi 2005;34:413-21, UK cohort Atherosclerosis 2005;181:93-100, Chinese cohort (2-3 times overestimate). "

      Truly, Framingham need some tweaks I'm sure, especially for the over 50s. Many more ageing people are exercising these days. Risk calculators can't just ignore such an important risk factor.

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    5. read me

      educator

      In reply to Paul Rogers

      1. The Japanese eat very little fat and suffer fewer heart attacks than Brits.
      2. The Mexicans eat a lot of fat and suffer fewer heart attacks than Brits.
      3. The Chinese drink very little red wine and suffer fewer heart attacks than Brits.
      4. The Italians drink a lot of red wine and suffer fewer heart attacks than Brits.
      5. The Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than Brits.
      CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

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    6. Evelyn Haskins

      retired

      In reply to read me

      Ooo. I can't speak any other language.

      Except maybe Auslan (Australian Sign Language). Do you think that might help?

      I think though that maybe I'd better start learning German :-)

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  2. John Crest

    logged in via email @live.com.au

    No. Because I don't take medical advice from the ABC.

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  3. David Marcus

    logged in via email @ticktock.net.au

    An issue passed over in this article is the measurement of risk. Having looked at the risk calculator, it is very hard for any male over 50 NOT to be designated as high risk, hence if this is the guideline for prescribing statins no wonder they are used so heavily. If the actual risk is 20% (so high) then statins will (on average) reduce it to 16%. Note that the calculator says this is the risk of 'CVD' - they don't say risk of heart attack or stroke. Some better communication is needed.

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    1. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to David Marcus

      Hi David, the measurement of 'risk' in the Australian calculator is based on the long term Framingham study, which identified the risk factors that best predicted whether people had a heart attack or stroke. As you say, being older and male does make you more likely to be over the 15% high risk threshold, because age and gender are two of the most predictive risk factors, but a bigger problem is that low risk people are being prescribed statins unnecessarily. That's why it's important to account for the effect of non-modifiable risk factors, rather than focusing on cholesterol in isolation. The term 'cardiovascular disease' or CVD includes heart attack and stroke, but I agree it should be clearer.

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    2. Paul Rogers

      Manager

      In reply to David Marcus

      I agree, David. I don't know if GPs use these calculators, but I do wonder at the precision. I guess the smart GP is going to use his personal knowledge and interaction with the patient to some extent to further apply risk judgement.

      Even so, I tried about 5 different calculators from reputable sources and for me they varied by 7%, in the range 9% to 16%. I note that cvdcheck does not even include BMI or waist circumference. And why on earth would it include ECG LVH? How often would that be available?

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    3. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to Paul Rogers

      Hi Paul, one reason for the different calculations you found may be that different versions of the Framingham risk model are being used - the Australian and New Zealand guidelines use the 5 year risk calculation, but other countries use a 10 year calculation that has an alternative version using BMI if cholesterol is not known. There are also other risk prediction models that may predict risk more accurately in specific populations, for example QRISK2 accounts for socio-economic areas in the UK.

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  4. Robert Smart

    retired

    Vitamin-d/sunshine proponents claim that statins are effective because they are similar to vitamin-d and are unnecessary if your vitamin-d levels are nice and high. Yet I've never seen this addressed by statin proponents, nor have I heard of how effectiveness of statins varies with vitamin-d level, nor have I heard of controlled trials that compare statin with vitamin-d supplementation. Given the pharmaceutical industry's appalling record, it is incumbent on government research to answer these questions.

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  5. John Charlesworth

    Scientist

    You really should read the latest analysis of the 2012-2013 Cochrane study:

    “Should people at low risk of cardiovascular disease take a statin?”

    BMJ 2013; 347 : f6123 doi: 10.1136/bmj.f6123 (Published 22 October 2013 )

    http://www.abc.net.au/catalyst/heartofthematter/download/StatinsshouldNOTbebroadedtowiderpopulation.pdf

    The bottom line:

    “Our calculations using data presented in the 2012 CTT patient level meta-analysis show that statin therapy prevents one serious cardiovascular event…

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    1. Paul Rogers

      Manager

      In reply to John Charlesworth

      Sure, but that's one analysis and opinion. Catalyst took sides here and couched the whole thing in combative, crusading rhetoric. That may make good television for the gullible masses but it's not necessarily good science.

