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I saw that the patients had a history of heart problems. If you reduce deaths from 8.3% of the study group to 6.9% that is a 24% reduction in deaths among the group previously having had heart attacks. A 24% reduction in this group is quite significant.
You're missing the difference betweem ARR vs RRR (Absolute vs Relative Risk Reduction)--
Eg- suppose there's a disease that kills 2 out of every 1000 pts (0.2% death rate), and you discover a treatment that reduces that to 1 out of 1000-- that's a 50% RRR (WOW!!!) but only a reducton of 0.1% ARR (death rate goes from 0.2% to 0.1%)---
---as opposed to a disease that kills 50 out of 100 (50% death rate) and a new treatment reduces that to 40 out of 100. That's only a 20% RRR and only a 10% ARR. ...Which has a greater effect on its disease-- the one with a 50% RRR or the one with a 20% ARR? ...For the innumerate among us, the first treatment requires that 1000 pts be treated to save one life, while the second only requires 10 pts to be treated to save one life. Teh second is the jore effective treatment.
Always beware of studies that report RRR. It's a trick to make unimpressive, single digit percentages look like they're really impressive double digit improvements.
For the statin data in question, you need to treat 50 MI survivors in order to save one repeat MI (2% ARR)....BigPharm lobbying with the help of unscrupulous lawyers in court has made that 2% figure to be held in more esteem than it merits clinically...When the penalty for not prescribing it can be 10s of millions of dollars in a malpractice decision, the docs don't care if they need to treat 49 pts needlessly for every single pt saved. .... Follow the money, not the science.
Last edited by guidoLaMoto; 05-03-2023 at 11:01 AM..
Short answer-- Lawyers. and most docs are ignorant of the actual statistics...In your case, with such a high risk of CAD based on family history, not to mention, you've already been proven to have CAD & carotid stenosis, we have to concede that 2% improvement is 2% improvement. (see below)
(BTW- carotid artery stenosis is more predictive of CAD than it is of future stroke. Your doc should always listen to your neck with his stethoscope (if he even has a stethoscope anymore, let alone knows how to use it.)
Thank you for documenting my point for me-- Read that study synopsis-- They studied pts who already have had a heart attack and the statin only reduced the risk of a second heart attack by 1.9% absolute risk reduction (ARR), but they disingenuously reported it as a 24% relative risk reduction (RRR)....Using statins before there is demonstrable CAD has never been shown to prevent its development.
That is a two percentage point difference, not a two percent difference. There was a 24% difference. From a public health standpoint that is a lot of heart attacks.
DH recently had an ultrasound of his neck because his internist heard a bruit. Yes, there are still some who have stethoscopes and know how to use them! His carotids looked fine. He has taken a statin practically since they came on the market. He will be 79 in a couple of weeks.
I started a statin when my genealogy research uncovered the extent of cardiovascular disease in my family tree, based on death certificates.
The decision to use a statin should be based on an assessment of all risk factors for cardiovascular disease.
My PCP put me on a statin years ago. No side effects at all, but I must admit I enjoy the righteous indignation of those lay people who think they know what statins do.
Location: By the sea, by the sea, by the beautiful sea
68,329 posts, read 54,381,135 times
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Quote:
Originally Posted by LittleDolphin
Curious--if one eats a heart-healthy diet and exercises and is at a healthy weight, can they still get a widow- maker heart attack if genetically disposed to heart disease?
Guess my main question is if a person can become almost bullet-proof to heart disease through lifestyle?
I doubt lifestyle will ever rule over genetic predisposition.
I doubt lifestyle will ever rule over genetic predisposition.
Yeah, lifestyle is mostly about how you want to feel every day you are alive. I do not think we have as much control over longevity as people would like to believe.
You're missing the difference betweem ARR vs RRR (Absolute vs Relative Risk Reduction)--
Eg- suppose there's a disease that kills 2 out of every 1000 pts (0.2% death rate), and you discover a treatment that reduces that to 1 out of 1000-- that's a 50% RRR (WOW!!!) but only a reducton of 0.1% ARR (death rate goes from 0.2% to 0.1%)---
---as opposed to a disease that kills 50 out of 100 (50% death rate) and a new treatment reduces that to 40 out of 100. That's only a 20% RRR and only a 10% ARR. ...Which has a greater effect on its disease-- the one with a 50% RRR or the one with a 20% ARR? ...For the innumerate among us, the first treatment requires that 1000 pts be treated to save one life, while the second only requires 10 pts to be treated to save one life. Teh second is the jore effective treatment.
