Dear Peter
After I got your newsletter about your book & Dr. Kendrick's book, I decided to order them from our local library (Mandurah). Had to wait a little bit for Dr. Kendrick's, but when I read it, I found it a bit technical (I am not from a medical/nursing background), but very interesting. However, I had to wait quite a while for your book, and finally it came in about 6 weeks ago. Our local library must have got it in especially for me - I was the first person to borrow it the Librarian said!! Your book was much easier to read for a lay person, and as I had it out for a month (and read it in 3 nights) I lent it to a friend who also enjoyed it. Now I'm going to give 2 of my cousins (from Balcatta and Noranda) the name of your book so that they can order it from their libraries. I've dallied a bit doing this as their libraries will probably borrow it from the Mandurah Library; Dr. Kendrick's book came from another library, and that's why I had to wait a couple of weeks.
I started taking medicine for cholesterol back in 1990 and my husband was very annoyed that I took it - had just shifted down from Kalgoorlie to Mandurah and went to the doctor to have a skin cancer removed, and he put me onto medicine for cholesterol (which was a bit high) and menopause (which I didn't need)!! However, when my husband died early in 1992 I found I was forgetting to take both medicines and 3 weeks after he died I gathered up all his medicines and what was left of both of mine and took them to the chemist to dispose of. When I have told friends what I did they all say I should not have stopped taking them instantly, should have slowly decreased the dosage. But, I'll tell you what, it didn't make one scrap of difference to me just stopping. However after reading your book I realise that it has affected me by depleting my CoQ10 and since I have been taking that over the past 16 months I feel so much better; but didn't really realise this until I read your book.
My late husband and I were both into alternative medicine, though I did listen to that registered doctor in 1990. But since he died I have really got more into alternative medicine and feel better for it. I'm sure my vitamin tablets are far better for me than drug medicines. I had to have a shoulder operation 2 years ago and the nurse admitting me at St. John of God Hospital in Subiaco, couldn't believe I didn't take a drug medicine of any type at my age (I will be 73 in a couple of weeks).
I belong to OSWA and went to the February meeting, which you were not able to make. The talk went off very well even though you were not there. I know it's a bit late but I wish to convey my sympathies to you on the passing of your dear mother.
Yours sincerely
Margaret Green
Silver Sands.
Showing posts with label Cholestrol. Show all posts
Showing posts with label Cholestrol. Show all posts
Friday, May 6, 2011
Tuesday, May 3, 2011
More Deception
The studies on statins also report “relative risk,” not “absolute risk” or “real risk.” The relative risk reduction is highly misleading (5,6,7,8,9) if not deceptive. An example of relative risk is: if you have four people in a study who die in the placebo group (no drug) compared to three people who die in the drug treatment group—that is, four were expected to die but with the drug only three did—then there is a 25% relative risk reduction. However, to get this effect of saving one life you would have to treat 1,000 people and the real risk reduction is 0.1%. Relative risk is like adding 1+1 to get 11 or 2+5 to get 25 or more. How can the pharmaceutical companies and the researchers working for them get away with this? This is probably because (at least in my experience) most people are afraid of statistics.
In studies by the Medical Research Council dating back to the late 1980s, researchers found that of 1,000 men ranging in age from 35 to 64 who received treatment for mild hypertension over five years, there were six fewer strokes and two fewer cardiovascular events than would be expected.(10,11) The real risk reduction over five years was 0.9%. Ten years later, a study of Pravachol® was released in the media, with much fanfare, as having a 22% drop (relative risk, not real risk) in mortality. However, when one looks at the numbers and statistics behind the calculations, treating 1,000 middle-aged men who had hypercholesterolemia (high cholesterol) and no evidence of a previous myocardial infarction with pravastatin for five years resulted in seven fewer deaths from cardiovascular causes, and two fewer deaths from other causes than would be expected in the absence of treatment.(12) The real risk reduction, however, was a mere 0.9%, less than 1% or nine lives out of 1,000 when treated for five years. The research was sponsored by Bristol-Myers Squibb Pharmaceutical (West of Scotland Coronary Prevention Study). Conservatively, put another way, researchers treated 1,000 people for five years at a total cost of over $5 million to save seven people from CVD. One might wish to compare this to the cost and efficacy of adopting healthy lifestyle choices.
