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SHOULD ANYBODY BE TAKING STATIN DRUGS FOR PREVENTION?
Since the advent of statin drugs, the testing of cholesterol levels and various prescriptions has become a lucrative mainstay of medical practice. The fear mongering regarding blood cholesterol levels had to also be ratcheted up from nowhere to the present fever pitch, to convince people that they would have to take these expensive and side effect laden drugs for the rest of their lives.
Trained to be cheerleaders for pharmaceutical companies, most doctors stepped right in line and prescribed these to almost everyone with a pulse, and the American Academy of Pediatrics now recommends cholesterol screenings for “high-risk” children ages two and up, stating, “For children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered.”
The fact that there are no short term or long term safety studies of the drugs at all in children seems not to be a concern.
After the JUPITER study in 2008 was published in the New England Journal of Medicine, a new era of statins for everyone was proclaimed by the medical establishment and their media lapdogs:
The investigators from the study concluded: “In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events.” (ClinicalTrials.gov number, NCT00239681)
The medical establishment was quick to believe these conclusions:
“A new study has found that cholesterol medicines known as "statins" may reduce the risk of strokes heart attacks and death by almost half when studied in patients with normal levels of cholesterol. With this finding at least 32 million people would be eligible for treatment. The drug studied is AstraZeneca Plc’s Crestor®.
The patients eligible for the study are those who have high amounts of a protein linked to inflammation. After using this drug their risk would be reduced by 47 per cent according to research published today in the New England Journal of Medicine corresponding to a presentation at a cardiology meeting.
Researchers report that by using Crestor® for at least five years people diagnosed with normal cholesterol could avert 250,000 heart complications.” (interactmd.com)
Media doctors and academics quickly jumped in:
"The extent of reduction in death, heart attacks, and stroke is larger than we've seen in any trial I can remember," said Dr. Steven Nissen, a prominent Cleveland Clinic cardiologist. "I don't know how you get much bigger than that."
Said Dr. W. Douglas Weaver, president of the American College of Cardiology:
“[The findings] really change what we are going to do in the future. This targets a patient group that normally would not be screened or treated to prevent cardiovascular disease. This will become an important part of the armamentarium of the primary care doctor. I see this as being part of that panel of preventions that they will be applying in men over 50 and women over 60.”
Dr. Tim Garder, president of the American Heart Association, opines without any evidence whatsoever that “This is likely to be a class effect, not a specific drug effect. This is a win for all statins, I would say.”
In no small measure a reflection of the influence of drug company advertisement revenue, the media was eager to sensationalize and exaggerate drug claims.
The lead headline from MSNBC:
“People with low cholesterol and no big risk for heart disease dramatically lowered their chances of dying or having a heart attack if they took the cholesterol pill Crestor®, a large study found.”
The headline from Fox News:
“Study: Cholesterol Drug Causes Risk of Heart Attack to Plummet”
The New York Times headline and lead (on the front page, no less):
“Cholesterol-Fighting Drugs Show Wider Benefit
A large new study suggests that millions more people could benefit from taking the cholesterol-lowering drugs known as statins, even if they have low cholesterol, because the drugs can significantly lower their risk of heart attacks, strokes and death.”
"Cholesterol Drug Cuts Heart Risk in Healthy Patients
AstraZeneca PLC’s cholesterol drug Crestor® sharply lowered risk of heart attacks among apparently healthy patients in a major study that challenges longstanding heart-disease prevention strategies. The findings could substantially broaden the market for statins, the world’s best-selling class of medicines."
But, the lovely fiction that lowering cholesterol is the Holy Grail for cardiovascular disease is beginning to unravel. Last month, the first newsletter item pointed out that evidence is accumulating that statins actually increase the risk of strokes that are the result of bleeding from a blood vessel in the brain.
Furthermore, a recent study suggests that elevated cholesterol levels have little relationship to the risk of the type of stroke where the blood flow to the brain is decreased (ischemic strokes).
The study in question was published earlier this year in the journal Annals of Neurology. In this study, about 14,000 men and women were followed for more than 30 years. The relationship between cholesterol levels and risk of ischemic stroke was analyzed.
The results showed:
1. no relationship at all in women
2. no increased risk of stroke in men unless cholesterol levels were extremely raised (9.0 mmol/l or more – equivalent to 348 mg/dl or more)
In other words, there was little or no relationship between cholesterol levels and risk of ischemic stroke. (Varbo A, et al. Nonfasting triglycerides, cholesterol, and ischemic stroke in the general population. Annals of Neurology. Article first published online: 18 FEB 2011)
A closer look at the actual data from JUPITER suggests that the highly publicized benefits for heart attacks were exaggerated, if not completely misrepresented.
