The Heart Attack Grill

reposted from:

The Heart Attack Grill in Chandler, Arizona

The Heart Attack Grill is a hospital-themed restaurant in Chandler, Arizona,

which has become famous for embracing and

promoting an unhealthy diet of

extremely large hamburgers

One year crabsallover Anniversary of Hacker's Diet

Do statins cut risk for the healthy?

reposted from: http://www.nhs.uk/news/2009/07July/Pages/Statinsandheartrisk.aspx

Do statins cut risk for the healthy?

NHS ChoicesJul 01, 2009 10:32:00 GMT Share

Researchers say that “statins cut the risk of heart attacks by 30% even in healthy people” and lower the chance of dying from any cause by 12%, the Daily Mail reported. It said that the drugs are currently only given to people who are at signficant risk of heart attack or stroke. The latest review of the research has renewed the ongoing debate over whether everyone over 50 should be prescribed statins.

The news story is based on a large systematic review of 10 trials, which pooled the results of over 70,000 people. It found that, over an average 4.1 years, statins reduced the risk of death by any cause, as well as from heart attacks and strokes, in people who had not been diagnosed with cardiovascular disease but who had the risk factors for it.

As all these people had some degree of cardiovascular risk, such as high blood pressure, high cholesterol or diabetes, describing them as “healthy” does not clearly portray their risk status. However, these important findings indicate that a number of people could benefit from long-term statin use. As the authors say, identifying the people with risk factors could be a challenge and giving statins to everyone over a certain age would have significant cost and safety implications.

Where did the story come from?

The research was carried out by Dr JJ Brugts from the Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, and colleagues from other international institutions. Several of the authors had affiliations with various pharmaceutical companies. The study was published in the peer-reviewed British Medical Journal.

What kind of scientific study was this?

This systematic review investigated whether statins reduce deaths from any cause and reduce the risk of major coronary and cerebrovascular events (such as heart attacks and strokes) in people who have cardiovascular risk factors but have not been diagnosed with cardiovascular disease. It also looked at whether gender, age (above or below 65) and diabetes have an effect.

The researchers carried out a search of several medical databases to identify trials that compared any statin with a control or placebo drug and their effects on “cardiovascular disease”, “coronary heart disease”, “cerebrovascular disease”, “myocardial infarction” or “cholesterol”. The trials were at least a year long and at least 80% of the participants had no existing cardiovascular disease. Following a quality assessment, 10 trials met the inclusion criteria.

The main outcome that the researchers examined in their analyses was death from any cause, followed by death from heart disease and stroke. Where data was available, they looked at these outcomes in several subgroups: men, women, the young, the elderly and people with diabetes. Where possible, results from the separate studies were pooled in meta-analysis.

What were the results of the study?

Of the 10 studies, two trials examined people with high cholesterol (one of which was in men only), one was in elderly people with cardiovascular risk factors, two were in people with high blood pressure and other risk factors, three were in people with diabetes, one was in people with low cholesterol and one was in people without vascular disease.

In total, the 10 studies included 70,388 participants who had been randomly allocated to receive a statin (35,138 participants) or a control pill (35,250). The number of participants in the trials ranged from 1,905 to 17,802. The average age of participants was 63 and the average length of follow-up was 4.1 years. Overall, 23% of the participants had diabetes. The different trials contained varying numbers of people with other risk factors, such as smoking, BMI, blood pressure and cholesterol.

During follow-up, 5.1% (1,725) of the statin group died compared with 5.7% (1,925) of the control group. Statin treatment significantly reduced the risk of death from any cause by 12% (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.81 to 0.96). During this time, 4.1% of the statin group had a major coronary event, such as a heart attack, compared with 5.4% of the control group. In addition, 1.9% of the statin group had a major cerebrovascular event compared to 2.3% of the control group. Therefore, risk of any major coronary event, such as a heart attack, was 30% lower in the statin group (OR 0.70, 95% CI 0.61 to 0.81) and risk of stroke was 19% lower (OR 0.81, 95% CI 0.71 to 0.93).

Analysis of the subgroups (men, women, young, elderly and people with diabetes) showed that statins did not affect risk differently in any particular group.

What interpretations did the researchers draw from these results?

The researchers concluded that, in patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and significant reductions in the risk of major cardiovascular events, such as heart attack and stroke.

What does the NHS Knowledge Service make of this study?