In the Heart Protection Study in the United Kingdom, more than 20,000 participants aged 40 to 80 years with high risk of cardiovascular disease but average-to-low levels of total cholesterol and LDL cholesterol were treated with 40mg daily of simvastatin (marketed under several trade names including Zocor). Of 20,500+ study participants, 577 on statins died from a heart attack, 701 not treated died from a heart attack. That is a 25% relative risk reduction over five years. Sounds good, doesn’t it? The real percentage improvement is actually 1.7%. Over the five-year study(13), they saved 25 people per year in a high-risk population with previous cerebrovascular disease, peripheral artery disease, renal impairment or diabetes. These are seriously ill people and the researchers still achieved a benefit of only 1.7%. Researchers neglected to mention that around 30,000 people were not allowed in or dropped from the study and not counted in the percentage of people with side effects. There were 10,269 people on statins and 10,267 people on a placebo.(14)
A study of 90,056 participants combining 14 randomised trials looked at the best outcome for people who had pre-existing conditions: 47% had pre-existing chronic heart disease, 21% had a history of diabetes and 55% a history of hypertension. The death rate was 8.5% among the statin group compared to 9.7% in the control group. This difference represents 1.2% (15).
The well-known JUPITER study compared a placebo group to a statin-taking group. The study found that there were 68 heart attacks in the placebo group and 31 heart attacks in the drug treatment group—a 58% relative risk reduction. There were 64 strokes in the placebo group, compared to 33 strokes in the treatment group, a relative risk reduction of 48% (16). Sounds good, doesn’t it? However, the drug treatment group had 8,901 participants in it. In real terms, the heart attack risk went from a very low 0.76% to 0.35% and the risk of stroke went from 0.72% to 0.37%. Effectively, if you treat 300 people with expensive and dangerous drugs you might save one life. Under the best possible scenario, the real risk reduction was well under one half of one percent. The real risk reduction of consuming a handful of raw mixed nuts is much higher. It is interesting to note that one of the risk factors used to select the participants in the study was C- Reactive Protein (CRP) an indicator of inflammation, the real cause of CVD.
In an independent assessment of the same statistics in 2010 titled “Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy. A Critical Reappraisal “ by Michel de Lorgeril and her 8 colleagues found that “the JUPITER Study” was severely flawed (17). This recent analysis did a careful and independent review of both results and methods used in the Jupiter Study and reported that the “trial was flawed”. In an unprecedented attack on the study they (scientist other than myself usually don’t say boo even when it is serious) stated that “The possibility that bias entered the trial is particularly concerning because of the strong commercial interest in the study.” In other words the big pharmaceutical money influenced the study. And concluded "The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.” This is a scathing attack in scientific terms of the earlier drug company sponsored study. Scientist do not go out of their way to create waves but these ones have not just found different results but also criticised the earlier studies link with pharmaceutical industry. It highlights not only that the studies don’t show any significant results but these studies and the education of our doctors is strongly influenced by the drug companies.(18)
More recently, a study reported in the BMJ was a meta-analysis of 10 randomized clinical trials of about 70,000 people followed for an average of four years. In these trials, people with risk factors for cardiovascular disease but no history of existing disease were randomized to receive statins or no treatment. The relative risk reduction was 12% for total mortality, 30% for coronary event and 19% for a cerebrovascular event (stroke). However, the real risk reduction was 0.6%, 1.3% and 0.4% respectively. The actual number needed to treat to save one life was 167. Despite this outcome the authors of the study concluded, “In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly (statistical not clinical) improved survival and large (statistical) reductions in the risk of major cardiovascular events.” (“emphasis added.”). In fact, the authors had significant associations with the drug companies and failed to mention it was statistically significant but not clinically significant. Again, busy medical professionals tend to read only the abstracts; claims like this are pretty convincing, though very misleading.
