Dr Dingle's Blog / medical myths

More cholesterol deception

More cholesterol deception

An old but worthwhile article by Duff Wilson, March 30, 2010 in the The New York Times “Risks Seen in Cholesterol Drug Use in Healthy People” highlights yet again the fatal flaws we have in promoting cholesterol lowering drugs.

The study Duff Wilson reports on found a 55 percent reduction in heart attacks, 48 percent reduction in stroke, and a 45 percent reduction in angioplasty bypass surgery. Sounds good doesn’t it? Unfortunately it is another example of statin statistics where they are not giving you all the real information and what they are giving you is designed to mislead everyone (especially doctors who don’t know how to read stats).

The actual rate of heart attacks was only 0.37 percent, or 68 patients out of 8,901 who took the placebo (a sugar pill). Those who took the statin (Crestor) dropped to 0.17 percent, or 31 patients. That is a 55 percent relative risk reduction but only 0.2 percentage real (or absolute) risk reduction — or 2 people out of 1,000. That is 500 people need to be treated with the statin for a year to avoid one usually survivable heart attack. Doesn’t sound so good any more does it? The stroke numbers were similar. This is considered statistically significant but nowhere near clinically significant and well below the real reduction of 50% people expect to get from a drug. In fact 2500 times less than what the public expect. The most ridiculous part of all this is that 7 grams of almonds will give 2-4 times the benefit of the drug. At $3.50 a pill, to prescribe the statin for 500 people for a year would be $638,000 to prevent one heart attack. At that price you could have free almonds for everyone, gym membership and personal coaching thrown in for a year. My option of course would not only reduce the risk of heart attack and stroke a lot more but also reduce all chronic illness and save hundreds of lives out of 500 people. Where has all the common sense gone.

 

If you want the full article go to http://www.nytimes.com/2010/03/31/business/31statins.html

 

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Big studies are the first hint that statin drugs don’t work

Big studies are the first hint that statin drugs don’t work

The first hint that the statin drugs don’t save lives is the size of the studies. If the drugs were so effective and the “miracle drugs” they are made out to be, researchers could treat 100 or maybe even 20 patients and see a benefit. Yet these meta-analyses use thousands of people—10,000, 50,000 or even 90,000—treated to show a benefit. If it is so good why do they need such large samples?

 

As readers of the scientific journals we should not get confused between statistical significance and clinical significance. “Statistically significant” means that the outcome was likely (95% chance) a result of the treatment whether it was 100% effective or less than 0.1% effective. That is, if you treat 1,000 people to save one life (0.1%) it may be statistically significant but it is not clinically significant. Clinical significance is 20% to 30% or more. The best studies on statins by the drug companies report statistical significance, mostly 1% or less, and none at all have so far found any clinical significance. Obviously, they should not be used.

 

Unfortunately, busy medical professionals don’t have time to review the statistics and few of them are actually aware of the different ways the statistics can be manipulated.

 

 

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Statin drugs do not work

Statin drugs do not work

The statin drugs are effective at around 1%. That is you have to treat 100 people to prevent one heart attack. This is not very effective, in fact it is ridiculously ineffective. Other than what I have been writing over the last year to verify this all need to do is go to the Pfizer (who make Lipitor) website and look for a table in a document titled “Product Information Lipitor” which presented the following table.

PRODUCT INFORMATION

LIPITOR®(atorvastatin)

Endpoint

LIPITOR 10mg N(%)

Placebo N(%)

Absolute Risk Reductiona %(95%CI)

Number Needed to Treat Per Year

Relative Risk Reduction %(95%CI)

P value

Primary

Fatal CHD and Non-fatal MI

100 (1.9)

154 (3.0)

1.07

(0.47 to 1.67)

310.5

36 (17 to 50)

0.0005

Secondary

Total Cardiovascular Events Including Revascularisation Procedures

Total Coronary Events

Fatal and Non-fatal Stroke

Non-fatal MI (excludes Silent MI) and Fatal CHD

 

387 (7.6)

 

 

178 (3.5)

89 (1.7)

86 (1.7)

 

483 (9.5)

 

 

247 (4.8)

119 (2.3)

137 (2.7)

 

1.9 (0.08 to 2.96)

 

 

1.4 (0.06 to 2.14)

0.06 (0.05 to 1.14)

1.0 (0.42 to 1.56)

 

176.0

 

 

241.9

555.2

329.1

 

20 (9 to 30)

 

 

29 (14 to 41)

26 (2 to 44)

38 (19 to 53)

 

0.0008

 

 

0.0006

0.0332

0.0005

aBased on difference in crude events rate occurring over a medium follow-up of 3.3years.

