the many alleged benefits of statin treatment

You have probably read many newspaper articles about the benefit of statins in a diversity of medical conditions, for instance cancer, heart failure, Alzheimers disease, you name it. Observe that the evidence for such statements rarely come from controlled, randomized trials but from case-control studies between patients who are on statin treatment and matched individuals not on such treatment. There is a serious bias inherited in all such studies: patients and control individuals are not matched in every aspect. One of THINCS´ members, Professor Joel Kauffman (see our Members´ list) recently commented yet another similar article where the authors claimed better longevity due to statin treatment. Kauffman´s argumesnt are valid also for other similar articles. Uffe Ravnskov Here is Professor Kauffman´s text: Donald W. Miller, MD, asked whether there were any flaws in this study: Mehta JL et al., Am J Cardiol 2006;98:923-928 (Abstract below) First, there is no funding source given, and no conflict of interest statements, so the whole thing is suspect for those reasons alone. The patients are not in matched groups at baseline; they are quite different to start with. Those given statins had, at baseline, TC = 203, LDL = 124; those not given statins had TC = 187, LDL = 112. Authors appear totally unaware that high TC and LDL in this age group are beneficial, not detrimental. So the risk scores are spurious, since "high" LDL (>=100 mg/dL) was counted as risky, when we know it is not. Also "hypertension" up to 190/95 is not a risk factor, but was counted as one. So 2 risk factors were spurious. Therefore, the "graded" relation between risk scores of statin users and risk of death is meaningless. Of the potential confounders, socioeconomic status was ignored. Authors wrote that patients had "...a high degree of compliance..." with statin prescriptions because they and the costs of medical consults at the VA are free. This is in total disregard of the general findings (see MMM, Myth 3) that 1/2 of statin users stop within a year and 3/4 within 2 years. There is no evidence of compliance whatever. Most revealing, however, is Fig. 1. Since those not prescribed statins have lower cholesterol levels, they are much less healthy in this age group. Low-C is associated with cancer, depression, criminality, drug abuse, suicide, etc. Up to age 53, more died than those prescribed statins. Of those on statins, there was an odd excess of deaths at ages 54-58. If statins were beneficial, we would expect to see the number of patients dying at high ages to be higher. In fact, it is lower. From age 86 on up, twice the % on statins died. The authors were stubbornly ignorant that the few good effects of statins are not due to cholesterol lowering, but to an aspirin-like effect on thromboxane A2, or some other unrecognized route. They do not note the total non-relation of achieved TC and LDL levels with survival observed in the J-LIT study (see MMM). Moreover, the chief statin used in both J-LIT and this VA study was Zocor. For this study to have been of any use, the two patient groups would have needed to be matched for baseline levels of C, LDL, CVD, diabetes, and other conditions. And compliance. Re compliance: statins are normally prescribed so as to lower TC by about 30% and LDL-C by about 40%. The actual overall lowering of TC in the study was 6%, and of LDL-C was 7%. This is a powerful indicator of non-compliance. So can any of you find a real benefit of statins in this study? ----Joel Mehta JL, Bursac Z, Hauer-Jensen M, Fort C, Fink LM. Am J Cardiol. 2006 Oct 1;98(7):923-8. Epub 2006 Aug 7 Comparison of mortality rates in statin users versus nonstatin users in a United States veteran population. Department of Internal Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA. [email protected] Statins have been shown to be effective in reducing cardiovascular events and overall mortality in primary and secondary prevention trials. This study was designed to examine the effect of statin use on overall death. Cross-sectional data were obtained from the Department of Veterans Affairs Veterans Integrated Service Network 16 database for approximately 1.5 million veterans followed up in 10 hospitals in the southern United States. Statins were prescribed more often to elderly subjects with a history of coronary artery disease, hypertension, diabetes mellitus, current smoking, and using cardiovascular drugs (beta blockers, aspirin, angiotensin-converting enzyme inhibitors, and calcium channel blockers). The predictors of death were, as expected, cancer, diabetes mellitus, the use of cardiac drugs, and age. Importantly, using statins showed a highly significant negative association with death (odds ratio 0.54, 95% confidence interval 0.42 to 0.69, p <0.0001), even after adjustment for all other variables. Overall, the mean age at death among statin users was 2 years older than among nonstatin users, despite statin users being at a higher risk of death. In conclusion, the results of this study have shown that using statins is a potent life-saving strategy. The benefit observed in this study is unique because almost 1/2 the patients were >or=70 years of age when statin therapy was initiated. 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