Monday, 31 March 2014


reposted from:
crabsallover highlightskey pointscomments / links.

Doctors launch new tool to measure your 'heart age' - further advance on QRISK2

reposted from:
crabsallover highlightskey pointscomments / links.

QRISK®-lifetime is the risk engine used at the heart of the new JBS3 calculator. I not sure of the link between JBS3 and QRISK.

“People are being urged to find out their "true" heart age in order to cut the risk of heart attacks and strokes,” BBC News reports. Doctors have put together a new risk calculator called JBS3 that can tell you the real “age” of your heart.
Risk calculators for cardiovascular diseases or CVDs (conditions that affect the heart and blood vessels) are nothing new. The “granddaddy” of risk calculators – the Framingham risk calculator – has been available for years.
But this new JBS3 calculator has the benefits of:
  • being easily accessible online
  • providing what is thought to be an accurate risk estimate of experiencing a serious CVD such as a heart attack or stroke
  • unlike previous risk calculators it is of use to younger adults who, while possibly not having a short-term risk of CVD, could be on the route to a stroke or heart attack due to unhealthy lifestyle choices
This new JBS3 calculator was specifically designed to help healthcare practitioners identify and communicate risk of CVDs to the “sizeable number” of people whose risk in the next 10 years is low, but who may be at high risk over their lifetime.
The calculator includes estimates of someone’s “heart age” and the years they can be expected to enjoy without developing cardiovascular disease.
It also shows the benefits that people would experience if they made changes in their lifestyle such as stopping smoking, or reducing blood pressure or cholesterol levels. It also shows the effects of delaying making these changes.
The ultimate aim of the calculator is to empower people to reduce their risk of cardiovascular disease.
It is expected that the JBS3 calculator will become an important component of the NHS Health Check plan – an ongoing programme for adults aged 40 or over.

Who has produced the risk calculator?

The risk calculator has been produced by experts from 11 UK professional societies (the Joint British Societies or JBS) and charities involved with cardiovascular disease (CVD) prevention.
The tool is based on the available scientific evidence and on assumptions where evidence is not available.
It is part of newly updated JBS guidelines on the prevention of cardiovascular disease, called JBS3.
The guidelines have been written for GPs and practitioners to help guide their work with patients, in preventing CVD.

Why is a new calculator needed?

The JBS notes that although CVD deaths have almost halved in the last 40-50 years, cardiovascular disease is still the leading cause of deaths worldwide. This is especially the case as levels of risk factors for CVD, such as obesity and diabetes, are increasing.
They say that currently, prevention strategies target only those at high short term risk (within the next 10 years) of a heart attack orstroke.
They point out that this ignores many individuals – often younger people and women – who may not be at short term risk, but whose family history and lifestyle factors mean they may be at high risk of developing CVD in their lifetime.
There is a growing body of evidence, they say, that CVD develops over a long term with most heart attacks and strokes occurring in people in the “intermediate risk” category.
The new calculator assesses the risk of heart disease and stroke throughout someone’s lifetime, as well as in the short term.

What sort of people is the risk calculator recommended for?

The JBS recommends that the new calculator is used by healthcare professionals for estimating CVD risk for all individuals except those already known to have CVD or specific conditions that put them at high risk, such as diabetes, chronic kidney disease, or a specific genetic condition that leads to high cholesterol.
One of its main aims is to identify the “sizeable” number of people who are at low short term risk but high lifetime risk, of CVD. It aims to help both patients and health professionals better understand cumulative lifetime risk and what can be done to lower it.

What factors does the risk calculator assess and what results does it give?

The calculator assesses established risk factors for cardiovascular disease such as blood pressure, cholesterol levels, smoking status, family history, age and gender. It uses these to calculate not only the risk of CVD within the next 10 years, but over a lifetime. These are displayed in a number of ways that a healthcare professional can use to discuss these figures with their patient:
  • A person’s “Heart age”, compared to someone of the same age, gender and ethnicity with optimal risk factors (for example, not smoking and not overweight or obese).
  • “Healthy years” – a thermometer image showing how many years an individual can be expected to survive without having a heart attack or stroke.
  • An “Outlook screen” showing a graph with the chance of survival without a CVD event.
The tool also enables the healthcare professional to show the patient the potential effect on CVD risk of various lifestyle changes or interventions such as lowering blood pressure, or stopping smoking.

