January 29, 2008
Statins Not for People at Low Risk
The journalistic bandwagon is rolling. A column in today's New York Times by Tara Parker-Pope echoes the theme blared across the cover of BusinessWeek last week: statin drugs may lower cholesterol, but for people whose only risk of a heart attack is elevated cholesterol, they have no impact on overall mortality.
The BusinessWeek story was especially provocative because the cover had the word "Lipitor" in bold red letters sitting astride a pile of pills arranged in the shape of a question mark.
Now, call me a cynic, but why does my perverted mind think to itself as I watch this coverage: "Yeah, now we hear, just when the world's best-selling drug is about to go off patent. Where were these guys three years ago?"
Why do I say three years ago? Because in September 2004 a coalition of more than 30 academic physicians and researchers inspired by John Abramson, author of "Overdosed America," and organized by yours truly at the Center for Science in the Public Interest made the same point. Indeed, we wrote a letter to the National Heart Lung and Blood Institute (NHLBI) outlining all the evidence, which was there in published clinical trials for anyone who cared to look. Statins, the letter said, may lower cholesterol in people at low risk and even many sub-groups at moderate risk of a heart attack like women and older people, but there was no evidence that the drugs actually saved lives.
The group also called for an independent panel to review the evidence, since the National Cholesterol Education Program panel of NLHBI had been dominated by physicians with ties to statin manufacturers. The letter, released to the press, drew this defensive response from Barbara Alving, then head of NHLBI. Despite the two sides being out in the open -- good reporters always love a cat fight, right? -- the mainstream of the national press ignored us.
Okay. I'm crying over spilled milk this morning. But let me renew our plea. How about it NHLBI? Now that even the national press gets it, can we get that independent panel to review the evidence?
Posted by gooznews at January 29, 2008 08:18 AMThe question: "Who should get statins for high cholesterol", can be answered very easily. All patients at intermediate risk for heart disease, that is, they have one or two known risk factors, should have a coronary calcium heart scan (the presence of calcium in the coronary artery means there is plaque in the coronary artery) with an EBCT scanner (electron beam CAT scan of the heart). If they have no plaque, they can avoid statins and have a very, very low risk of a heart attack in 10 years (0.04%). The radiation dose from this specialized CAT scan is about that of two chest xrays, the cost is less than $400.00 (about two to three months of the cost of cholesterol meds. The subsequent side effects of statins and associated lab costs could potentially be avoided. There are 1,000 scientific articles on such scanning. Coronary calcium on an EBCT heart scan is more predictive of heart attack risk than all the common risk factors. It is endorsed by the American Heart Association and approved by Medicare in Calif.. Why isn't as well known nationwide or being paid for by insurance companies? Widespread screening will save multi-millions of dollars (billions?)in drug cost for those that don't need them, and save the lives of those with normal cholesterol who have plaque on the scan and do need the drugs (yes, half of all heart attacks occur in patients with "normal cholesterol). Other screening tests are mandated to be covered by law (pap smears, mammograms etc), yet heart disease kills more of us than all other diseases. Why not mandate that the "mammogram of the heart", that is, the coronary calcium heart scan, also be covered by insurance? The reason the coronary calcium scan is not more widely used is that drug companies have indoctrinated doctors for almost two decades that everyone with high cholesterol should be on a statin. If we measure the coronary calcium score, we can save money and save lives!
Larry Santora MD
Interventional Cardiologist
Author, "The OC Cure for Heart Disease"
Orange County Heart institute
Orange, CA.
Did someone say conflict of interest Dr. Santora? Where are the RCTs that suggest this is life saving? Why does the USPHTF not recommend this? Well, because it is costly and the evidence simply isn't there yet.
Posted by: doctoringethics at February 4, 2008 12:05 AMWhat about reducing morbidity, hospitalizations? Is is not important to reduce these too? Statins have been proven to prevent stroke and MI with much lower NNT compared with the incidence of serious side effects like rhabdomyoysis
Posted by: NM at February 6, 2008 04:53 AM