More telling however, is the latest findings in June 2010 where two major independent studies, one the re analysis of the Jupiter Study reported above and the other “A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants” (don’t worry about the title) by Ray Kausik and 6 other independent researchers. The study, wait for it, found the use of statins in high-risk individuals was not associated with a statistically significant reduction in mortality. That is, they don’t save lives. Their data combined from 11 studies with 65 229 participants followed for approximately 244 000 person-years, a very big study, reported that this “meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.” In other words they don’t save lives even in a high risk group. Even if you have all the elevated risk factors these drugs don’t work.
How many more studies to we need to do to show these drugs don’t work.
(5) Fidan, D., B. Unal, et al. (2007). "Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000–2010." QJM 100: 277-289.
(6) Franco, O.H., A. Peeters, et al. (2005). "Cost effectiveness of statins in coronary heart disease." Journal of Epidemiology and Community Health 59: 927-933.
(7) Franco, O.H., E.W. Steyerberg, et al. (2006). "Effectiveness calculation in economic analysis: the case of statins for cardiovascular disease prevention." Journal of Epidemiology & Community Health 60: 839-845.
(8) Capewell, S. (2008). "Will screening individuals at high risk of cardiovascular events deliver large benefits? No." British Medical Journal 337: a1395.
(9) Nuovo, J., J. Melnikow, et al. (2002). "Reporting number needed to treat and absolute risk reduction in randomized controlled trials." Journal of American Medical Association 287: 2813-2814.
(10) Medical Research Council Working Party (1985). "MRC trial of treatment of mild hypertension: principal results." British Medical Journal 291: 97-104.
(11) Miall, W.E. and G. Greenberg (1987). Mild Hypertension: Is There Pressure to Treat? An account of the MRC trial. New York, Cambridge University Press.
(12) Shepherd, J., S.M. Cobbe, et al. (1996). "Prevention of coronary heart disease with Pravastatin in men with hypercholesterolemia." New England Journal of Medicine 333: 1301-1307.
(13) Heart Protection Study Collaborative Group (2002). "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial." Lancet 360: 7-22.
(14) Ibid.
(15) Cholesterol Treatment Trialists' Collaborators, C. Baigent, et al. (2005). "Efficacy and safety of cholesterol lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins." Lancet 366: 1267-1278.
(16) Ridker, P.M., E. Danielson, et al. (2008). "Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein." New England Journal of Medicine 359(21): 2195-2207.
(17) Ray, K.K., S.R.K. Seshasai, et al. (2010). "Statins and all-cause mortality in high-risk primary prevention: A meta-analysis of 11 randomized controlled trials involving 65 229 participants." Archives of Internal Medicine 170(12): 1024-1031.
(18) de Lorgeril, M., P. Salen, et al. (2010). "Cholesterol lowering, cardiovascular diseases, and the Rosuvastatin-JUPITER controversy: A critical reappraisal." Archives of Internal Medicine 170(12): 1032-1036.
In studies by the Medical Research Council dating back to the late 1980s, researchers found that of 1,000 men ranging in age from 35 to 64 who received treatment for mild hypertension over five years, there were six fewer strokes and two fewer cardiovascular events than would be expected.(10,11) The real risk reduction over five years was 0.9%. Ten years later, a study of Pravachol® was released in the media, with much fanfare, as having a 22% drop (relative risk, not real risk) in mortality. However, when one looks at the numbers and statistics behind the calculations, treating 1,000 middle-aged men who had hypercholesterolemia (high cholesterol) and no evidence of a previous myocardial infarction with pravastatin for five years resulted in seven fewer deaths from cardiovascular causes, and two fewer deaths from other causes than would be expected in the absence of treatment.(12) The real risk reduction, however, was a mere 0.9%, less than 1% or nine lives out of 1,000 when treated for five years. The research was sponsored by Bristol-Myers Squibb Pharmaceutical (West of Scotland Coronary Prevention Study). Conservatively, put another way, researchers treated 1,000 people for five years at a total cost of over $5 million to save seven people from CVD. One might wish to compare this to the cost and efficacy of adopting healthy lifestyle choices.
