Ravnskov of Cholesterol Skeptics/Thincs disses Canada's new

Discussion in 'Health and medical' started by mfg, Oct 30, 2003.

  1. mfg

    mfg Guest

    Ravnskov of Cholesterol Skeptics responds to Canada's new guidelines
    for physicians to treat cardiovascular disease, potential
    cardiovascular disease, and imagined cardiovsascular disease:

    From: uffe ravnskov
    To: [email protected]
    Sent: Thursday, October 30, 2003 11:24 AM
    Subject: new guidelines


    Dear Mr Evenson
    A friend of mine sent me your article about the new Canadian
    guidelines. Evidently the Canadian authorities have bought the new
    American ones uncritically.
    Here is a summary of the way these guidelines were created:

    1. A small group of private individuals come together and call
    themselves the "Expert Panel."
    2. These people recieve large sums of money from pharmeceutical
    companies to give talks, do research, etc.
    3. The Expert Panel rewrites the guidelines and issue them with the
    apparent endorsement of the federal government.
    4. Thirty million more Americans now need to be on
    cholesterol-lowering drugs.
    5. Insurance companies, Medicare, etc. pay the pharmeceutical
    companies billions of dollars a year for those drugs.

    Here is the list of commitments for the members of the expert panel:
    Financial Disclosure:
    Dr Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer,
    and Bristol-Myers Squibb. Dr Hunninghake has current grants from
    Merck, Pfizer, Kos Pharmaceuticals, Schering Plough, Wyeth Ayerst,
    Sankyo, Bayer, AstraZeneca, Bristol-Myers Squibb, and G. D. Searle; he
    has also received consulting honoraria from Merck, Pfizer, Kos
    Pharmaceuticals, Sankyo, AstraZeneca, and Bayer. Dr McBride has
    received grants and/or research support from Pfizer, Merck,
    Parke-Davis, and AstraZeneca; has served as a consultant for Kos
    Pharmaceuticals, Abbott, and Merck; and has received honoraria from
    Abbott, Bristol-Myers Squibb, Novartis, Merck, Kos Pharmaceuticals,
    Parke-Davis, Pfizer, and DuPont. Dr Pasternak has served as a
    consultant for and received honoraria from Merck, Pfizer, and Kos
    Pharmaceuticals, and has received grants from Merck and Pfizer. Dr
    Stone has served as a consultant and/or received honoraria for
    lectures from Abbott, Bayer, Bristol-Myers Squibb, Kos
    Pharmaceuticals, Merck, Novartis, Parke-Davis/Pfizer, and Sankyo. Dr
    Schwartz has served as a consultant for and/or conducted research
    funded by Bristol-Myers Squibb, AstraZeneca, Merck, Johnson &
    Johnson-Merck, and Pfizer.

    Read also my comments to the American guidelines on
    http://www.ravnskov.nu/ncep_guidelines.htm

    Best wishes

    Uffe Ravnskov, MD, PhD; independent researcher
    Spokesman for THINCS, The International Network of Cholesterol
    Skeptics ( www.thincs.org )
    www.ravnskov.nu/uffe





    And the National Post story on the new heart
    disease guidelines which will leave no-one unmedicated. In fact,
    Genest one of the stooges on the take here, was quoted as saying last
    spring "Is there anyone who shouldn't be on statins?"


    Heart doctors redefine 'normal'
    Lower cholesterol, lower blood pressure now
    expected

    Brad Evenson
    National Post

    Thursday, October 30, 2003


    To all Canadians who plan to get a medical exam
    soon: Brace yourselves
    for bad news.

    That beer belly is no longer a source of humour.
    Your borderline blood
    pressure has crossed the border. And those
    cholesterol levels that last
    week seemed normal, are now the dark precursors
    of a heart attack.

    Guidelines for what is "normal" cardiovascular
    health have fallen. The
    new normal is lower, lower, lower.

    As a result, millions of Canadians with no
    outward signs of heart
    disease can soon expect to be prescribed a
    shelf-load of pills,
    including statins, diuretics and ACE inhibitors,
    to safeguard their
    hearts.

    "In the past we looked at a lot of patients as
    kind of being in the grey
    zone and decided, 'Well, maybe we'll try diet for
    another year,' " says
    Dr. Ruth McPherson, director of the lipid clinic
    at the University of
    Ottawa Heart Institute. "Now we're being a little
    more categorical that
    these people definitely will benefit from
    treatment."

    This week, the Canadian Medical Association
    Journal published a summary
    of new guidelines for blood fats. Among the most
    stringent in the world,
    they shift focus from so-called bad (LDL)
    cholesterol toward the lack of
    good (HDL) cholesterol levels. They also cast a
    suspicious eye on big
    waistlines and insulin levels.

    The shift follows changes in May to blood
    pressure guidelines, which
    replaced the category "high normal" with the
    worrisome-sounding label
    "pre-hypertensive."