This large and thorough review of 10 trials found that, over an average follow-up of 4.1 years, statins significantly reduced the risk of death from any cause as well as the risk of heart attacks and strokes in people without cardiovascular disease but who had risk factors.

These are important findings and should be interpreted accurately:

• When combining the results of different trials, there is always some degree of limitation which arises from differences between the trials. These include different populations, different trial drugs, different concurrent use of other medications, different methods of assessing outcomes and different length of follow-up. In particular, the participants of the different trials are likely to have had a highly varied level of cardiovascular risk. As the authors acknowledge, in three of their included trials, a small proportion of participants had existing cardiovascular disease.

• Although the majority of study participants did not have existing cardiovascular disease, they all had cardiovascular risk factors (which varied depending on the trial). Therefore, although some of the newspapers suggest that statins should be given to “all” or “healthy” people above a certain age, this is not strictly the case. If people have existing cardiovascular risk factors, it seems plausible that reduction of one of them, such as cholesterol, will influence risk in some way. How much the risk is reduced may depend on the type of risk factors that the people have, which this review was not able to examine.

These findings indicate that a number of people could benefit from long-term statin use. However, as the authors say, identifying the people with risk factors could be a challenge. Administering statins to all people above a certain age in a ‘cover all’ approach would have significant cost and safety implications.

Links To The Headlines

Prescribe statins to those at risk at 40, study says. The Times, July 01 2009

Should all over-50s take anti-cholesterol drug? Statins even cut heart attack risk in the healthy. Daily Mail, July 01 2009

Statins 'cut risk of dying by more than a tenth'. The Daily Telegraph, July 01 2009

Statins 'slash risk of heart attacks by 30%'. Daily Express, July 01 2009

Links To Science

Brugts JJ, Yetgin T, Hoeks SE, et al.The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009; Published 30 June

The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors

Abstract: http://www.bmj.com/cgi/content/abstract/338/jun30_1/b2376

full article: http://www.bmj.com/cgi/content/full/338/jun30_1/b2376?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Brugts&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

Daily Mail Article: http://crabsalloverhealth.blogspot.com/2009/07/should-all-over-50s-take-anti.html

Published 30 June 2009, doi:10.1136/bmj.b2376
Cite this as: BMJ 2009;338:b2376

Research

The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials

J J Brugts, doctor¹, T Yetgin, doctor¹, S E Hoeks, epidemiologist¹, A M Gotto,professor, doctor², J Shepherd, professor, doctor³, R G J Westendorp,professor, doctor⁴, A J M de Craen, epidemiologist⁴, R H Knopp, professor, doctor⁵, H Nakamura, professor, doctor⁶, P Ridker, professor, doctor⁷, R van Domburg, epidemiologist¹, J W Deckers, doctor¹

¹ Department of Cardiology, Erasmus MC Thoraxcenter, 3015 GD, Rotterdam, Netherlands, ² Weill Medical College of Cornell University, NY, USA, ³University of Glasgow, Scotland, ⁴ Department of Gerontology and Geriatrics, Leiden University Medical Center, Netherlands, ⁵ Department of Medicine and Northwest Lipid Research Clinic, WA, USA, ⁶ Mitsukoshi Health and Welfare Foundation, Tokyo, Japan, ⁷ Brigham and Women’s Hospital, Boston, MA, USA

Correspondence to: J J Brugts j.brugts@erasmusmc.nl

Objectives To investigate whether statins reduce all cause mortality and major coronary and cerebrovascular events in people without established cardiovascular disease but with cardiovascular risk factors, and whether these effects are similar in men and women, in young and older (>65 years) people, and in people with diabetes mellitus.

Design Meta-analysis of randomised trials.

Data sources Cochrane controlled trials register, Embase, and Medline.

Data abstraction Two independent investigators identified studies on the clinical effects of statins compared with a placebo or control group and with follow-up of at least one year, at least 80% or more participants without established cardiovascular disease, and outcome data on mortality and major cardiovascular disease events. Heterogeneity was assessed using the Q and I² statistics. Publication bias was assessed by visual examination of funnel plots and the Egger regression test.

Results 10 trials enrolled a total of 70 388 people, of whom 23 681 (34%) were women and 16 078 (23%) had diabetes mellitus. Mean follow-up was 4.1 years. Treatment with statins significantly reduced the risk of all cause mortality (odds ratio 0.88, 95% confidence interval 0.81 to 0.96), major coronary events (0.70, 0.61 to0.81), and major cerebrovascular events (0.81, 0.71 to 0.93). No evidence of an increased risk of cancer was observed. There was no significant heterogeneity of the treatment effect in clinical subgroups.