Can you give an example of the figures the calculator might produce?

The press release accompanying the release of the guideline and calculator gives an example of a 35 year old female smoker, with:
  • a high systolic blood pressure (the first number in a blood pressure reading) of 160 mm Hg
  • a high total cholesterol of 7mmol/l (the recommended level for healthy individuals is 5mmol/l)
  • plus a family history of premature CVD
The calculator estimates that the woman would have a “true heart age” of 47 (above her actual age). She could expect to survive to the age of 71 without having a heart attack/stroke. Her 10 year risk would be less than 2%.
The calculator estimates that if this woman stopped smoking, cut her total cholesterol to 4mmol/l and her systolic blood pressure to 130 mm Hg, her heart age would fall to 30 (below her actual age). She could expect to live to the age of 85 before having a heart attack/stroke and more than halve her 10 year risk to less than 0.25%.

How will the risk calculator be used in the NHS?

The JBS3 risk calculator is going to form a key component of the NHS Health Check programme in England aimed at 40-74 year olds. The authors note it is not intended to prompt blanket prescribing of the cholesterol lowering drugs statins and other heart health drugs.
In a related press release the Joint British Societies are quoted as saying “It is important to emphasise that, for the majority, the strong message will be the potential gains from an early and sustained change to a healthier lifestyle rather than prescription of drugs,”.
Lifestyle changes include quitting smoking, achieving a healthy weight through adopting a healthy diet and boosting the amount of regular exercise while curbing sedentary activity.

Can I use the risk calculator?

The JBS3 risk calculator is openly available online. However it has been designed for use by doctors and other healthcare practitioners with their patients. To work, the calculator requires values you may not have access to yourself (such as your cholesterol levels and blood pressure).
While the calculator can give you a relatively accurate risk assessment it is recommended that the results it provides are also assessed by a health professional.
If you are aged 40 or above you can have a free NHS Health Check which will assess your risk of heart disease as well as other chronic diseases such as dementia, stroke and kidney disease.
The JBS3 risk calculator is not appropriate for people who have existing CVD and should only be used with caution in patients with certain high risk conditions such as high blood pressure, diabetes and chronic kidney disease.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Why take statins? - British Heart Foundation

reposted from:


Statin drugs - British Heart Foundation

Statins are the most commonly prescribed medicines in the UK. They work to lower the level of cholesterol in your blood. There are different types of statins, but they all work in much the same way.

Why do I need to lower my cholesterol?

Cholesterol is essential for your body to work well, but too much ‘bad cholesterol’ (called low-density lipoprotein or LDL) is unhealthy. Statins reduce the amount of ‘bad cholesterol’ your body makes.
High levels of ‘bad cholesterol’ in your blood can lead to fatty deposits building up in your arteries. This can increase your risk of developing cardiovascular disease, which includes conditions such ascoronary heart disease  (leading to angina and heart attack) and stroke.
Your body will always make cholesterol so if you stop taking a statin, it’s likely your cholesterol levels will rise. If you are prescribed a statin, you need to take it every day. Statins are most beneficial when you take them on a long-term basis.

Why do I need to take statins? 

If you’ve had a heart attack or stroke, you may be advised to take statins in order to reduce your risk of another event. If you have peripheral arterial disease statins can help to slow the progression. If you are diabetic, you are at a much higher risk of developing cardiovascular disease, and taking statins will help to reduce this risk.
Even if you’re in good health, you may be prescribed statins if you’re at high risk of developing cardiovascular disease, for example, if you have a strong family history of cardiovascular disease. Statins can help lower your risk.

When should I take my statin?

It’s important to take your medication regularly as prescribed. Most statins are taken at night, as this is when most of your cholesterol is produced. Check with your doctor or pharmacist when you should be taking your statin.
Most statins come as tablets. The most common one is simvastatin.
Look up your medication on the Medicine Guides website.

Are there any foods, drinks or other medications I should avoid? 

Check with your doctor or pharmacist before you take any other medications. Taking certain medicines together may affect how well they work.
If you’re taking simvastatin or atorvastatin, avoid grapefruit and grapefruit juice as they can increase your risk of side effects.
If you take another type of statin, limit your intake of grapefruit juice to very small quantities or you may want to avoid it all together.