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    2. Bob Liddelow

      No title

      In reply to Paul Rogers

      Some alternative aggression is needed to combat the energy and persistence with which the manufacturers of statins promote their prescription to large populations. This promotion proceeds with about as much balance as the Catalyst program but is far more lucrative. As well as that, one peer-reviewed article can be just as persuasive, if not more so, than multiple reports which limit published results to the effect on CVDs while avoiding any mention of total mortality, even though the data is there. Not good science.

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    3. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to John Charlesworth

      That report listed in Catalyst shows that asking your doctor for advice is not a very good option.
      As stated elsewhere it's the doctors who need to be reeducated to balance the sales pitch from pharmaceutical reps etc.
      Whose responsibility is that?

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  6. Gary Cassidy

    Thanks for the article.
    RE: "Rather, it shows that PEOPLE may not be appropriately informed about who benefits from taking this medicine."
    Should that not more appropriately read "... that DOCTORS may not be appropriately informed"

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  7. Pera Lozac

    Heat management assistant

    "If your risk of having a heart attack or stroke over the next five years is 30%, taking statins will reduce it to 24%. If it’s 10%, your risk is reduced to 8%. "

    ...and if my chances of dying of a heart attack are 100% statins will reduce it to 98%.....

    Do you even realise how statistically insignificant this is and how ridiculous this statement is to start with. On top of that statins will increase my sugar blood levels which will of course result in me taking more medication for that. After that is a high blood pressure, and another set of medication for that. Did anyone do a study how different medication interact. What is obvious is that the only ones who are wining are big Pharma and doctors paid to promote their products. Another Phizer sponsored statin symposium in Hilton Vienna - why not! It is all for the benefit of humanity.

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    1. Reema Rattan

      Editor at The Conversation

      In reply to Pera Lozac

      Actually, if your risk is 100%, statins will reduce it to 80%.

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    2. Pera Lozac

      Heat management assistant

      In reply to Reema Rattan

      Thank you for the correction. I still have sand in my eyes but I can see clearly now. I was not arguing your pseudo-statistics but the bigger picture. Meaning that I have 20% less chance of dying from a heart attack but 150% more chance of getting significantly decreased life expectancy and life quality due to diabetes. How is that helping me exactly?

      I cannot understand how can anyone with half a brain seriously contemplate to "calculate" a chance of getting a heart attack. People like that…

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    3. Evelyn Haskins

      retired

      In reply to Pera Lozac

      I dunno. But I interpret it as 'taking stantins is a gamble which MIGHT help you to live longer (though not necessarily in good health).

      My personal philosophy is that IF a recommened treatment does NOT cause side efects, then I am am willing to give it a go.

      IF a recommended treatment causes side effects I will do a personal assessment of which I find worse. In the case of statins it is toss up between possibly of dying two years earlier than I might otherwise and the thought of living with the possibly life threatening side effects.

      Having a sister-in-law who was at death's door through taking statins as prescribed by her doc. I think that I will simply pass on the statins.

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  8. John Wright

    logged in via LinkedIn

    I would be grateful if you could explain why the CTT trialists produced results not seen elsewhere. I think many readers would appreciate an explain action at to why they chose a non standard surrogate endpoint to arrive at their data. Your comments regarding absolute risk make eminent sense and yet the industry benefits from selective use of surrogates such as in the 4 key studies used to form both CTT and the Cochrane review 2012. It would also be interesting if you could comment on the conflict of interest statements in the CTT group, given the discussions on this site and in leading journals over recent months.
    Or you could just read and quote from the Abramson BMJ review of the CTT paper and the accompanying editorial. Perhaps you could explain why you chose to quote CTT but not it's critique.

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    1. John Wright

      logged in via LinkedIn

      In reply to John Wright

      Apologies for typos, predictive text and me are not natural bedfellows.

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    2. Jenny Doust

      Professor of Clinical Epidemiology at Bond University

      In reply to John Wright

      Lots of interesting points have been made, and I think it illustrates that the public would have more faith in the industry trials if the data were more freely available to all researchers for further scrutiny and analysis.
      The CTT Collaboration has put out several publications - see the link in the article above. They have looked at a number of endpoints, not just soft endpoints or surrogate endpoints, but endpoints that matter to patients, such as fatal and non-fatal heart attacks and fatal…

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  9. Evelyn Haskins

    retired

    > . . . The most common side effects are fatigue, exercise intolerance, cataracts, and sometimes, memory loss . . .>

    Good grief! If I could just find some medication that would relieve my fatigue, exercise intolerance, stop my cataracts from getting worse and improve my memory (or at least stop it getting worse. then I'd happily take something that has a side-effect of increasing serum cholesterol.

