New Guidelines for statin use

By rmrd0000 on Tue, 11/19/2013 - 11:48am |

The new risk calculator over-estimates the risk of cardiovascular events in the population. High risk groups benefit from statins. The new risk calculator places too many people in the high risk group when the new risk calculator is compared with actual cardiovascular events detected in epidemiological studies.

This is an active subject of discussion in the cardiology community. Even those who support use of statins in high risk groups have reservations about the new risk calculator.

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http://www.medscape.com/viewarticle/814579

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A credibility disaster for cardiology:

Risk Calculator for Cholesterol Appears Flawed
By Gina Kolata, New York Times, Nov. 17/18, 2013

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.

“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”[....]

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review. Both reported back that the calculator was not working among the populations it was tested on by the guideline makers.

That was unfortunate because the committee thought the researchers had been given the professors’ responses, said Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University.

Drs. Ridker and Cook saw the final guidelines and risk calculator on Tuesday at 4 p.m., when a news embargo was lifted, and saw that the problems remained.

On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond [.....]

Asked to comment on the situation on Sunday, some doctors said they worried that, with many people already leery of statins, the public would lose its trust in the guidelines or the heart associations.

“We’re surrounded by a real disaster in terms of credibility,” said Dr. Peter Libby, the chairman of the department of cardiovascular medicine at Brigham and Women’s Hospital. [....]

by artappraiser on Wed, 11/20/2013 - 11:46am

with many people already leery of statins…

I have a friend who was diagnosed with a disease of the lung lining (I forget its exact name, but its not a cancer) that some scientists have attributed to the use of statins (which he was using). He stopped using the statins, switched to a mostly-vegan lifestyle (to control his cholesterol, which is why he was taking the statins) and has held the disease at bay. The life expectancy for someone diagnosed with his particular disease is about 6 months post-diagnosis, and he was diagnosed about a year ago, so the fact that he hasn't gotten any worse (and has possibly gotten better) is quite significant, at least to his friends and family.

by Verified Atheist on Wed, 11/20/2013 - 11:56am

There is no doubt statins are good for something, but what's become very clear to me since the initial report came out is that they don't understand what that is! This NYT Nov. 13 article basically made that point loud and clear to me: they are admitting that they never did really understand cholesterol function in the human body and they guessing that statins do something but they don't know what.

I didn't need convincing, already had high suspicion. I have two very close relatives who both had very bad reactions to statins. (One of them really looked like a classic candidate, the other is a healthy exerciser with his only risk being stress.) But not only that. Five years ago I had someone very close dying in the ICU after a heart operation. I did some research on her problem, and then I got a chance to talk to the fancy schmancy heart surgeon leading her team, he was explaining to me how and why things looked bleak. And I said I noticed this paper about how statins helped 12 infants with similar complications, do you know it? And he said: oh yeah, statins, maybe we should try that....and he did...That was the end of my respect for fancy schmancy heart surgeons.

Mho, people have to realize how little doctors really truly understand how a lot of the things they do work. You have to find a doctor who will work as a team with you and experiment with things, a back and forth process. That is all there is. Really. Never just do things because they say so and continue even though the treatment is making you feel lousy, and you always have homework to do if you are getting worse. The people who are too ill to do homework and have no advocate to counter the doctors' "wisdom" are the ones who are at the greatest disadvantage.

Edit to add: As to your example. In my experience, many doctors do not study side effects of prescriptions assiduously. (Pharmacists probably do more.) It is basically your job to read about them and watch for them and report them to the doctor. And if serious, in many cases they will pooh pooh it because they are afraid of being sued. The one relative reaction to statins ended up in an all-night visit to the emergency room as suggested by our State Poison Hotline when they heard the symptoms he was having. When he told the doctor, the doctor actually said: "patients should never read the inserts that come with the prescription!" Needless to say he is no longer employed by my relative.

by artappraiser on Wed, 11/20/2013 - 12:27pm

Absolutely. The worst doctors are the ones who won't admit what they don't know and how confident they are in what they think they know. I'm glad I've managed to locate a good one. I think it's also true that the smartest doctors have enough confidence to share their limitations with their patients.

by Verified Atheist on Wed, 11/20/2013 - 12:57pm

Your link requires account registration to view anything, I just get a sign-in page.

by artappraiser on Wed, 11/20/2013 - 11:48am

Sorry about that, I accessed the link from work.

the authors of the new guidelines defend their recommendations here.

by rmrd0000 on Wed, 11/20/2013 - 1:48pm

A NYTimes "Room for Debate Discussion": When Medical Experts Disagree, Nov. 17, 2013

Guidelines released last week by the American Heart Association and the American College of Cardiology could transform the way cholesterol-lowering statin medicines, like Lipitor, above, are used. But despite the pedigree of the recommendations, some physicians objected to them. Now the calculator that patients and doctors were supposed to use to assess risk under the new benchmarks has been found to be flawed. This isn’t the first time medical recommendations have confused or divided respected authorities.

How should doctors and patients react to new findings that come out about health concerns? How do you know whom to trust?