In the Heart Protection Study in the United Kingdom, more than 20,000 participants aged 40 to 80 years with high risk of cardiovascular disease but average-to-low levels of total cholesterol and LDL cholesterol were treated with 40mg daily of simvastatin (marketed under several trade names including Zocor). Of 20,500+ study participants, 577 on statins died from a heart attack, 701 not treated died from a heart attack. That is a 25% relative risk reduction over five years. Sounds good, doesn’t it? The real percentage improvement is actually 1.7%. Over the five-year study(13), they saved 25 people per year in a high-risk population with previous cerebrovascular disease, peripheral artery disease, renal impairment or diabetes. These are seriously ill people and the researchers still achieved a benefit of only 1.7%. Researchers neglected to mention that around 30,000 people were not allowed in or dropped from the study and not counted in the percentage of people with side effects. There were 10,269 people on statins and 10,267 people on a placebo.(14)
A study of 90,056 participants combining 14 randomised trials looked at the best outcome for people who had pre-existing conditions: 47% had pre-existing chronic heart disease, 21% had a history of diabetes and 55% a history of hypertension. The death rate was 8.5% among the statin group compared to 9.7% in the control group. This difference represents 1.2% (15).
The well-known JUPITER study compared a placebo group to a statin-taking group. The study found that there were 68 heart attacks in the placebo group and 31 heart attacks in the drug treatment group—a 58% relative risk reduction. There were 64 strokes in the placebo group, compared to 33 strokes in the treatment group, a relative risk reduction of 48% (16). Sounds good, doesn’t it? However, the drug treatment group had 8,901 participants in it. In real terms, the heart attack risk went from a very low 0.76% to 0.35% and the risk of stroke went from 0.72% to 0.37%. Effectively, if you treat 300 people with expensive and dangerous drugs you might save one life. Under the best possible scenario, the real risk reduction was well under one half of one percent. The real risk reduction of consuming a handful of raw mixed nuts is much higher. It is interesting to note that one of the risk factors used to select the participants in the study was C- Reactive Protein (CRP) an indicator of inflammation, the real cause of CVD.
In an independent assessment of the same statistics in 2010 titled “Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy. A Critical Reappraisal “ by Michel de Lorgeril and her 8 colleagues found that “the JUPITER Study” was severely flawed (17). This recent analysis did a careful and independent review of both results and methods used in the Jupiter Study and reported that the “trial was flawed”. In an unprecedented attack on the study they (scientist other than myself usually don’t say boo even when it is serious) stated that “The possibility that bias entered the trial is particularly concerning because of the strong commercial interest in the study.” In other words the big pharmaceutical money influenced the study. And concluded "The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.” This is a scathing attack in scientific terms of the earlier drug company sponsored study. Scientist do not go out of their way to create waves but these ones have not just found different results but also criticised the earlier studies link with pharmaceutical industry. It highlights not only that the studies don’t show any significant results but these studies and the education of our doctors is strongly influenced by the drug companies.(18)
More recently, a study reported in the BMJ was a meta-analysis of 10 randomized clinical trials of about 70,000 people followed for an average of four years. In these trials, people with risk factors for cardiovascular disease but no history of existing disease were randomized to receive statins or no treatment. The relative risk reduction was 12% for total mortality, 30% for coronary event and 19% for a cerebrovascular event (stroke). However, the real risk reduction was 0.6%, 1.3% and 0.4% respectively. The actual number needed to treat to save one life was 167. Despite this outcome the authors of the study concluded, “In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly (statistical not clinical) improved survival and large (statistical) reductions in the risk of major cardiovascular events.” (“emphasis added.”). In fact, the authors had significant associations with the drug companies and failed to mention it was statistically significant but not clinically significant. Again, busy medical professionals tend to read only the abstracts; claims like this are pretty convincing, though very misleading.