In a critique last year published in the Archives of Internal Medicine, Dr. Michel de Lorgeril points out that there was in fact, identical cardiovascular mortality between the treatment groups. In addition, the JUPITER trial involved several conflicts of interest:
“It was conducted by a sponsor with obvious commercial interests. Nine of 14 authors of the JUPITER article have financial ties to the sponsor. The principal investigator has a personal conflicts of interest as a co-holder of the patent for the C-reactive protein test” that figured prominently in the rational for statin therapy. In addition, the monitoring board that made the decision to halt the trial early was chaired by an investigator who “has been and still is involved in many other industry-sponsored lipid lowering trials” (Arch. Int. Med. 2010;170:1,032-6)
In a second study detailed on page 1024 of the same issue, Dr. Kausik K. Ray and his associates performed a meta-analysis of 65,229 men and women with approximately 244,000 person-years of follow up. “All cause mortality was not significantly different between patients taking statins and those taking placebo or control therapies.”
In an editorial in that issue, Lee Green M.D., stated: “Tens of millions of billions of dollars of revenue for the sponsor over the patent life of the drug were at stake in the JUPITER trial, as well as potentially millions of dollars in royalties for the principal investigator. And, with three quarters of statin users taking the drugs for primary prevention, enormous revenues are at stake.
The results make it clear that for primary prevention in the short term, statin’s benefits are very small, and in the long term….we really must admit that we do not know” (Family Practice News July 2010 p 10.)
So, in my opinion, most cholesterol testing and treatment is unnecessary. Cholesterol is a necessary intermediary in the production of a great many hormones and structural components of the body. Physicians are ill-advised to ignorantly interfere with these pathways.
But the cholesterol myth is keeping a lot of people wealthy, and engages a lot of doctor’s time and attention. Seeing the change in a laboratory number is simple and satisfying. Dumbing down medical practice to writing prescriptions benefits everyone except the patient.
It is likely that every electronic medical record in existence has cholesterol testing and treatment programmed into it, and as a result, the bogeyman of “high cholesterol levels” will endure like a bad horror movie zombie, and will continue to waste billions of dollars and uncountable hours of testing, treatment, and patient “education” that could be better directed elsewhere.
"Is Anyone Thinking?" Department
VAMPIRES AND WEREWOLVES AND GHOSTS, OH MY
Is no one besides me tired of the endless assault of fictional monsters across the land? What’s worse, instead of real monsters, they are huggable and sensitive monsters who endlessly pursue a cliché ridden search to find their “humanity”.
Horrible and frightening on the outside, their true inner nature is exactly the opposite – warm, caring and sensitive – but, oh so misunderstood.
Book and screenwriters have the situation completely wrong. The misunderstood monster with a heart of gold or the angst filled “I can’t help myself but I hate what I do” monster endlessly portrayed by fifth rate fiction writers does not exist, and is a bad role model to boot.
Real monsters look just like everyone else, but they have no humanity on the inside. Their heartlessness is what makes them monsters, not their canines or fur or decaying flesh. They are insensitive to other’s suffering, and sometimes their own, and their repulsive acts and despicable behavior defines their monstrosity.
Because they are heartless, they have no moral compass. Remorse, if seen, is acted rather than felt. There is no hesitation to commit horrific crimes against their fellow men and women, friends, strangers, wives, husbands, children, parents, family members. It makes no difference.
In fact, the modern monster is much too easily understood. But true human beings, those who do have a heart and are saddened and shocked by the carnage of modern monsters, live mostly in denial that such monsters live all around them.
They remain in denial as mutilated and decaying bodies fill the case files of detectives in tiny hamlets, rural outposts, and enormous cities.
They remain in denial even as sensationalist print and screen media exploits an endless and burgeoning parade of those few degenerates who are actually caught, repackaging their passage through our feckless legal system as entertainment.
They remain in denial despite revelations that for every monster, the most recent horror is not the first, and that previous efforts at isolation, therapy, or rehabilitation, have failed, and monsters were released to prey again.
And, to no one’s surprise, monstrous acts were again the result. Monsters don't rehabilitate.
Monsters don’t indulge their urges every day. They are opportunists that slink beyond the glare of light, camouflaged by their ability to appear to be human beings. But, there are ways to tell.
Monsters delight at killing or torturing animals as children or adults.
Monsters are inventive at cruelty.
Not all narcissists are monsters, but all monsters are narcissists.
Monsters do not display humility, appreciation, or gratitude.
A great many monsters have mastered charm and their victims remain unaware of their peril until it is too late.
And, like their fictional counterparts, monsters are extremely dangerous. Even as individuals, their accumulated toll of horrors is too great to list.
Given power and position, they have covered the globe with blood and suffering, and continue to do so today.
Screen based fiction is a pleasant opiate for our society. Its success at lulling people into passivity, sleep and confusion is truly awesome.
Its negative effects on attention and intellect are evident in every corner of the United States.
Who is left who has the courage to identify, oppose and destroy the monsters? "Rampant" by Elixir. Visit their website for sample tracks and to buy their CDs.
Featured Music at the Office
Who is left who has the courage to identify, oppose and destroy the monsters?
"Rampant" by Elixir. Visit their website for sample tracks and to buy their CDs.