Do statins have side effects?

Like all medication, statins have potential side effects. The most common are muscular aches and pains, but many people experience none at all. Statins are among the safest and the most studied medications available today.
If you do experience side effects, or if your side effects change or become worse, tell your GP.
Statins target the liver cells where cholesterol is made. Before you start taking statins, you will have a blood test to check how well your liver works. Your doctor may request that you have a follow-up blood test a few months later. If your liver is affected, your doctor may want to reduce your dose or change your statin to another kind of medication that lowers your cholesterol.
Find out about other possible side effects from our Statins information sheet.

Can I buy statins over the counter?

Low-dose statins are available at some pharmacies without a prescription, but they are not a substitute for prescription statins or for making lifestyle changes to reduce your cholesterol level. If you are at high risk of heart disease, your doctor may prescribe a statin for you.

What are the differences between statins?

Lots of people don’t need a strong statin to reduce their cholesterol level. Your GP or cardiologist will find the right statin for you, depending on your medical history and the cholesterol level they think you should aim for.
If you’re sensitive to one statin, you might not be sensitive to another. You should have a blood test after any change of statin to see how effectively the new medicine is lowering your cholesterol.

Can I take a statin if I'm pregnant?

If you’re pregnant, breastfeeding or planning a pregnancy, you should not take statins. If you’re already taking statins but would like to become pregnant, speak to your GP first.

How else can I lower my cholesterol?

You can also lower your cholesterol by:

Statins reduce my risk of heart attack or stroke by 20%!

I started taking statins (Pravastatin 10mg/day) in January 2013 after I decided that statins would be good for my health.

With I reckon I have cut my risk of a heart attack or stroke in the next 10 years from 7.8% to 6.3%, a 20% reduction. I've had no side effects.

I can't be sure of course that it was the statins that caused the Cholesterol/HDL ratio reduction. Changes in my diet and / or exercise in the last year might have helped too.

Before I took Statins (3/1/13)

1 Year after taking Statins (21/3/14)

What's your QRISK?

Wednesday, 26 March 2014

Lipid Modification - NICE draft guidelines 2014

reposted from:

Consultation documents

The full version describes the evidence and views that have been considered, and sets out the provisional recommendations that have been developed. My recommended read.
The NICE version presents the provisional recommendations only with some brief supporting information. My recommended read.
crabsallover highlightskey pointscomments / links.

Statins aren't a wonder drug

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crabsallover highlightskey pointscomments / links.

Calculate risk of having a heart attack or stroke within the next 10 years - use QRISK2

It takes seconds to calculate your risk:

New draft NICE guidelines may be ratified July 2014 recommending use of Statins if your risk of having a heart attack or stroke within the next 10 years is 10% (cf. currently 20%).

See the great interactive 'how statins work'. viz

  1. Cholesterol is produced mainly in the liver. There is good cholesterol and bad cholesterol. Too much bad, LDL-cholesterol, however, can cause hardening of the arteries. 
  2. The liver contains an enzyme called HMG-CoA reductase, which produces cholesterol ...
  3. Statins replace the HMG-CoA that exists in the liver, thereby slowing down the cholesterol production process ...
  4. The 'inhibition' of HMG-CoA enzyme by the statin has other effects, on top of reducing the amount of cholesterol produced. It also increases the production of LDL receptors, proteins which 'catch' the bad cholesterol and draw it into the liver cells to be broken down.
Modified by Chris Street from Guardian Feb 2014 http: //

Whilst NICE and Rory Collins are recommending use of Statins with 10% 10 year risk of heart attack or stroke, John Abramson, a clinician working at Harvard medical school claims his BMJ published analysis showed statins did not significantly reduce mortality in the 20% or 10% risk groups. (Guardian Feb 2014).

Wednesday, 19 March 2014

Saturated fats and heart disease link 'unproven'

reposted from:
and follow up by Fergus Walsh: :-
'It said that - contrary to decades of public health advice - switching from saturated fats found in foods like butter, cheese and fatty meats, to polyunsaturated fats such as vegetable oils and fish - did not seem to have any benefit for the heart. 
This surprised not only me but the people who co-funded the research, the British Heart Foundation (BHF). 
Pretty much every respectable health body says that we should cut down on food that is high in saturated fat because it can cause cholesterol levels in the blood to build up. 
Raised cholesterol increases your risk of heart disease. Some unsaturated fats can lower blood cholesterol so the assumption has been that this will cut your heart disease risk. 
But the analysis of dozens of international studies did not yield clear evidence that switching to mono and polyunsaturated fats reduced the risk of cardiovascular disease. ' says Fergus Walsh.  More...