More telling however, is the latest findings in June 2010 where two major independent studies, one the re analysis of the Jupiter Study reported above and the other “A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants” (don’t worry about the title) by Ray Kausik and 6 other independent researchers. The study, wait for it, found the use of statins in high-risk individuals was not associated with a statistically significant reduction in mortality. That is, they don’t save lives. Their data combined from 11 studies with 65 229 participants followed for approximately 244 000 person-years, a very big study, reported that this “meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.” In other words they don’t save lives even in a high risk group. Even if you have all the elevated risk factors these drugs don’t work.
How many more studies to we need to do to show these drugs don’t work.
(5) Fidan, D., B. Unal, et al. (2007). "Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000–2010." QJM 100: 277-289.
(6) Franco, O.H., A. Peeters, et al. (2005). "Cost effectiveness of statins in coronary heart disease." Journal of Epidemiology and Community Health 59: 927-933.
(7) Franco, O.H., E.W. Steyerberg, et al. (2006). "Effectiveness calculation in economic analysis: the case of statins for cardiovascular disease prevention." Journal of Epidemiology & Community Health 60: 839-845.
(8) Capewell, S. (2008). "Will screening individuals at high risk of cardiovascular events deliver large benefits? No." British Medical Journal 337: a1395.
(9) Nuovo, J., J. Melnikow, et al. (2002). "Reporting number needed to treat and absolute risk reduction in randomized controlled trials." Journal of American Medical Association 287: 2813-2814.
(10) Medical Research Council Working Party (1985). "MRC trial of treatment of mild hypertension: principal results." British Medical Journal 291: 97-104.
(11) Miall, W.E. and G. Greenberg (1987). Mild Hypertension: Is There Pressure to Treat? An account of the MRC trial. New York, Cambridge University Press.
(12) Shepherd, J., S.M. Cobbe, et al. (1996). "Prevention of coronary heart disease with Pravastatin in men with hypercholesterolemia." New England Journal of Medicine 333: 1301-1307.
(13) Heart Protection Study Collaborative Group (2002). "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial." Lancet 360: 7-22.
(14) Ibid.
(15) Cholesterol Treatment Trialists' Collaborators, C. Baigent, et al. (2005). "Efficacy and safety of cholesterol lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins." Lancet 366: 1267-1278.
(16) Ridker, P.M., E. Danielson, et al. (2008). "Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein." New England Journal of Medicine 359(21): 2195-2207.
(17) Ray, K.K., S.R.K. Seshasai, et al. (2010). "Statins and all-cause mortality in high-risk primary prevention: A meta-analysis of 11 randomized controlled trials involving 65 229 participants." Archives of Internal Medicine 170(12): 1024-1031.
(18) de Lorgeril, M., P. Salen, et al. (2010). "Cholesterol lowering, cardiovascular diseases, and the Rosuvastatin-JUPITER controversy: A critical reappraisal." Archives of Internal Medicine 170(12): 1032-1036.
Monday, May 2, 2011
Statin Statistics: Lies and Deception
In an independent meta-analysis (when a number of studies are put together to achieve more statistical power) of randomized controlled trials in patients without CVD, statin therapy decreased the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality.(1) Taking statins for a number of years will not reduce mortality: “Primary prevention with statins provides only small and clinically hardly relevant improvement of cardiovascular morbidity/mortality.”(2) “Hardly relevant” means there is virtually no clinical benefit; as the authors of these particular studies are independent, they gain nothing by stating this. Another review found that “current clinical evidence does not demonstrate that titrating lipid therapy (trying to lower cholesterol with statins) to achieve proposed low LDL cholesterol levels is beneficial or safe.”(3) In other words, lowering lipids has no real benefit and has the potential for adverse effects. Following up on this, in a major independent review of studies funded by the Ministry of Health of British Columbia (Canada) on statins and primary prevention, researchers reported that “statins have not been shown to provide an overall health benefit in primary prevention trials.”(4) This is a government report carried out by an independent university yet its findings are still ignored.