Version : pfplipit10708                                                                        Commercial/Non-Commercial

 

The table is duplicated here exactly as it appears on the Pfizer website. It is the research on taking 10 mg of Lipitor. It shows in the fourth column the “Absolute Risk Reduction” of between 0.06% and 1.9%, that is, very low real risk reduction. In the sixth column it shows the relative risk reduction of between 20% and 38%, which looks so much better but is really misleading. This is where the doctors get confused. They think it is the absolute risk reduction. The fifth column, “Number Needed to Treat Per Year,” is the most telling as it shows to have a single effect you need to treat between 176 and 555.2 people, depending on the outcome desired. That is a lot of people have to be taking this drug to stop one heart attack or possibly save a single life. Levels like this are not clinically significant and do not warrant taking this drug. To be clinically significant it needs to be an absolute risk of 25-30%, not 1 or 2%. I know it sounds a bit repetitive but you can get a much greater effect with only a small change in your diet.

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Cholesterol is good for you

Cholesterol is good for you

Not only is cholesterol not the enemy, but also it is essential to good health and wellbeing. Every cell in the body needs cholesterol in its membrane, where cholesterol plays a critical role in cell communication. Without cholesterol, cell membranes are incomplete and, as a result, their functional role deteriorates. Cholesterol is also used in the mitochondria of the cell and plays a vital role in cell energy production—not to mention its essential role in the brain structure and function. Cholesterol is the starting material of many essential chemicals including vitamin D, steroid hormones and the bile acids necessary for digestion.

For major drug companies, convincing the public that lower cholesterol levels equal good health is a marketing scheme. The goal of these companies is not your good health; it’s their profits. This “marketing messaging” has gone too far, especially considering that recent studies show that cholesterol may have protective properties against cancer.

Cholesterol is the most abundant organic molecule in the brain which contains almost a quarter of the unesterified cholesterol present in the entire body. In 2001, in groundbreaking research and with media fanfare, cholesterol was identified as the synaptogenic factor that is responsible for the development of synapses, the connections in the brain. The glial cells of the central nervous system that perform the housekeeping functions in the brain produce their own cholesterol for the specific purpose of providing nerve cells with the vital component required for synapse function. Cholesterol is also required for the function of serotonin receptors in the brain. Serotonin is the chemical in our brain that makes us feel happy. Low cholesterol level has been associated with mortality due to suicides and accidental deaths

A thirty-year study published in 1987 provides evidence that elevated cholesterol in people over the age of 50 does not increase the risk of heart attack. Cholesterol levels of people free of coronary heart disease (CHD) and cancer were measured; the study found that there was no increase in death rate in those with high cholesterol. Research on the effects of cholesterol levels and age shows that high cholesterol levels in people over the age of 75 are protective, not harmful. A separate study published in the European Heart Journal (1997) found that the risk of cardiac death was the same in groups of people with low or normal cholesterol levels as those with high cholesterol.

Maybe we need to rethink the billions of dollars we spend each year on drugs that lower cholesterol and spend the money on the real risk factors associated with cardiovascular disease: our lifestyles and choices, including nutritional and environmental factors that increase inflammation.

Stay tuned because there is more to come over the next weeks.

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Cholesterol: It’s Not the Killer

Cholesterol: It’s Not the Killer

Since the advent of cholesterol lowering drugs cholesterol has become “public enemy number one” and has taken nearly all the blame for the increase in CVD. Unfortunately this has led to a lot of misinformation and misdirection in treating the real illness of CVD and its causes.

The current ideology is far from the truth and can be dangerous—particularly since the overwhelming current evidence points to CVD as a result of poor lifestyle and dietary choices that lead to inflammation. In reality, CVD is now recognized as a disease of low-grade chronic inflammation of the vascular lining and an inappropriate wound healing of blood vessels. There is now extensive and growing evidence that inflammation is central to all stages of this disease, from the initial lesion to end-stage thrombotic complications. CVD is not a disease of cholesterol or even cholesterol accumulation.

Cholesterol is associated with the risk of CVD but it is not the disease. The cholesterol levels measured at the doctor’s office and in most studies are blood cholesterol levels and are representative of liver function . Cholesterol is a symptom of an underlying health problem. It predicts less than 35% of cardiovascular disease.  The only reason we try to get it down is because a drug company can make money selling drugs.

Along with other signalling molecules, insulin controls the packaging of cholesterol and triglycerides into LDL (low-density lipoproteins), VLDL (very low-density lipoproteins), HDL (high-density lipoproteins) and other lipoproteins. Glucagon (a hormone secreted by the pancreas) inhibits the enzyme and insulin activates the enzyme. To control cholesterol production, you want to increase glucagon and decrease insulin. That is, consume only low GI foods.

There is also strong evidence that stress increases a person’s inflammatory markers and cholesterol. One possibility may be that stress encourages the body to produce more energy in the form of metabolic fuels—fatty acids and glucose.

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