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However, the risk of atherosclerotic heart disease is not 2 in a million. It is much higher than that, and the risk can be individualized by considering all of the patient's history.
My God SuzyQ! I SAID it was an EXAMPLE for illustration purposes. So EVERYONE would get the point.
It would be very nice if we could tell which of the 39 would be the 20 who benefited so we did not have to treat all 100. There is no way to do that, so we offer treatment (it's the patient's choice) to all 100. Note that the man in the calculator is also told to make lifestyle changes and treat his hypertension.
By emphasizing only mortality, by the way, you are being deceptive. Statins are given to prevent all atherosclerotic events, including nonfatal heart attacks and strokes and the need for bypass surgery, not just deaths.
Just stop. Stop and think for just one minute. Are you answering what I said about relative vs absolute risk reduction? Are you trying to distract from what I obviously was trying to explain?
Do you understand the marketing strategy of reporting ONLY relative risk reduction is intentionally deceptive?
Do you understand that we cannot make sense of a report that mentions only relative risk reduction?
Do you understand that statin drugs are used for primary prevention in patients who have a very small chance of having a heart attack?
Have you read any articles I linked? Have you read anything I said? Aren't you just reflexively repeating your tired story about the wonders of statins drugs?
How can YOU have an opinion on my thread if you didn't even read it?
I read quite a few of your incoherent rambling posts. You have extremely strong feelings about statins so you will find articles that will jibe with your beliefs. There are a few very well educated folks on this thread that have been the common sense element to your beliefs and your opinions. I am giving a thumbs up to them because I have more faith in their approach on this topic complete with case reviewed studies, as opposed to your, I don't even know how to phrase it, ramblings. You might have some very valid points but your approach in delivering them needs a little refinement.
Let me ask you this: Lets say you had bad cholesterol numbers even though you exercised daily, were at your perfect weight, and ate a healthy diet, would you take prescribed statins to lower the numbers into a healthy range?
I may have posted this before, but it quantifies the effect of modern medical treatment on coronary heart disease mortality, although just from 1980 to 2000:
The age adjusted death rate was cut about in half.
"Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively)."
That was a reduction of 341,745 deaths from coronary heart disease in 2000.
Since that study was published death from heart disease has dropped even further. it is now 166 per 100,000 for all heart disease and both sexes.
I read quite a few of your incoherent rambling posts. You have extremely strong feelings about statins so you will find articles that will jibe with your beliefs. There are a few very well educated folks on this thread that have been the common sense element to your beliefs and your opinions. I am giving a thumbs up to them because I have more faith in their approach on this topic complete with case reviewed studies, as opposed to your, I don't even know how to phrase it, ramblings. You might have some very valid points but your approach in delivering them needs a little refinement.
Let me ask you this: Lets say you had bad cholesterol numbers even though you exercised daily, were at your perfect weight, and ate a healthy diet, would you take prescribed statins to lower the numbers into a healthy range?
Some people have extremely high cholesterol because of genetic defects, and they often die relatively young because their arteries get clogged with cholesterol. This is only a small minority of the population, and we cannot generalize from them. Unfortunately, the medical industry has generalized form them, and assumes everyone should have cholesterol under a certain limit.
If my cholesterol were over the currently accepted limit, but there was no reason to suspect heart disease or familial hypercholesterolemia (FH), then I definitely would NOT take statins.
Unfortunately, many millions are in that situation and are taking the drugs. Mostly because of incorrect generalizing from FH to ordinary high cholesterol. And because of drug company marketing that uses relative risk reduction and fails to mention absolute risk.
And by the way I don't hate statins. I have always been skeptical of them, and certain other drugs. But the reading I did for this thread has made me even more skeptical of the drug industry.
Allow me to suggest you take the rest of the day off and go fishing or something. Watch a comedy. Read a book for pure enjoyment. Take a nap. Pet a dog. Eat a cupcake.
If you had read my thread, which of course you did not, you would have seen plenty of evidence for not taking statin drugs unless you belong to the minority of people who need them.
I'm tired of you speaking for me - you are very disrespectful - your attitude alone hurts your case. I can read your "evidence" and accept it or not.
It is NOT just my opinion. If you had read it, you would know that I cited mainstream journal articles and mainstream experts. You ignored everything.
