Cholestrol: opinions please

Discussion in 'Health and medical' started by Kevin Arouza, Feb 10, 2004.

  1. Nigel

    Nigel Guest

    [email protected] wrote in
    news:[email protected]:

    > On Wed, 11 Feb 2004 02:14:12 GMT, Nigel <I.don'[email protected]> wrote:
    >
    >>They do not separate drugs and lifestyle (diet and exercise) in their conclusion. They suggest
    >>_both_. But if lifestyle is enough to gain the desired results, why bother with the drug?
    >
    > MANY people are unable to effect and/or have great difficulty with lifestyle change. Having an
    > effective and safe alternative is a positive thing.
    >

    Those that are unwilling to make lifestyle changes to reduce their risk of heart disease have
    implicitly chosen an early death. Unfortunately it is rare for someone to actually put it to them in
    those terms giving them the stark reality of their choices.

    For those that have made the required lifestyle modification and continue to have lipid profiles
    outside of normal, there is no evidence that their risk of a first MI is reduced by use of HMG CoA
    redutase inhibitors.

    >>
    >>> From the Prosper Study:
    >>>
    >>> "A longer-term trial or a greater number of elderly patients would be required to determine the
    >>> specific effects of pravastatin 40mg in elderly subjects without previous vascular disease."
    >>>
    >>
    >>No demonstrable effect in primary prevention in the elderly (supports Al's point).
    >
    >>> Also:
    >>>
    >>> "Pravastatin did not cause any significant increase in liver or muscle adverse events, including
    >>> rhabdomyolysis, in this highly susceptible patient population."
    >>>
    >>
    >>OK, there appears to be no statistically significant rise in adverse events.
    >>
    >
    > That's a big OK that others simply refuse to acknowledge.
    >

    So they are ignoring the currently available evidence.

    >>
    >>> [Of course, Bristol-Myers Squibb Company sponsored the PROSPER trials so the above should be
    >>> completely disregarded as it should also in your little two-page info sheet.Right? :) ]
    >>>
    >>> ASCOT Study:
    >>>
    >>> "Professor Björn Dahlöf from the Sahlgrenska University Hospital, Östra, Sweden and ASCOT study
    >>> co-chairman, adds: "At present, large numbers of people around the world are affected by high
    >>> blood pressure, with only normal or slightly raised cholesterol, causing significant levels of
    >>> ill health and mortality. This study shows that statins are effective, lowering cholesterol
    >>> levels, and reducing the likelihood of heart attacks and strokes."":
    >>>
    >>>
    >>
    >>Again, look at the inclsuion criteria; patients had to have high blood pressure (i.e. already
    >>at risk)
    >
    > MANY people have high blood pressure.
    >

    And high blood pressure is a risk factor for development of CHD. In a person with high blood
    pressure and an abnormal lipid profile, treating the high blood pressure will result in a greater
    risk reduction than treating the abnormal lipid profile.

    >>> WOSCOP Study:
    >>>
    >>> "We can say now with confidence that pravastatin reduces the risk of heart attack and death in a
    >>> broad range of people - not just those with established heart disease, as has been previously
    >>> proven, but also among those who are at risk for their first heart attack," said principal
    >>> investigator James Shepherd, M.B.Ch.B, PH.D., professor, University Department of Pathological
    >>> Biochemistry, Royal Infirmary, Glasgow, Scotland.
    >>>
    >>>
    >>
    >>Patients in this study actually had to fail to produce reduction through diet modification before
    >>being included.
    >>
    > So is Mr. Shephard lying about his study?
    >

    Look at the words - ...those who are at risk...

    You may recall the aspirin primary prevention trials from the late 80's. The results of those
    studies were substantially the same, but the conclusions reached were different. Both studies found
    that an aspirin daily reduced the risk of death from MI. One study concluded that almost everyone
    should take an aspirin daily to prevent a first MI. The other concluded that there was no benefit,
    as mortality was the smae in both groups. After more than ten years of argument, the prevailing
    view is that aspirin doesn't change mortality except those at risk and so is not needed in
    virtually everyone.
     


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