    I also have a strong suspicion that the reasom that 'statins/ decuce the likelihood of dying from heat disease is because they die from iatrogenic disease before the heart has a chance to fail.

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  10. David Maddern

    logged in via Facebook

    Dang theis iPad the CVDchk doesn't work

    But I am not worried about CVD on the grounds that a huge study of China found that heart, kidney, cancer, obesity are down to getting most of your protein from animal sources, as villages that got most of their protein from plant sources did not get these Diseases of Western Affluence as they have been dubbed.

    While people generally say 'how could I give up meat' other people are talking about whether a certain drug class is efficacious, as if it is…

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  11. Paul Hampton-Smith

    logged in via Facebook

    Isn't "high cholesterol" too broad a term nowadays? I thought it was more important to reduce the *ratio* of HDL to LDL. The reason I'm interested is because (and I guess it usually comes down to a personal situation, doesn't it?) I actually have reasonably low cholesterol, but very low HDL (and evidence of plaque build-up), so my doctor prescribed statins. I took myself off them because of somewhat disconcerting memory loss.

    Is there research available on this situation, ie the combination of total cholesterol within normal range and a low HDL:LDL ratio?

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    1. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to Paul Hampton-Smith

      Hi Paul, to clarify the approach used in the current Australian guidelines - cholesterol ratio is used in the Framingham risk calculation, and is defined as total cholesterol divided by HDL.

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  12. Steven Rudolphy

    GP & Part Time Senior Lecturer in General Practice (Cairns Campus) at James Cook University

    Doctors, hypercholesterolaemia is a risk factor not a disease give statins to those at risk, be aware of possible side effects, ask patients if they are getting them, stopping them generally is not the end of the world.

    Patients, you should know if you are at high risk you should definitely take your prescribed statin, tell your doctor if you think you have side effects.
    If you are at low risk we need to treat 50 of you to stop one health event, this is not new news but (maybe) even your doctor…

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    1. David Stewart

      Writer, civil engineer at Self-employed

      In reply to Steven Rudolphy

      Is this conversation still alive?
      The seat belt analogy is a weak. As a driver I am at risk from external events (others' poor driving, my vehicle failing, etc) when I am competent and in control of my own vehicle. I will not take statins on the off-chance that another may have life-style weaknesses.

      The statistical base of much of medical advice available to the public is also weak and I have sympathy for Pera Lozac's comments herein. When I taught statistics 30 years ago much of the canon…

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    2. Steven Rudolphy

      GP & Part Time Senior Lecturer in General Practice (Cairns Campus) at James Cook University

      In reply to David Stewart

      I agree no one should force you to take statins.

      I also think people should look after themselves. When 65% of the population is overweight it does not seem to be happening.

      Myself, GPs I talk to and medical literature are not sure how to address the obesity epidemic. Maybe medical researchers and myself and colleagues are stupid and don't address lifestyle and diet (we have 300 diabetics in our practice they all get diet and lifestyle advice but rarely lose weight or exercise more - they seem happy to take statins when indicated).

      I think the seatbelt analogy is quite nice I also advise some patients in the borderline statin area, life for GPs is rarely as black and white as you think, that taking a statin is like having 8 air bags, you still need to maintain the car and drive carefully though.

      Drive safely.

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    3. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Steven Rudolphy

      http://www.youtube.com/watch?v=FSeSTq-N4U4

      Not sure how old this presentation from a Swedish doctor is, but it just appeared on You Tube a day or two ago.

      I basically agree with all he says. I like that he also espouses the paradigm change now under way in resetting dietary advice away from the current government and vested interest kind.
      The consequences of which are graphically illustrated here.

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    4. Rotha Jago

      concerned citizen

      In reply to John Doyle

      Thank you John for the excellent You Tube video link.
      Any doctor who takes the time to watch it will know why his patients are still obese and suffering.
      Good news for diabetics as well.
      Thanks again.

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    5. Evelyn Haskins

      retired

      In reply to Steven Rudolphy

      .> I agree no one should force you to take statins. >

      Hi Steven,

      What is your take on this?

      http://www.sciencedaily.com/releases/2013/12/131217210549.htm
      An Apple a Day Keeps the Doctor Away
      Dec. 17, 2013 — Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the UK -- similar to giving statins to everyone over 50 years who is not already taking them -- according to a study in the Christmas edition of The BMJ.