The problem really comes down to vested interests and the abuse of statistics. To overcome the limitations of small studies, vested parties combine many studies into a meta-analysis. The researchers themselves select the studies used in the meta-analysis. A fundamental problem is that researchers with direct links to drug companies have the authority to select the most positive studies and ignore the rest—including independent studies not funded by pharmaceutical companies. Despite this, they have still not been able to show any clinically significant findings.
As readers of the scientific journals, we should not be confused between statistical significance and clinical significance. For an outcome to be “statistically significant” means that the outcome was likely result of the treatment—whether the result 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” means 20% to 30% or more. The drug companies’ most positive studies on statins for prevention of CVD report statistical significance, mostly 1% or less, and none have found any clinical significance.
Busy medical professionals don’t have time to review the statistics; few of them may be aware of the different ways the statistics are manipulated. So if the experienced professionals don’t understand the results of these studies, how do we expect the media or public to understand?
(1) Thavendiranathan, P., A. Bagai, et al. (2006). "Primary prevention of cardiovascular diseases with statin therapy: A meta-analysis of randomized controlled trials." Archives of Internal Medicine 166: 2307-2313.
(2) Vrecer, M., S. Turk, et al. (2003). "Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials." International Journal of Clinical Pharmacology and Therapeutics 41(12): 567-577.
(3) Hayward, R.A., T.P. Hofer, et al. (2006). "Narrative review: Lack of evidence for recommended low-density lipoprotein treatment targets: A solvable problem." Annals of Internal Medicine 145(7): 520-530.
(4) University of British Columbia (2003). "Do statins have a role in primary prevention? A review by the Therapeutics Initiative of the Department of Pharmacology & Therapeutics of the University of British Columbia." Therapeutics Letter (48).
The problem really comes down to vested interests and the abuse of statistics. To overcome the limitations of small studies, vested parties combine many studies into a meta-analysis. The researchers themselves select the studies used in the meta-analysis. A fundamental problem is that researchers with direct links to drug companies have the authority to select the most positive studies and ignore the rest—including independent studies not funded by pharmaceutical companies. Despite this, they have still not been able to show any clinically significant findings.
As readers of the scientific journals, we should not be confused between statistical significance and clinical significance. For an outcome to be “statistically significant” means that the outcome was likely result of the treatment—whether the result 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” means 20% to 30% or more. The drug companies’ most positive studies on statins for prevention of CVD report statistical significance, mostly 1% or less, and none have found any clinical significance.
Busy medical professionals don’t have time to review the statistics; few of them may be aware of the different ways the statistics are manipulated. So if the experienced professionals don’t understand the results of these studies, how do we expect the media or public to understand?
(1) Thavendiranathan, P., A. Bagai, et al. (2006). "Primary prevention of cardiovascular diseases with statin therapy: A meta-analysis of randomized controlled trials." Archives of Internal Medicine 166: 2307-2313.
(2) Vrecer, M., S. Turk, et al. (2003). "Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials." International Journal of Clinical Pharmacology and Therapeutics 41(12): 567-577.
(3) Hayward, R.A., T.P. Hofer, et al. (2006). "Narrative review: Lack of evidence for recommended low-density lipoprotein treatment targets: A solvable problem." Annals of Internal Medicine 145(7): 520-530.
(4) University of British Columbia (2003). "Do statins have a role in primary prevention? A review by the Therapeutics Initiative of the Department of Pharmacology & Therapeutics of the University of British Columbia." Therapeutics Letter (48).
