44 ms·

Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, vol. 2021, no. 9, 2013, https://d

Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, vol. 2021, no. 9, 2013, https://doi.org/10.1002/14651858.cd004816.pub5 https://doi.org/10.1002/14651858.cd004816.pub5. Page 11. If you have an account at Cochrane: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004816.pub5/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... If not, just get it from LibGen with: 10.1002/14651858.CD004816.pub5

sohex 3y ago
The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to these low risk groups." And as haldujai mentioned this is explicitly regarding their use for primary prevention, not with regards to usage for secondary prevention which has strong supporting evidence.
- rgbgraph 3y ago
  Generally, you read the papers for their methodology and their data — not for the author commentary; and then make up your own mind. One man’s “benefits of statins for primary prevention” is another’s “the benefits are too meager to be notable.” Please provide me literature from a reputable publication (viz. the AHA, Cochrane, or the New England Journal of Medicine), that has not been funded by a pharmaceutical company — that demonstrates strong supporting evidence for the usage of statins in secondary prevention; wherein the experiment does not extrapolate from LDL values to determine mortality risk (I will concede defeat if you can find any paper that utilizes CAC scans and shows a reversal in atherosclerosis), and/or shows a greater than 2% absolute reduction all-cause or CVD-only mortality risk. You will not find such a paper, because it does not exist. Most funding has gone towards primary prevention in young adults — while little more than weak associative studies have been published for secondary prevention (and countless others I no doubt have never seen the light of day).
  - haldujai 3y ago
    So every link I provided give you a risk of MACE. Reversal of atherosclerosis is not the outcome measure we care about lol. Certainly not lowering coronary calcium which is not possible. You’re literally making this up… Statins work amazingly not just for LDL reduction but plaque stabilization. As an aside a 2% ARR is huge, it means the number needed to treat is 50 to save a life. For something with next to no serious side effects, rhabdo/diabetes is dramatically overstated. Pertinently, the number needed to treat for MACE is 39. That’s hugely significant.
    - rgbgraph 3y ago
      Then we are at an uncrossable philosophical chasm. I don’t consider 2% ARR huge — especially when the risks of side-effects have been down-played. We can argue about this all we want, but it’s no longer a matter of fact, but of opinion and values.
      - haldujai 3y ago
        You seem to be misunderstanding how evidence works, it is not about “what you consider” and is entirely based on fact. We also don’t talk ARR in isolation when we decide on interventions, it’s NNT vs NNH and considering the specific risk being reduced and the specific harm. I’ll use your 2% ARR for death although there are better numbers in different patient populations. In other words: Statins will save 1 life for every 50 patients treated and prevent 1 in ~20-40 non-fatal cardiac events, a medically significant result period. The NNH is > 100, and the harm is a self-limiting myopathy (and a possible risk of accelerated diabetes-onset in observational studies, that is still outweighed by the reduction in all-cause mortality and MACE). The evidence is unequivocal that the benefits far outweigh the harms. Separately, you have a personal choice to take/not take any treatment, and you may personally feel treating 50 people to save 1 life is not worth it for you, because you subjectively feel the numbers don’t fit your personal risk/benefit model. This is where you are saying 2% ARR is insignificant to you but this says nothing about the evidence or rationale behind the treatment. > risks of side-effects have been down-played. Except every study looking at side-effects has shown they were overstated in the initial trial. “The most severe complication of SI is discontinuation of effective cholesterol-lowering treatment in patients who, by virtue of their CVD risk and cholesterol level, might otherwise benefit.” https://www.sciencedirect.com/science/article/abs/pii/S0021915020303476 https://www.sciencedirect.com/science/article/abs/pii/S00219...

sohex 3y ago

The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to these low risk groups." And as haldujai mentioned this is explicitly regarding their use for primary prevention, not with regards to usage for secondary prevention which has strong supporting evidence.

rgbgraph 3y ago
Generally, you read the papers for their methodology and their data — not for the author commentary; and then make up your own mind. One man’s “benefits of statins for primary prevention” is another’s “the benefits are too meager to be notable.” Please provide me literature from a reputable publication (viz. the AHA, Cochrane, or the New England Journal of Medicine), that has not been funded by a pharmaceutical company — that demonstrates strong supporting evidence for the usage of statins in secondary prevention; wherein the experiment does not extrapolate from LDL values to determine mortality risk (I will concede defeat if you can find any paper that utilizes CAC scans and shows a reversal in atherosclerosis), and/or shows a greater than 2% absolute reduction all-cause or CVD-only mortality risk. You will not find such a paper, because it does not exist. Most funding has gone towards primary prevention in young adults — while little more than weak associative studies have been published for secondary prevention (and countless others I no doubt have never seen the light of day).
- haldujai 3y ago
  So every link I provided give you a risk of MACE. Reversal of atherosclerosis is not the outcome measure we care about lol. Certainly not lowering coronary calcium which is not possible. You’re literally making this up… Statins work amazingly not just for LDL reduction but plaque stabilization. As an aside a 2% ARR is huge, it means the number needed to treat is 50 to save a life. For something with next to no serious side effects, rhabdo/diabetes is dramatically overstated. Pertinently, the number needed to treat for MACE is 39. That’s hugely significant.
  - rgbgraph 3y ago
    Then we are at an uncrossable philosophical chasm. I don’t consider 2% ARR huge — especially when the risks of side-effects have been down-played. We can argue about this all we want, but it’s no longer a matter of fact, but of opinion and values.
    - haldujai 3y ago
      You seem to be misunderstanding how evidence works, it is not about “what you consider” and is entirely based on fact. We also don’t talk ARR in isolation when we decide on interventions, it’s NNT vs NNH and considering the specific risk being reduced and the specific harm. I’ll use your 2% ARR for death although there are better numbers in different patient populations. In other words: Statins will save 1 life for every 50 patients treated and prevent 1 in ~20-40 non-fatal cardiac events, a medically significant result period. The NNH is > 100, and the harm is a self-limiting myopathy (and a possible risk of accelerated diabetes-onset in observational studies, that is still outweighed by the reduction in all-cause mortality and MACE). The evidence is unequivocal that the benefits far outweigh the harms. Separately, you have a personal choice to take/not take any treatment, and you may personally feel treating 50 people to save 1 life is not worth it for you, because you subjectively feel the numbers don’t fit your personal risk/benefit model. This is where you are saying 2% ARR is insignificant to you but this says nothing about the evidence or rationale behind the treatment. > risks of side-effects have been down-played. Except every study looking at side-effects has shown they were overstated in the initial trial. “The most severe complication of SI is discontinuation of effective cholesterol-lowering treatment in patients who, by virtue of their CVD risk and cholesterol level, might otherwise benefit.” https://www.sciencedirect.com/science/article/abs/pii/S0021915020303476 https://www.sciencedirect.com/science/article/abs/pii/S00219...