You can't face the fact that the drug companies are not perfectly honest angels. All you have to do is look at how they report risk reduction -- only relative, seldom or never absolute. There is NO WAY to make sense of a risk reduction statement if you only know the RRR.
Hypothetical, exaggerated example for instruction purposes:
Let's say 2 people out of 1,000,000 are likely to be struck by lightening while in their bathtub.
I am selling a device that you can install on your bathtub that will prevent 1 person from being struck by lightening. So it goes from two in a million to one in a million.
Got it so far?
Now, in order to present my device in a better light, according to the advice of my marketing director, I express the relative risk reduction, instead of the absolute risk reduction.
Amazing new product! Reduces your risk of being struck by lightening in your bathtub by 50 percent!!!!
Well, seeing that ad, you just gotta have it. But ... hmm ... we don't know what the actual risk is, from that ad. Would our customers be happy if they knew their absolute risk reduction is only a mere .0001%?
This is elementary school math, SuzyQ, so everyone should be able to get the point.
Correct - and SO elementary that it is silly for you to keep harping on it as though you've found the holy grail proving some wrongdoing or clear intention to deceive. Just because you were fooled on the difference between absolute and relative - or did you just go straight to Diamond, PhD. to get your message points? - doesn't mean everyone else is too ignorant of statistics to know and understand the difference. You clearly understimate those you perceive to be your enemy.
Just stop. Stop and think for just one minute. Are you answering what I said about relative vs absolute risk reduction? Are you trying to distract from what I obviously was trying to explain?
Do you understand the marketing strategy of reporting ONLY relative risk reduction is intentionally deceptive?
Do you understand that we cannot make sense of a report that mentions only relative risk reduction?
Do you understand that statin drugs are used for primary prevention in patients who have a very small chance of having a heart attack?
Have you read any articles I linked? Have you read anything I said? Aren't you just reflexively repeating your tired story about the wonders of statins drugs?
The problem I have with your nattering on about absolute risk reduction is that you are pulling numbers out of thin air that do not relate to the real risks of having a heart attack or stroke. You never explained where your NNT=250 came from, and I showed you much lower NNTs than that. You seem to be unable to understand that not everyone has the same risk of developing atherosclerotic cardiovascular disease.
I have also given examples of use of the cardiac risk calculator to help determine whether use of a statin would provide clinically significant benefit. You have ignored it.
If an article uses relative risk reduction and you want to know absolute risk reduction you can calculate it yourself.
The risk calculator will not advise a statin for someone at "very small chance of having a heart attack".
Example: 50 year old male: not African American, normal blood pressure, not diabetic, nonsmoker, with a total cholesterol of 200:
"On the basis of your calculated risk for heart disease or stroke less than 7.5% (3.9%), the ACC/AHA guidelines suggest you have no indication to be on a statin."
Let's do another: 60 year old female, African American, normal blood pressure, not diabetic, nonsmoker, with a total cholesterol of 200:
"On the basis of your calculated risk for heart disease or stroke less than 7.5% (5.2%), the ACC/AHA guidelines suggest you have no indication to be on a statin."
Start adding in smoking, diabetes and, and hypertension any or in combination - and the risk goes up, and the statin comes into play.
Let's run the calculation for a 65 year old male hypertensive, diabetic smoker, cholesterol 250:
"On the basis of your age, your calculated risk for heart disease or stroke over 7.5% (54.2%), and diabetes, the ACC/AHA guidelines suggest you should be on a high intensity statin."
I read quite a few of your incoherent rambling posts. You have extremely strong feelings about statins so you will find articles that will jibe with your beliefs. There are a few very well educated folks on this thread that have been the common sense element to your beliefs and your opinions. I am giving a thumbs up to them because I have more faith in their approach on this topic complete with case reviewed studies, as opposed to your, I don't even know how to phrase it, ramblings. You might have some very valid points but your approach in delivering them needs a little refinement.
Let me ask you this: Lets say you had bad cholesterol numbers even though you exercised daily, were at your perfect weight, and ate a healthy diet, would you take prescribed statins to lower the numbers into a healthy range?
You are describing me and the answer is No I will not take a statin. The danger from potential side effects is greater than death. I doubt you would understand that ,but quality of life is more important than length of life.
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