Wednesday, September 8, 2010
Even more on cholesterol
All of what I have been saying about cholesterol has been supported in the latest 2 major studies published in the June 2010. The first study “Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy. A Critical Reappraisal “ by Michel de Lorgeril and her 8 colleagues found that one of the major studies, probably the most influential of the studies to justify cholesterol lowering drug use and sponsored by the drug companies “the JUPITER Study” was severely flawed. This study did a careful and independent review of both results and methods used in the Jupiter Study and reported that the “trial was flawed”. In an unprecedented attack on the study they (scientist other than myself usually don’t say boo even when it is serious) stated that “The possibility that bias entered the trial is particularly concerning because of the strong commercial interest in the study.” In other words the big pharmaceutical money influenced the study. And concluded "The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.” This is a scathing attack in scientific terms of the earlier drug company sponsored study. Scientist do not go out of their way to create waves but these ones have not just found different results but also criticised the earlier studies link with pharmaceutical industry. Why this is so important is that my next book “the great cholesterol deception” does exactly that. It highlights not only that the studies don’t show any significant results but these studies and the education of our doctors is strongly influenced by the drug companies. (Arch Intern Med. 2010;170(12):1032-1036. )
In the second study “Statins and All-Cause Mortality in High-Risk Primary Prevention. A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants” (don’t worry about the title too much) by Ray Kausik and 6 other independent researchers found the use of statins in this high-risk individuals was not associated with a statistically significant reduction. That is they don’t save lives. Their data combined from 11 studies with 65 229 participants followed for approximately 244 000 person-years, a very big study reported that this meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.” In other words they don’t save lives even in a high risk group. Even if you have all the elevated risk factors they don’t work. (Arch Intern Med. 2010;170(12):1024-1031).
Combining the results of the two studies cholesterol lowering drugs do not reduce the risk of heart attack, stroke or all cause mortality (eg cancer) in high risk individuals. They don’t work but cost the Australian tax payer more than $1 billion a year and up to a thousand dollars a year for individuals. Why doesn’t the government open it eyes. It could save a lot of pain and suffering (because of the serious side effects) and a lot of money? Why? All the major political parties get donations from the big pharmaceutical companies. Yes I have a chapter on that too.
Please circulate this information to everyone you know it might save their life and money.
In the second study “Statins and All-Cause Mortality in High-Risk Primary Prevention. A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants” (don’t worry about the title too much) by Ray Kausik and 6 other independent researchers found the use of statins in this high-risk individuals was not associated with a statistically significant reduction. That is they don’t save lives. Their data combined from 11 studies with 65 229 participants followed for approximately 244 000 person-years, a very big study reported that this meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.” In other words they don’t save lives even in a high risk group. Even if you have all the elevated risk factors they don’t work. (Arch Intern Med. 2010;170(12):1024-1031).
Combining the results of the two studies cholesterol lowering drugs do not reduce the risk of heart attack, stroke or all cause mortality (eg cancer) in high risk individuals. They don’t work but cost the Australian tax payer more than $1 billion a year and up to a thousand dollars a year for individuals. Why doesn’t the government open it eyes. It could save a lot of pain and suffering (because of the serious side effects) and a lot of money? Why? All the major political parties get donations from the big pharmaceutical companies. Yes I have a chapter on that too.
Please circulate this information to everyone you know it might save their life and money.
Monday, September 6, 2010
Cholesterol debate
We have been researching the cholesterol issue for the past 2 years. Cholesterol is not the killer just a simple indicator that the liver is under a bit of stress. Nor is saturated fat the issue. If you look at heart attack figures around the world you find they are more closely linked with stress than anything else. The French, Swiss, Belgians, Dutch (Netherlanders) etc have high saturated fats and cholesterol and the lowest rates of heart attach in the world. It is not French paradox and wine it is the lifestyle and a healthy diet. It is so simple.
The cholesterol we monitor in the body is produced by the liver. This will be increased if you have sugar (hi GI), stress and too little water. But all it is telling you is that something is wrong. You don’t shoot the messenger.