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Tuesday, 18 March 2014

Statins side effects are minimal, study argues

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Thursday March 13 2014
Statins are used to lower blood cholesterol levels
“Cholesterol-lowering statins have almost no side effects,” The Guardian reports. A new UK study argues that the majority of reported side effects are actually due to the nocebo effect  symptoms that are “all in the mind”. 
The researchers looked at the combined results of 29 studies and found there was no difference in the incidence of common side effects in the treated group compared to those in the placebo group. However, there was a slightly higher occurrence of diabetes.
Statins slightly reduced the risk of death from any cause, as well as the risk of heart attack and stroke in people with or without vascular disease. 
However,  the research did not include analysis for some reported side effects of statins, such as memory problems, blurred vision, ringing in the ears or skin problems.
The frequently reported side effect of muscle weakness was only considered if there was also a 10-fold rise in a muscle enzyme associated with muscle injury. Muscle aches, in particular, were no more common in the statin group than the placebo group.
This research has provided a novel approach to assessing the risks and benefits of using statins. Arguably, it provides the most comprehensive research yet on the number of people thought to have genuine side effects, and the risks and benefits of taking statins in both low- and high-risk groups for cardiovascular diseases such as heart attacks.
However, some headlines  such as “Statins are safe”  have overstated the case. There is no such thing as an entirely "safe" drug for everyone who takes it. If a drug doesn’t have side effects, it doesn’t work.
If you have any concerns about taking statins, you should discuss this with your GP or health advisor.

The nocebo effect

Most people have heard of the placebo effect – where people see an improvement in symptoms, despite having been given a dummy treatment; this is thought to be down to the power of the own mind.

Well, the nocebo effect is its evil twin. People can develop what they believe are side effects, even though they have been given a dummy treatment.

Ben Goldacre, one of the authors of the study in question, says that if you want to see the nocebo effect in action, when sitting on a sofa with friends suddenly ask: “does this things have fleas in it?”.

Where did the story come from?

The study was carried out by researchers from Imperial College London and the London School of Hygiene and Tropical Medicine. They say they did not receive any grants from any funding agency in the public, commercial or not-for-profit sectors. The authors are supported by the British Heart Foundation, the National Institute for Health Research and the Wellcome Trust.
The study was published in the peer-reviewed medical journal European Journal of Preventive Cardiology.
The media reported that this study shows that statins have no side effects in comparison to placebo.
This is misleading, as the research was aiming to ask a different question: “What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?”
And the researchers were more cautious in their conclusion.
It has not comprehensively looked at all side effects, and it gives no indication of the severity or frequency of side effects experienced.
The media also did not report how small the benefits of statins were found to be in this study. This is an important consideration for people who want to make an informed choice when weighing up the risks and benefits of statin treatment.

What kind of research was this?

This was a meta-analysis of double-blind randomised controlled trials. This means the researchers added together and analysed the results of all studies that met their inclusion criteria. Double-blind randomised controlled trials are the gold standard for studies of whether a drug works or not, as they compare a drug directly with a placebo (dummy), and neither the participant nor the clinician knows which one they are taking. This removes any bias that could affect the results.
Studies of safety are often based on long-term observational studies, often without a placebo. The approach of reviewing randomised trials for safety data, as used by these researchers, would be particularly good at checking on differences between a drug and placebo.

What did the research involve?

