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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?


To: Lane3 who wrote (7225)6/28/2009 11:45:48 AM
From: Road Walker  Respond to of 42652
 
Therefore, statins have not been shown to provide an overall health benefit in primary prevention trials

Pretty much made your whole point... he's a doctor and didn't know that.



To: Lane3 who wrote (7225)6/28/2009 1:46:52 PM
From: skinowski  Read Replies (1) | Respond to of 42652
 
About the stent study, the devil is in the detail, it seems. "Stents don't work" makes a catchy headline, but the comparison was apparently between different types of intervention - between angioplasty, angio with stenting, and CABG surgery - NOT between stenting and doing nothing.

It is a well known thing that often after an angioplasty of a sclerotic artery the vessel undergoes so called "remodeling" - and often, in fact, continues to become wider as times goes by. It is thought that stents will further decrease incidence of restenosis. However, it is an evolving field, and it is possible that the answer will vary depending on specifics of he case.

Angio and stents are wonderful. I love them. I started many years ago, when the best we could do for a person having an acute coronary syndrome or a heart attack was to give them a few meds, and hope. Nowadays, i see people who would be spending weeks in the hospital, and often walk out very damaged, invalids - if at all - being sent home one or two days later, practically undamaged, with their coronaries wide open.

Can't get any of those great new achievements without trying new things. All this data is work in progress. New technologies will keep changing the data - and the entire picture. Bureaucrats are not good at that.

I'm still at work and can't look at that other article. Will get to it when I can and comment.



To: Lane3 who wrote (7225)6/29/2009 8:01:09 AM
From: skinowski  Read Replies (1) | Respond to of 42652
 
Check the comment below about the JUPITER study. Note that they excluded people with high cholesterol. And yet, they had to stop the study early - because of the difference in outcomes.


The JUPITER trial enrolled healthy subjects who did not have high cholesterol levels, according to conventional benchmarks.3 The entry criterion of a low-density lipoprotein (LDL) cholesterol level of less than 130 mg per deciliter (3.4 mmol per liter) is below the currently recommended threshold for initiating pharmacologic treatment for primary prevention, although treatment at this level is indicated in patients who have clinical coronary disease or diabetes.3 In JUPITER, a high-sensitivity C-reactive protein level of 2.0 mg per liter or higher was an additional entry criterion to identify higher-risk subjects. The trial of nearly 18,000 patients was stopped, with only 1.9 of its proposed 4 years of follow-up concluded, when the data and safety monitoring board noted a significant reduction in the primary end point among participants assigned to receive rosuvastatin (142 primary events, vs. 251 in the placebo group; hazard ratio, 0.56; 95% confidence interval [CI], 0.46 to 0.69). There was a similar reduction in a combination of the more important hard outcomes: myocardial infarction, stroke, or death from cardiovascular causes (83 events in the rosuvastatin group vs. 157 in the placebo group; hazard ratio, 0.53; 95% CI, 0.40 to 0.69).

The results of JUPITER raise two important questions about the primary prevention of coronary disease. Should indications for statin treatment be expanded? And how should measurements of high-sensitivity C-reactive protein be used?

The relative risk reductions achieved with the use of statin therapy in JUPITER were clearly significant.

content.nejm.org

It could be that Crestor is more effective than the older Pravastatin? In any case, this illustrates that the entire issue is work still in progress - and always will be. For the time being, imo, a person with several risk factors should be considered for statin therapy. Below is a link to current recommendations for primary prevention from AHA:

americanheart.org