In Japan when they increased both the saturated fat in the diet and cholesterol in the blood in the 1950s the heart attack rates go down. There are hundreds of cases like this that completely dispel the cholesterol hypothesis.
More importantly the cholesterol hypothesis and that is what it is, just a hypothesis. But people treat it like fact. However, in science (and i am a scientist) if a hypothesis is tested and it fails it is no longer considered a valid hypothesis except in medicine where money and the volume of media whitewash it all.
Not only can I find a single bit of fact in the cholesterol hypothesis but it acts like a chameleon, one of those lizards that change color to suit the background. It has changed so many times. First it was just saturated fat and cholesterol, then it was cholesterol, then it was LDL cholesterol, then LDL and HDL ratios, then VLDL, then HDL and the number of changes just keep happening.
This is the greatest lie that has ever been sold to the public. Cholesterol is just a marker and as highlighted above one of the most important functional molecules in the body.
For a great book on this get “the great cholesterol con” by Malcolm Kendrick and MD with a conscience and common sense. And in two months I will have my book out The great cholesterol deception”. Notice the similarity in titles but I only just found the other book 2 weeks ago.
Also note that this information is exactly what the pharmaceutical companies don’t want out there so please spread it around.
The cholesterol we monitor in the body is produced by the liver. This will be increased if you have sugar (hi GI), stress and too little water. But all it is telling you is that something is wrong. You don’t shoot the messenger.
In Japan when they increased both the saturated fat in the diet and cholesterol in the blood in the 1950s the heart attack rates go down. There are hundreds of cases like this that completely dispel the cholesterol hypothesis.
More importantly the cholesterol hypothesis and that is what it is, just a hypothesis. But people treat it like fact. However, in science (and i am a scientist) if a hypothesis is tested and it fails it is no longer considered a valid hypothesis except in medicine where money and the volume of media whitewash it all.
Not only can I find a single bit of fact in the cholesterol hypothesis but it acts like a chameleon, one of those lizards that change color to suit the background. It has changed so many times. First it was just saturated fat and cholesterol, then it was cholesterol, then it was LDL cholesterol, then LDL and HDL ratios, then VLDL, then HDL and the number of changes just keep happening.
This is the greatest lie that has ever been sold to the public. Cholesterol is just a marker and as highlighted above one of the most important functional molecules in the body.
For a great book on this get “the great cholesterol con” by Malcolm Kendrick and MD with a conscience and common sense. And in two months I will have my book out The great cholesterol deception”. Notice the similarity in titles but I only just found the other book 2 weeks ago.
Also note that this information is exactly what the pharmaceutical companies don’t want out there so please spread it around.
Wednesday, April 21, 2010
Sugar and Heart Attack
Continuing my campaign against sugars added to all our foods a recent article in the Journal of the American Medical Association (JAMA. 2010;303(15):1490-1497) found a high intake of added sugar is associated with increased risk for low HDL cholesterol and high triglycerides (blood fats). The HDL cholesterol is the one that transports the cholesterol back to the liver where it is used. When the HDL is low it is associated with a higher level of heart attack and stroke risk.
Compared with adults who got less than 5% of their total energy intake from added sugars, those getting 17.5%–25% of their energy from added sugars were about twice as likely to have low HDL levels.
The message lower your sugar to lower you risk of heart attack and stroke.
Compared with adults who got less than 5% of their total energy intake from added sugars, those getting 17.5%–25% of their energy from added sugars were about twice as likely to have low HDL levels.
The message lower your sugar to lower you risk of heart attack and stroke.
Tuesday, April 6, 2010
More Cholesterol Deception
A recent 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 the new york times web page
Please copy this blog and send it on to everyone you know.
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 the new york times web page
Please copy this blog and send it on to everyone you know.
Wednesday, February 10, 2010
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.
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.
Monday, February 8, 2010
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.
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.
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.
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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