The researchers found studies comparing statins to placebo and pooled the results to see if statins increase the risk of side effects, compared to rates in the placebo arm.
Two large databases were searched for relevant studies looking at statins being compared to placebo for cardiovascular disease prevention. Studies were excluded if they compared statins with standard therapy or no treatment. They also excluded studies that mainly included people on renal dialysis, those with organ transplants or if other non-statin medication was also started. This was because people in these categories did not represent the majority of people treated with statins.
They separately analysed studies of primary cardiovascular disease prevention (i.e. in people who had not had a heart attack or stroke) and secondary cardiovascular disease prevention (reducing the risk of a further heart attack or stroke in people who have already had one or the other).
They recorded any serious events for each trial and pooled the results, including:
  • mortality of any cause
  • fatal heart attack
  • non-fatal heart attack
  • fatal stroke
  • non-fatal stroke
  • any life-threatening condition
  • any hospitalisation
They also recorded other side effects, but only if they were reported in at least two trials and the sample size was at least 500 people:
  • increased liver enzymes
  • newly diagnosed diabetes mellitus
  • myopathy symptoms (muscular weakness)
  • muscle aches
  • increased creatine kinase (a muscle enzyme that raises during muscle injury) more than 10 times the upper limit of normal
  • back pain
  • newly diagnosed cancer
  • kidney problems
  • insomnia
  • gastrointestinal disturbance, nausea
  • dyspepsia (indigestion), diarrhoea or constipation
  • fatigue
  • headache
  • suicide
They performed internationally recognised statistical analysis to pool the results together. They then calculated the increased risk of experiencing each side effect for participants taking the statins and for participants taking placebo. They subtracted the placebo risk from the statin risk to find the absolute increase in risk for being on statins. By doing this, they worked out the proportion of symptoms that would not have been attributable to taking medication.
The researchers reported risks as “absolute risks” and calculated the reduction in risk by subtracting the risk in one arm from that in the other. This makes a direct comparison of the possible risks and benefits.

What were the basic results?

They found 14 randomised controlled trials, which included 46,262 people without previous heart disease or stroke (primary prevention). They also found 15 randomised controlled trials, including 37,618 people who already had heart disease or stroke (secondary prevention). On average, the trials lasted between 6 months and 5.4 years, and those included were mostly men.
In the studies, on people who had not already suffered from a heart attack or stroke, the rate of new-onset diabetes for people on statins was 2.7% and on placebo was 2.2%.
The difference between rates on treatment and on placebo is 0.5% (95% confidence interval [CI] 0.1 to 1%), meaning there was a small, statistically significant increase in the rate of developing diabetes with a statin.
This means that in 100 people taking statins, 20 cases of newly diagnosed diabetes mellitus could be due to taking this medicine. In people who had already suffered from a heart attack or stroke, there was only one study that reported new onset diabetes, and no significant effect was seen.
In the studies on people who had not already suffered from a heart attack or stroke, the risk of death from any cause on statins was 0.5% (CI -0.9 to -0.2%) less than the risk on placebo. The risk of a heart attack was 1% (CI -1.4 to -0.7%) less and the risk of stroke 0.3% (CI -0.5 to -0.1%) less.
In the studies on people who had already suffered from a heart attack or stroke, the reduction in absolute risk of death from any cause was even more: 1.4% (CI -2.1 to -0.7%) less compared to placebo. Statins also significantly reduced the risk of a heart attack by 2.3% (CI -2.8 to -1.7%) and the risk of stroke was 0.7% (-1.2 to -0.3%) less.
The proportion of people developing symptoms or other blood test abnormalities was as follows:
  • In both study groups, liver enzymes rose in 0.4% of people on statins. No symptoms were reported, and it is unclear if this was harmful.
    There was no significant difference between
  • taking statins or placebo for any of the other adverse events or side effects listed above.
  • With regards to muscle weakness, this was only recorded if the muscle enzyme (creatinine kinase) level was greater than 10 times the upper limit of normal, so was found in just 16/19,286 people on statins and 10/17,888 on placebo in the primary prevention group. A separate category for muscle aches were experienced in 1744/22,058 (7.9%) in people on statins and 1646/21,624 (7.6%) on placebo.

How did the researchers interpret the results?

At the doses tested in these 83,880 patients, only a small minority of symptoms reported on statins are genuinely due to the statins; almost all reported symptoms occurred just as frequently when patients were administered placebo. New-onset diabetes mellitus was the only potentially or actually symptomatic side effect whose rate was significantly higher on statins than placebo; nevertheless, only one in five of these new cases were actually caused by statins.