Conclusion In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.

© Brugts et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
http://creativecommons.org/licenses/by-nc/2.0/

Should all over-50s take anti-cholesterol drug? Statins even cut heart attack risk in the healthy

reposted from: http://www.dailymail.co.uk/health/article-1196672/Should-50s-anti-cholesterol-drug-Statins-cut-heart-attack-risk-healthy.html

Original Research: http://crabsalloverhealth.blogspot.com/2009/07/benefits-of-statins-in-people-without.html

By JENNY HOPE

Last updated at 7:25 AM on 01st July 2009

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Heart disease czar Roger Boyle says all OAPS should ideally be taking statins

Statins cut the risk of heart attacks by 30 per cent even in healthy people, researchers say.

The cholesterol-busting drugs also reduce the chances of death from all causes by 12 per cent.

The findings, from a review of studies involving people without heart disease, will renew the heated debate over whether everyone over the age of 50 should be prescribed the powerful drugs.

At present they are given only to those at significant risk of a heart attack or stroke.

Many experts say wider access to the cheap drug could save hundreds of thousands of lives while also saving the NHS billions every year.

But others warn of the dangers of 'mass medicalisation' of the population.

More than six million adults already take statins, saving around 10,000 lives a year. The cheapest versions cost as little as 7p a day.

The Government's heart disease czar Roger Boyle says all older people should ideally be taking statins or a polypill, new tablets being developed which contain the drugs.

And last month heart expert Professor Malcolm Law wrote in the British Medical Journal that everyone over 55 should be given statins in the same way that everyone would be offered a vaccine against swine flu if it became serious.

Fuelling a drug debate: Statin pills cut the risk of heart attacks by 30 per cent

But some say such a move could lull the public into forsaking a healthy lifestyle or boost the ranks of the 'worried well'.

Mike Rich, of the Blood Pressure Association, said: 'There are other proven ways to prevent high blood pressure such as healthy eating and regular exercise, which have other benefits too.

'There is a danger that these important lifestyle factors could be overlooked in favour of popping a pill.'

Although low dose statins can be bought over the counter, effective versions of the drugs cannot legally be purchased without a prescription.

The latest review analysed the results of ten large trials involving more than 70,000 patients who did not have established cardiovascular disease.

The trials compared statin therapy with placebo agents or no treatment and tracked patients for an average of four years.

Deaths from all causes were cut by 12 per cent among those taking statins, and the risk of major events such as a heart attack went down by 30 per cent. The risk of a stroke was cut by 19 per cent.

No significant treatment differences were found between men and women, young and old, and those with and without diabetes. There was no raised risk of cancer, feared as a possible side effect.

Dr Jasper Brugts of Erasmus Medical Centre, Rotterdam, which carried out the study, said the findings justify giving statins to those without established cardiovascular disease, but with risk factors such as high blood pressure and diabetes.

Writing on the BMJ website, he aid: 'People at increased risk for cardiovascular disease should not be denied the relative benefits of long-term statin use.'

He said men over 65 with risk factors, or older women with diabetes and risk factors, would probably benefit most.

At present, those with established risk factors including diabetes are eligible for statins because they are being prescribed for secondary prevention of heart and circulatory problems.

The big issue is whether taking statins would benefit 'healthy' people for primary prevention.

A drive is planned by GPs over the next five years where adults aged 40 to 74 will be invited for a health check to identify heart and stroke risk, as well as kidney disease. Anyone in this age group who is believed to have a 20 per cent risk of suffering a heart attack or stroke over the next ten years will be eligible for the drugs.

It is thought that 15million people will benefit from checks. The move could prevent a further 15,000 heart 'events' each year, such as heart attacks and strokes, in addition to the 7,000 heart attacks already being prevented.

But GP Dr Malcolm Kendrick, author of The Great Cholesterol Con, said the jury was still out on whether statins provide any overall health benefit for people without a history of heart disease.

Dr Kendrick, a long-standing sceptic about statins for those at low risk of heart problems, said: 'The suggestion that people at low risk should be taking drugs for the rest of their lives is not supported by the trials.

In addition to the lack of benefit and expense, statins carry a substantial burden of side effects.'

The Department of Health said it would study the findings.