      It seems to me a far better option than taking statins :-)

      I stick to Jonathons, Bonzers and Sundowners as the others give me indigestion :-(

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  13. Carole Hubbard

    conservationist

    Before I begin I'd like to point out that I don't take any pharmaceutical drugs for anything except the occasional paracetamol, and wouldn't ever take pharmaceutical drugs even if offered by my doctor, and they have been offered, just on principle.
    Basically I don't believe pharmaceutical drugs are the way to go to improve a person's health long run. These types of drugs are more about making money for the pharmaceutical industry which is in business to make money above any other consideration, and indeed is constantly on the lookout for new diseases for which it can supply drugs.
    As far as evidence-based medicine is concerned, I think a lot of these studies that support pharmaceutical drugs are cherry-picked, possibly outsourced for others to come up with studies that support a certain drug.
    Further, meta-researcher Ioannidis commented in article http://preview.tinyurl.com/35fe5kb that up to 90% of all studies that doctors depend on are flawed.

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    1. Evelyn Haskins

      retired

      In reply to Carole Hubbard

      I wouldn't be taking paracetamol either. It is nowhere near as safe as the pharmaceutical companies would have us to believe.

      (And rememebr tha there a a LOT of toxins out there that are 'gentle to the stomach!)

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    1. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Paul Rogers

      I only managed to see this yesterday.
      It was a crappy ad-hominem attack, no reference to the science.
      In fact Holmes said he wouldn't comment on that.
      Just because the characters Maryanne interviewed had financial links to their work doesn't invalidate them any more than selling drugs invalidates the drug companies. They may be shonky but so are the drug companies it would seem.
      No mention that Maryanne has a medical PHD herself.
      The comment section shows many people come down on both sides of the debate.
      The Heart Foundation sent in a 9 page response. Sorry, they are also a tainted organisation who used to promote sugar as a health food and haven't improved on their advice since.
      All Media Watch did was fall in line with the vested interests frantically trying to put the genie back into a bottle.
      Very poor journalism!

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  14. John Charlesworth

    Scientist

    Having agreed that it is probably not a good idea to prescribe statins for those at low risk, i.e. primary prevention, could the authors comment on the findings of the "Evidence Based Medicine" review at the NNT (Number Needed to Treat) website regarding statin use for secondary prevention?

    http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/

    Benefits

    96% saw no benefit
    1.2% were helped by being saved from death
    2.6% were helped by preventing…

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    1. Paul Rogers

      Manager

      In reply to John Charlesworth

      I'm interested, John. Did you read and assess both reference papers, and the letters to the journal to do some sort of confirmatory assessment of the NNT analysis, or did you just accept their opinion?

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    2. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to John Charlesworth

      Hi John, thanks for your comment. The current Australian guidelines do recommend medication for primary prevention if the absolute risk is high (defined as having more than a 15% chance of having a heart attack or stroke in the next 5 years). If you have established cardiovascular disease (e.g. if you have had a heart attack), you are already known to be at high risk so the absolute risk calculation does not apply and medication is recommended as secondary prevention. So medication for high risk…

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    3. John Charlesworth

      Scientist

      In reply to Carissa Bonner

      Hi Carissa

      Yes, theNNT site calculated NNT as well as %, you just need to hit the correct button on their web page. For example

      1 in 83 were helped (life saved)
      1 in 39 were helped (preventing non-fatal heart attack)
      1 in 125 were helped (preventing stroke)

      I was able to deduce the values from the second reference given.

      On a more important note it appears the "Catalyst" program has now received support from an unlikely quarter.

      http://www.nytimes.com/2013/11/13/health/new-guidelines-redefine-use-of-statins.html?pagewanted=2&emc=edit_na_20131112

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    4. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to John Charlesworth

      Oh yes I missed the NNT button - thanks for clarifying.

      The new US guidelines will actually increase the use of statins for primary prevention, based on wider eligibility criteria (assuming they are followed).

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    5. Paul Rogers

      Manager

      In reply to John Charlesworth

      Wow, talk about a non-sequitur from Mr Charlesworth.

      1. No, the new US recommendations do not support the Catalyst television programs.
      2. Yes, lowering cholesterol does reduce mortality to a significant extent. This does not mean that optimum targets for LDL with statins are absolutely effective when other risk factors are present.
      3. Yes, statins may have an anti-inflammatory effect, but this mechanism and efficacy is by no means established. And as for your statement: "appears to be filtering through to the medical community", what absurd hubris from you!

      Cardiovascular disease is a multi-factorial disease by the way.