This meta-analysis pooled results from 29 studies and has shown a very small increased risk of newly diagnosed diabetes mellitus. This is the same as the decreased risk of any cause of death in people taking statins, compared to placebo, to prevent a heart attack or stroke.
The researchers point out some limitations to the meta-analysis:
  • Each study did not report on all of the side effects, meaning that for each category of side effect, the number of participants differed. The side effect categories were only included if at least 500 people had reported suffering from it. This means there may be numerous other side effects that were not covered by this research.
  • New onset diabetes was only documented in 3 of the 29 trials, though the numbers were still reasonably large.
  • Many trials do not state clearly how and how often adverse events were assessed. This is particularly important, as it is not clear from this type of analysis how often the side effects were experienced or the severity.
Side effects not covered by this review include memory problems, blurred vision, ringing in the ears and skin problems.
Anecdotally, muscle aches or weakness is one of the main reasons people stop taking statins. In this review, the category for muscle weakness was only looked at if the person also had a 10-fold increase in creatinine kinase level (indicating muscle damage). Muscle aches were separately recorded, as this is more common and not always experienced alongside muscle weakness. No firm conclusions can therefore be drawn from this meta-analysis regarding whether statins have an effect on the risk of muscle weakness, if there was less than a 10-fold increase in creatinine levels.
This research was limited to studying the side effects reported in the included studies. Although it was not a comprehensive study of all side effects, it has provided a novel approach to assessing the balance of risks and benefits.
It provides extremely useful data on the proportion of people expected to have genuine side effects and the balance of risks and benefits when taking statins in both low- and high-risk groups.
There are other ways you can lower your cholesterol levels, such as eating a healthy diet low in saturated fat and taking regular exercise.

Thursday, 13 March 2014

Claims new blood test can detect Alzheimer's disease

reposted from: NHS Choices with a fascinating comment on biostatistics by David Colquhoun.

Quoting [unedited] the opening paras:-
"“Blood test that can predict Alzheimer's,” was the headline used by BBC News, the Daily Mail and The Guardian today. Similar coverage was seen across many of the front pages of other newspapers. 
These headlines reflected new research showing how a simple blood test may be able to detect early signs of cognitive decline and mild Alzheimer’s disease. 
US researchers discovered a panel of 10 biomarkers that, with 90% accuracy, could distinguish people who would progress to have either mild cognitive impairment or mild Alzheimer’s disease within two to three years, from those who wouldn’t. 
While promising, the results were only based on a small group of adults over 70 years old who were studied over five years. Of those who developed mild cognitive impairment or mild Alzheimer’s disease, only 28 people had the test. Consequently, it is not clear if the test has any predictive power in the wider population, is applicable to younger adults, or can predict the disease more than two to three years in advance. 
The Daily Mail outlined how, while the research was a breakthrough, experts had warned it would bring “ethical concerns”. This is an important point, because there is currently no cure for Alzheimer’s disease, so some people may prefer not to know they might get it. The current unrefined test means at least one in 10 would be wrongly told they will go on to develop the condition, given the severity of the disease, this may cause significant needless worry."
End Quote

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Sunday, 9 March 2014

High protein diet not as bad for you as smoking

Reposted, without modification from:

crabsallover highlightskey pointscomments / links.

For me, the message from this research is that "low protein intake during middle age followed by moderate to high protein consumption in older adults may optimise health and longevity." 

From my other IGF-1 posts they seem to me to indicate to me that low IGF-1 levels are implicated in a long, healthy life. IGF-I (wikipedia).

Interesting comments to the Levine et al paper particularly from Jason Cholewa about high protein and body building. Choices

“People who eat diets rich in animal protein carry similar cancer risk to those who smoke 20 cigarettes each day,” reports The Daily Telegraph.

We have decades of very good evidence that smoking kills and – fortunately for meat lovers – this latest unhelpful comparison with high protein diets largely appears to be a triumph of PR spin.

The warning was raised in a press release about a large study which found that for people aged 50-65, eating a lot of protein was associated with an increased risk of dying.

However, the study, which assessed the diets of Americans in a single 24-hour period (rather than long-term), found in those aged over 65 that a high protein diet was actually associated with a reduced risk of death from any cause or from cancer. These differing findings meant that overall there was no increase in risk of death, or from dying of cancer with a high protein diet.

How much protein should I eat?
In this study, on average people ate 51% of their calories in the form of carbohydrates, 33% as fat and 16% as protein (11% animal protein). This is likely to be higher in fat and lower in carbohydrates than that recommended on the “Eatwell Plate” which shows the relative proportions of food that we should aim to eat.

