Cholesterol levels . Statins who and how much benefit. ?

[Guest guest]

An interesting look at statins

 

The real question is what benefit do statins confer

http://www.businessweek.com/magazine/content/08_04/b4068052092994.htm

Do Cholesterol Drugs Do Any Good?

 

Martin Winn's cholesterol level was inching up. Cycling up hills, he

felt chest pain that might have been angina. So he and his doctor

decided he should be on a cholesterol-lowering medication called a

statin. He was in good company. Such drugs are the best-selling

medicines in history, used by more than 13 million Americans and an

additional 12 million patients around the world, producing $27.8

billion in sales in 2006. Half of that went to Pfizer (PFE) for its

leading statin, Lipitor. Statins certainly performed as they should

for Winn, dropping his cholesterol level by 20%. " I assumed I'd get a

longer life, " says the retired machinist in Vancouver, B.C., now 71.

But here the story takes a twist. Winn's doctor, James M. Wright, is

no ordinary family physician. A professor at the University of British

Columbia, he is also director of the government-funded Therapeutics

Initiative, whose purpose is to pore over the data on particular drugs

and figure out how well they work. Just as Winn started on his

treatment, Wright's team was analyzing evidence from years of trials

with statins and not liking what it found.

 

Yes, Wright saw, the drugs can be life-saving in patients who already

have suffered heart attacks, somewhat reducing the chances of a

recurrence that could lead to an early death. But Wright had a

surprise when he looked at the data for the majority of patients, like

Winn, who don't have heart disease. He found no benefit in people over

the age of 65, no matter how much their cholesterol declines, and no

benefit in women of any age. He did see a small reduction in the

number of heart attacks for middle-aged men taking statins in clinical

trials. But even for these men, there was no overall reduction in

total deaths or illnesses requiring hospitalization--despite big

reductions in " bad " cholesterol. " Most people are taking something

with no chance of benefit and a risk of harm, " says Wright. Based on

the evidence, and the fact that Winn didn't actually have angina,

Wright changed his mind about treating him with statins--and Winn, too,

was persuaded. " Because there's no apparent benefit, " he says, " I

don't take them anymore. " ........

 

.......Plus, there are reasons to believe the overall benefit for

many patients is even less than what the NNT score of 100 suggests.

That NNT was determined in an industry-sponsored trial using carefully

selected patients with multiple risk factors, which include high blood

pressure or smoking. In contrast, the only large clinical trial funded

by the government, rather than companies, found no statistically

significant benefit at all. And because clinical trials themselves

suffer from potential biases, results claiming small benefits are

always uncertain, says Dr. Nortin M. Hadler, professor of medicine at

the University of North Carolina at Chapel Hill and a longtime drug

industry critic. " Anything over an NNT of 50 is worse than a lottery

ticket; there may be no winners, " he argues. Several recent scientific

papers peg the NNT for statins at 250 and up for lower-risk patients,

even if they take it for five years or more. " What if you put 250

people in a room and told them they would each pay $1,000 a year for a

drug they would have to take every day, that many would get diarrhea

and muscle pain, and that 249 would have no benefit? And that they

could do just as well by exercising? How many would take that? " asks

drug industry critic Dr. Jerome R. Hoffman, professor of clinical

medicine at the University of California at Los Angeles. ........ "

 

Thanks Vince