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    6. John Charlesworth

      Scientist

      In reply to Carissa Bonner

      Hi Carissa

      To quote from the NY Times report:

      "It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average risk of stroke, may find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels may no longer need them. "

      Recommendations by the medical profession are no longer a good predictor of what advice people will follow…

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    7. Carissa Bonner

      Research Coordinator and PhD Candidate in Public Health at University of Sydney

      In reply to John Charlesworth

      I agree that the guidelines will not necessarily be followed, but was referring to the drop in what is considered a high enough risk to warrant prescribing statins: 20% risk of a heart attack or stroke over 10 years is the threshold used in other 10 year absolute risk models, whereas the US is using a 7.5% threshold.

      But changing from a focus on cholesterol level to an absolute risk calculation is arguably more evidence-based and in line with UK, Australian and New Zealand guidelines.

      Further explanation of this can be found at:

      http://healthland.time.com/2013/11/12/new-guidelines-for-cholesterol-treatments-represent-huge-change/

      http://www.abc.net.au/worldtoday/content/2013/s3889887.htm

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  15. Paul Rogers

    Manager

    New US guidelines for statin treatment just released recommend this:

    "People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years."

    http://blog.heart.org/new-heart-disease-and-stroke-prevention-guidelines-released/

    Downloadable XLS calculator here:
    http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp

    This is hilarious. The 10 year risk for a male aged 65, even with ideal risk factors (column E) is 8.8. That means they recommend that all men over 65 should be on statins. I don't think so.

    And still no physical activity risk factor inclusion. (I hope statins aren't on the WADA list!)

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    1. Paul Rogers

      Manager

      In reply to John Doyle

      Ah yes John, but there is a difference between the logical center and the idiot extremes.

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    2. Paul Rogers

      Manager

      In reply to John Doyle

      Now John, that's worth a Conversation article all by itself!

      However, if MDs were serious about assessing CVD risk in individual patients, as well as the standard risk calculator, they may do well to look at waist and hip circumference, physical activity, hs-CRP and perhaps even A1C prior to prescribing statins.

      I all costs time and money of course, but then do we want fine tuning in CVD risk management or not?. Just an idea . . .

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    3. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Paul Rogers

      I agree. Risk factors are myriad. Doctors need to wean themselves off biased pharmaceutical advice. And boy, do we know that's a big field!
      In your case you have expressed a lot of support for PUFA oils over SFA oils/fats. I am in the SFA fats are good camp, and no evidence really overturns that. I'd like to see from you why you are not in that other camp. Our health depends on getting it right.
      Of course all foods have a mixture of all 3 types but PUFA's today are largely industrially created from seeds under high temperatures and pressures. They arrive on shelves often in clear containers and easily rendered rancid. Maybe, in ideal conditions, cold pressed oils are OK, but that's not what's on sale. Is that what researchers use? Do you know about that? We have read Ancel Keys admitted he used margarine as his typical saturated fat and other trans fats.
      But that genie was out of the bottle by then and nobody cared.

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    4. Carole Hubbard

      conservationist

      In reply to Paul Rogers

      And the fact the pharmaceutical companies spend 2/3 of their budget on lobbying, marketing, spin and hype, would anybody really know where the logical centre is?

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    5. Paul Rogers

      Manager

      In reply to John Doyle

      John, if you are a Paleo sort of guy; what makes you think polyunsaturated fats (omega-6) were not widely consumed in the Paleolithic? Take a look at any analysis of wild game for example: linoleic and arachidonic 18:2 and 20:4 abound.

      In addition, nuts would have been a staple. Three guys on foot with pointed sticks do not kill many antelopes! For example, the mongongo nut was a staple of the Bushmen of the Kalahari and it was about 50% linoleic n-6.

      http://elephantswithoutborders.org/blog/?p=662

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    6. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Paul Rogers

      Paul, please lets not confuse monounsaturated fats in fruit oils and other "paleo' foods with PUFA's from industrial processing. Nobody I know of is denigrating monounsaturated fats.
      Certainly not a lot of game was consumed by people then and probably not a lot of food of any kind. However animal fat etc was the most desired food item. Not sure why but I am of the opinion it was the most energy dense, which suited us as we have evolved relatively small stomachs for our needs. Our brains could not…

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    7. Paul Rogers

      Manager

      In reply to John Doyle

      John, sounds like you are doing well with your diet. Weight normalisation is the number one target. You will get cholesterol numbers and TG down while losing weight, but you have to consider what happens to lipids when weight is stabilised. I regard the coconut oil thing an unproven fad.