Always beware of studies that report RRR. It's a trick to make unimpressive, single digit percentages look like they're really impressive double digit improvements.
For the statin data in question, you need to treat 50 MI survivors in order to save one repeat MI (2% ARR)....BigPharm lobbying with the help of unscrupulous lawyers in court has made that 2% figure to be held in more esteem than it merits clinically...When the penalty for not prescribing it can be 10s of millions of dollars in a malpractice decision, the docs don't care if they need to treat 49 pts needlessly for every single pt saved. .... Follow the money, not the science.
I think the main issue here is that there are millions of MI survivors just in the US, so we really do have a lot of people who have had positive effects from statins even if it is only a 2% absolute improvement. On the other hand, if we only had 100 and needed 1000 to save one life, I’d agree that it doesn’t seem particularly worth it. I think we have so many medications that really only work for an absolute small percentage, but for those few it really does matter.
My PCP put me on a statin years ago. No side effects at all, but I must admit I enjoy the righteous indignation of those lay people who think they know what statins do.
I know what statins do, they give me heartburn 20 hours a day, every day. So, no statins for me.
Location: By the sea, by the sea, by the beautiful sea
68,329 posts, read 54,381,135 times
Reputation: 40736
Quote:
Originally Posted by Wile E. Coyote
Yeah, lifestyle is mostly about how you want to feel every day you are alive. I do not think we have as much control over longevity as people would like to believe.
Yeah, I'm not sure about longevity but I think lifestyle can affect your everyday life experience and overall mood. I got lazy during the pandemic but have been walking about 20 miles a week for the past 11 months or so and it's really improved my feeling of well being.
That is a two percentage point difference, not a two percent difference. There was a 24% difference. From a public health standpoint that is a lot of heart attacks.
DH recently had an ultrasound of his neck because his internist heard a bruit. Yes, there are still some who have stethoscopes and know how to use them! His carotids looked fine. He has taken a statin practically since they came on the market. He will be 79 in a couple of weeks.
I started a statin when my genealogy research uncovered the extent of cardiovascular disease in my family tree, based on death certificates.
The decision to use a statin should be based on an assessment of all risk factors for cardiovascular disease.
Think a little more about the math. You're not catching on either....But you're right about considering all risk factors. Hi chol as the only risk factor does not need (scientifically) to be treated.
In regards the "risk calculator"-- based on the fallacy that statistics apply to the individual.
In regards "2% represents a lot of people from the public health standpoint"-- think about the inverse-- how many people are treated needlessly with statins just to get that 2% advantage?...That's the qualitative value judgement we need to make when the quantitative results are small -- how small is too small to worry about? If statins cost $5000 a month, we'd see things differently.
In regards your hubby's carotid bruit-- If he were 49 or 59, I'd order a cardiac stress test or even go right for the angiography now. At 69- probably still get aggressive. At 79- depends on his general condition -- is he a "young 79" or an "old 79"?
For example, heart disease is the No. 1 killer of both men and women in the U.S. Yet some research shows it may be possible to prevent 80% of heart disease. Why?
“I have a colleague who says that coronary heart disease is a foodborne illness,” says Kelly. “And he’s right! For the vast majority of people, it’s caused by food and can be reversed by food.”
I have a colleague who says that coronary heart disease is a foodborne illness. And he’s right!
John Kelly, MD, MPH
So? Seems some research and Docs think we're not hard-wired to die/suffer from certain diseases just because some of our ancestors did...
What was the diet of our ancestors??
I'm thinking of Jim Fixx, the runner who popularized jogging/running in the U.S. Wrote a book on the topic.
He looked terrific. Slender, hardly any body fat. Ran miles and miles every day. Thought he'd live forever.
Didn't listen to his Doc. Ate a crummy diet. Found his body, dressed in running clothes, lying by the side of the road one cold morning He was only in his 50s..autopsy found his major heart arteries were clogged...
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