    "Definitely more people are now candidates for
    [drug] treatment," says
    Dr. McPherson, part of the working group that
    drafted the new
    cholesterol guidelines.

    "And some people are concerned about that. But
    the truth is that the
    safety of these medications is well established."

    The upshot is that people who three years ago
    could be told they were
    reasonably healthy will now be informed they are
    ticking cardiac time
    bombs.

    Researchers have been fighting for years over the
    best ways to predict
    and ward off heart disease.

    In recent years, such studies as the MIRACL trial
    and the Heart
    Protection Study have shown if you have a family
    history of heart
    disease, are overweight, diabetic or
    hypertensive, then treatment with
    lipid-lowering statins such as Lipitor or Zocor
    can save your life.
    "Even if you have a rock-bottom cholesterol
    level, if you have heart
    disease, going on statins definitely decreases
    your risk of having heart
    attacks and dying of heart disease," says Dr.
    McPherson. "That risk is
    decreased, in different studies, anywhere from
    25% to 50%."

    Now that they know it's possible to prevent
    cardiovascular disease,
    doctors are now inclined to be stickier about
    details.

    For example, research shows artery damage can
    start at blood pressure
    levels as low as 115/75 and doubles for each
    20/10 millimetres of
    mercury. Previously, such levels were considered
    satisfactory.

    At least four million Canadians have
    hypertension, sometimes known as
    the silent killer. Up to 30% of victims do not
    realize they have it.
    Controlling blood pressure can reduce the
    incidence of stroke by 40%,
    reduce heart attacks by 25% and lower the rate of
    heart failure by 50%.

    So hypertension guidelines have fallen.

    Previously, systolic pressure of 130 to 139 and
    diastolic pressure of 85
    to 89 were deemed "high normal." (Systolic is the
    pressure on blood
    vessels when the heart muscle is contracting, and
    diastolic is the
    pressure when the heart is pausing between
    beats.) Now this pressure is
    called pre-hypertensive, a name meant to evoke
    concern. Patients in this
    category may be told to lose weight, quit smoking
    and reduce salt
    consumption, or in some cases may be prescribed
    such drugs as diuretics
    -- "water pills" -- and ACE inhibitors.

    Many doctors find these new guidelines a
    headache.

    "The goal is to keep blood pressure below
    140/90," said a Vancouver
    family physician who asked not to be named.

    "But it's incredibly difficult. You need to use
    huge doses of drugs to
    get there. Patients have to be really committed.
    And let's face it,
    [high] blood pressure has no symptoms. So a lot
    of patients don't take
    it seriously."

    The new cholesterol guidelines may be equally
    troublesome.

    They recommend doctors use a ratio of total
    cholesterol to HDL
    cholesterol, an index shown to be a very good
    predictor of heart
    disease. The goal for most Canadians is to have a
    ratio of lower than
    5.0. But even in people at low risk for heart
    disease, a ratio of 6 or
    higher would prompt a doctor to prescribe drugs.

    That has raised serious concerns.

    Last month, a controversy erupted when
    researchers from the University
    of British Columbia questioned the wisdom of
    giving statins to patients
    with high cholesterol but no evidence of hardened
    arteries. "The best
    estimate of the treatment benefit is a 1.4%
    reduction in heart attacks
    and strokes," Jim Wright, a UBC professor of
    pharmacology, wrote in a
    letter to the National Post.

    Not only is this potential benefit small, Dr.
    Wright said he is not
    confident that long-term treatment with statin
    drugs is as safe as many
    researchers believe. An editorial this week in
    the British medical
    journal The Lancet raised similar concerns,
    saying not enough research
    had been done to support the safety and efficacy
    claims made by
    AstraZeneca for Crestor, its statin drug.

    Many researchers dispute Dr. Wright's concerns,
    but concede the
    potential benefit of treating patients at low
    risk for heart disease is
    probably quite small.

    Others say drug therapy is not the only answer.

    For example, earlier this year, University of
    Toronto researchers showed
    that eating an "ape" diet, similar to what humans
    consumed five million
    years ago, cuts down cholesterol as effectively
    as pharmaceutical drugs.

    The nutrition study, published in the Journal of
    the American Medical
    Association, said a diet rich in nuts, fibrous
    grains and vegetable
    proteins -- what our primate cousins eat every
    day -- can prevent heart
    disease.

    Finally, the new normal guidelines put a clear
    definition on an
    increasingly common woe known as the metabolic
    syndrome. When three risk
    factors occur in one patient, the danger of heart
    disease skyrockets.
    The new guidelines say if a patient has a waist
    circumference of greater
    than 102 centimetres (88 cm for women), high
    triglycerides, fasting
    glucose of 6.2 to 7.0, low HDL cholesterol and
    blood pressure higher
    than 130/85, then the patient is at substantial
    risk of heart disease.

    [email protected]
     
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