      Re plant diets, I tend to favour the hypothesis (and some evidence) from Wrangham et al that cooked tubers were the energy source that promoted the development of big, complex brains in Homo sapiens. After all, Homo sp was eating meat and n-3 for about 2.5 million years and was still as dumb as a post until about 150,000 years ago.

      As for me: I 'Eat Food, Not Too Much, Mostly Plants'. And as a former marathoner, triathlete and successful masters sprinter (odd combo I know), I still exercise a lot!

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    8. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Paul Rogers

      The blog I just posted below has a video within by a medical professor in South Africa which refers to marathoners like yourself.
      Another reason to read and listen.
      One thing is for sure, no diet suits everyone.
      Cooking was a fundamental advance for our species as it released the energy easily. Our big brains also got more complex because of our interactions with one another, cheating etc included.
      I don't exercise at all, but keep active. Walk a lot.

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    9. Paul Rogers

      Manager

      In reply to John Doyle

      Walking is good.

      Extreme endurance exercise in older age is probably not a good thing for some at least. Odd things happen with cardiac troponin etc.

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    10. Evelyn Haskins

      retired

      In reply to John Doyle

      > Nobody I know of is denigrating monounsaturated fats. >

      > Nobody I know of is denigrating monounsaturated fats. . . >

      I am.

      A 'mono-unsaturated' fat would actually be super-saturated -- all saturated bonds EXCEPT for ONE.
      The most common monounsaturated (aka singly saturated fats I nature are oleic and palmitoleic.

      I have trouble taking ‘professionals’ who cannot tell the difference between mono-unsaturated and mono-saturated seriously

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    11. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Evelyn Haskins

      Then you'd better set the record straight for us amateurs as well.
      I for one have only ever heard olive oil and the like referred to as mono unsaturated, and palmitic as saturated. Mono saturated has never been seen by me at least in The Conversation. You know, just 3 classes of fats/oils have covered 100% of the contributions within, until this, not to mention all the various presentations I've seen on the web.

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  16. Paul Rogers

    Manager

    The current state of knowledge regarding cholesterol, inflammation, and oxidation in relation to the initiation and progression of cardiovascular disease should be clarified because denial of this is at the heart of the cholesterol sceptic and anti-statin premise as reflected by the Catalyst programs.

    The accepted definitive process involves infiltration of the intima endothelium (artery wall) by LDL/ApoB/cholesterol particles. This is called 'Subendothelial Lipoprotein Retention'. In other words…

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    1. John Doyle
      John Doyle is a Friend of The Conversation.

      architect

      In reply to Paul Rogers

      Well that theory is in line with what I have read, Paul, except the small oxidised LDL particles were called "pattern B".
      However here is a blog with a competing theory that you will find very interesting. It's very wide ranging.
      http://drmalcolmkendrick.org/

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    2. Paul Rogers

      Manager

      In reply to John Doyle

      John, it's nothing new, these guys are clones of each other -- and they're all wrong!

      I must admit, it was sad to see Tim Noakes, something of an icon in the sports nutrition sciences, involved there. Limit CHO, reduce energy intake, lose weight, run faster because of it . . . doh? Even Homer could see through that one.

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    1. Rotha Jago

      concerned citizen

      In reply to Richard Hockey

      Why do we start talking about Cholesterol and then concentrate on controlling fat in the diet?
      Cholesterol and fat are totally different from each other.
      Vegans can have too much cholesterol when they eat no animal fats at all.
      Cholesterol is so vital to the body that it is made regardless of what we eat. Too little is far worse for good health than too much.
      Statins? it is risky to take them. If you do and suffer some other problem, look carefully at the list of possible side-effects, you will…

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  17. Ivana Fulli

    logged in via Twitter

    The French equivalent of NICE is called HAS (Haute Autorité de Santé for High Health Authority) reckons that statins are too often prescribed but ironically not enough to the person most likely to benefit from it.
    It says to have examined carefully in 2010 numerous studies from which 91 studies (170 000 subjects of study) been considered methodologically sound enough to be used to issue their guideline which is
    1) Statins prescription after a cardio-vascular accident with an estimated 10% risk reduction of a new accident.
    2) No statins prescription in primary prevention (in people who had never suffer from a cardio-vascular accident ) unless several cardiovascular risks factors are present at the same time (tobacco, high blood pressure, diabetes etc..) No prescription when isolated high cholesterol blood level (unless the patient is suffering from family hypercholesterolemia.)

    http://www.has-sante.fr/portail/jcms/c_1360516/fr/pour-un-bon-usage-des-statines

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