"Badant" <
[email protected]> wrote...
> Nigel <I.don'
[email protected]> wrote>...
> >
[email protected] (Kathy) wrote in
news:b98653c0.0401250033.1379a550 @posting.google.com:
> >
> > > "At the present time, the value of treating hyperlipidemia in patients greater than 80 years
> > > of age is unknown, and therapy in this age group must be individualized. (c)1999 by CVRR,
> > > Inc."
> > >
> > > Is this a joke or what? How can you individualize therapy if the value is unknown?
> > >
> >
> > Not a joke, the vocabulary of science.
> >
> > Therapy must be individualized to attain the clinical end point; a
change
> > of blood cholesterol levels as measured in the lab.
> >
> > Of unknown value because in this group, there is no evidence of a change
in
> > morbidity or mortality.
>
>
> Benefit? Little to none in ANY group. Rather, debilitating adverse effect.
ANY group? In the studies that I've seen, statins have decreased CV mortality by 40% or more and all-
cause mortality by around one-third.
> Unclogging the heart debate: Do cholesterol pills help or harm?
>
> By PAUL TAYLOR Saturday, January 24, 2004 - Page F4
>
> For the past three years, Melvyn Mould has been taking a medication to keep his cholesterol under
> control. The 62-year-old retired carpenter never liked the idea of being on a drug. So he also
> adhered to a strict low-fat diet and exercised regularly, hoping to reduce his dependence on the
> daily pill. And now Mr. Mould's efforts appear to be paying off.
>
> After recently doubling his exercise routine -- to six days a week from three -- his LDL, or so-
> called bad cholesterol, has been cut by almost half. If his LDL remains low at his next medical
> checkup, Mr. Mould's doctor may decide to reduce or eliminate the drug entirely.
>
> "I am really looking forward to my next appointment," says Mr. Mould, who lives in Toronto.
>
> Mr. Mould would be bucking a trend if he is taken off medication. More patients are going on these
> powerful drugs all the time. From 1998 to 2003, the number of prescriptions filled in Canada
> for cholesterol medications skyrocketed to 16 million from seven million, IMS Health Canada
> reports. The dollar value of those drug sales soared to $1.4-billion from $675-million.
>
> A panel of Canadian heart specialists recently issued new guidelines to help family physicians
> decide which of their patients should be taking cholesterol medications based on a variety of risk
> factors for cardiovascular disease. The guidelines, published in the Canadian Medical Association
> Journal, could increase the number of patients considered at high risk of a heart attack -- and
> deemed in need of immediate drug treatment.
>
> But some doctors are worried about the increasing reliance on medications. "My concern is that
> people may rush [to drug treatment] without actually seeing whether lifestyle changes can make a
> difference," said Dr. David Jenkins, director of a treatment clinic at St. Michael's Hospital in
> Toronto.
>
> Dr. Michael Evans, an assistant professor at the University of Toronto, shares those concerns. "As
> a family doctor, I would prefer if patients got increased exercise and developed better eating
> habits and therefore lost weight because they would have less chance of developing
> osteoarthritis and diabetes -- and it can even improve their sleep."
>
> Dr. Jim Wright, a professor at University of British Columbia, has touched off a fierce debate in
> the medical community by suggesting that some patients might actually be harmed by the over-
> prescription of these drugs.
>
> He points out that taking medication carries the risk of some side effects such as liver function
> problems, muscle aches and pains, and possible nerve damage. For patients who truly are at an
> elevated chance of suffering a debilitating or even lethal heart attack, those risks are clearly
> worth it. But the benefit is not so clear-cut in patients who are at far lower probability of
> having an attack, he argues.
>
> Dr. Wright recently reviewed the data from several major international trials of the leading cholesterol-
> lowering drugs, known as statins, to determine their effects on lower-risk patients. He found
> that the drugs produced a drop of 1 to 2 per cent in total heart attacks and strokes over a
> three-to-five-year period. But these benefits seemed to be washed away by other unexplained
> adverse events which weren't specified in the studies. The patients on the drugs ended up in
> hospital with "life-threatening events" just as many times as people popping the placebos.
>
> "There is good reason to not be taking the drugs unless you are pretty confident that you are in a
> group that is going to stand to benefit,"
> Dr. Wright said.
>
> He also takes issue with the new cholesterol guidelines, insisting that there is not enough
> scientific evidence to back them up.
>
> Dr. Ruth McPherson, one of the authors of the guidelines and a professor at the University of
> Ottawa, defends her work. "I don't think it's true that we are treating people who don't
> require treatment."
>
> The debate has become so heated, in part, because much is still unknown about cardiovascular
> disease. Studies have not yet demonstrated the ideal level for cholesterol.
>
> What has been clearly established is that lowering cholesterol in a person who has already had one
> heart attack greatly reduces the chances of a second attack. Treating these patients is known as
> secondary prevention, and all the experts agree that it makes sense to focus medical efforts on
> people with proven heart disease.
>
> But doctors also want to help people before they've had their first heart attack, a treatment
> strategy known as primary prevention. And this is where the guesswork begins. Medical experts have
> tried to put together a list of risk factors, such as cholesterol, blood pressure and smoking
> habits, which may predispose people to atherosclerosis.
>
> However, the known risks account for only about half of all cases of heart disease. To complicate
> matters further, the medical view of heart disease is rapidly changing with advances in research.
>
> Experts used to think heart disease was caused by the simple accumulation of fatty deposits inside
> blood vessels. Now, they see it as the end result of a far more complex inflammatory process. It
> starts when certain fats and other highly reactive substances float through the bloodstream
> gradually damaging the inside lining of the blood vessels. This leads to the buildup of plaque --
> a form of scar tissue -- which is filled with various fats and cellular debris. At first, the
> growing plaque doesn't impede blood flow. But in time, the plaque can rupture and form a clot --
> triggering a heart attack or stroke.
>
> If doctors had an easy way to peer inside blood vessels, they would have a better idea of which
> patients are at greatest risk of heart disease. Dr. David Spence believes he has developed just
> such a test. The professor at the Robarts Research Institute in London, Ont., has been using
> ultrasound to create two-dimensional images of plaque deposits in the arteries.
>
> His tests have focused on the carotid arteries just under the surface of the neck. Dr. Spence
> says these images of the carotid arteries provide a window of what's happening in blood vessels
> in the heart.
>
> In a five-year study, he found that patients with the highest plaque deposits in their carotid
> arteries were 3.5 times more likely to suffer a heart attack, stroke or death than those with the
> lowest deposits.
>
> "The benefit of doing these plaque measurements is that it sorts out who is at risk and who isn't
> -- and I believe it will make therapy much more cost effective, he said. "Some version of this is
> how people are going to be treating the arteries in the next ten years," he predicts. If he's
> correct, it may go a long way to settling the current debate.
>
> Paul Taylor is a Globe and Mail assistant national editor, responsible for health and science
> coverage.