There are several reasons to be cautious when interpreting the results of this study, including that the researchers did not take into account important factors such as physical activity in their study.

The claim in much of the media, that a high protein diet in middle-aged people is “as dangerous as smoking” is unsupported. We need to eat protein, we do not need to smoke.

Where did the story come from?

The study was carried out by researchers from the University of Southern California (USC) and other research centres in the US and Italy. It was funded by US National Institutes of Health, National Institute on Aging, and the USC Norris Cancer Center. The study was published in the peer-reviewed journal Cell Metabolism and has been made available on an open access basis to read for free.

In general, reporting of the results of the study was reasonable. However, the prominence given to the story (which featured as a front page lead in The Daily Telegraph and The Guardian) in the UK media seems disproportionate.

The headlines suggesting a high protein diet is “as harmful as smoking” was not a specific finding of the study and could be seen as unnecessary fear-mongering. This is particularly of note given that the effects of a high protein diet were found to differ dramatically by age.

To be fair to the UK’s journalists, this comparison was raised in a press release, issued by the University of Southern California. Unfortunately this PR hype appears to have been taken at face value.

What kind of research was this?

This study looked at the relationship between the amount of protein consumed and subsequent risk of death among middle aged and older adults. It used data collected in a previous cross-sectional study and information from a national register of deaths in the US.

While the data used allowed researchers to identify what happened to people over time, this wasn’t the original purpose of the data collection. This means that some information on what happened to people may be missing, as researchers had to rely on national records rather than keeping close track of the individuals as part of the study.

What did the research involve?

The researchers had data on protein consumption for 6,381 US adults aged 50 and over (average age 65). They then identified which of these people died over the following 18 years (up to 2006) using national records. The researchers carried out analyses to see whether people who ate more protein in their diets were more likely to die in this period than those who ate less protein.

The information on protein consumption was collected as part the third National Health and Nutrition Examination Survey (NHANES). These surveys are designed to assess the health and nutritional status of people in the US. The participants are selected to be representative of the general US population. As part of the survey they reported their food and drink intake over the past 24 hours using a computerised system. The system then calculated how much of different nutrients they consumed.

Each person’s level of protein consumption was calculated as the proportion of calories consumed from protein. Protein intake was classed as:
High – 20% or more of calories from protein (1,146 people)
Moderate – 10 to 19% of calories from protein (4,798 people)
Low – less than 10% of calories from protein (437 people)

The researchers used the US National Death Index to identify any of the survey participants who died up to 2006, and the recorded cause of death. The researchers looked at whether proportion of calories consumed from protein was related to risk of death overall, or from specific causes. As well as overall deaths, they were also interested in deaths specifically from cardiovascular disease, cancer, or diabetes.

The researchers also looked at whether the relationship differed in people aged 50-65 years, and older individuals, and whether it was influenced by fat, carbohydrate or animal protein intake.

The analyses took into account factors (confounders) that could influence the results, including:

  • age
  • ethnicity
  • education
  • gender
  • "disease status"
  • smoking history
  • participants’ dietary changes in the last year
  • participants’ attempted weight loss in the last year
  • total calorie consumption

The researchers also carried out studies to look at the effect of protein and their building blocks (amino acids) in yeast and mice.

What were the basic results?

On average, the participants consumed 1,823 calories over the day:

  • 51% from carbohydrates
  • 33% from fat
  • 16% from protein (11% from animal protein).

Over 18 years, 40% of participants died; 19% died from cardiovascular diseases, 10% died from cancer, and about 1% died from diabetes.

Overall, there was no association between protein intake and risk of death from any cause, or death from cardiovascular disease or cancer. However, moderate or high protein consumption was associated with an increased risk of death related to complications associated with diabetes.

The authors noted that the number of people dying from diabetes-related causes was low, so larger studies were needed to confirm this finding.

The researchers found that results for death from any cause and from cancer seemed to vary with age. Among those aged 50-65, those who ate a high protein diet were 74% more likely to die during follow up than those who ate a low protein diet (hazard ratio (HR) 1.74, 95% confidence interval (CI) 1.02 to 2.97).

People in this age group who ate a high protein diet were more than four times as likely to die from cancer during follow up than those who ate a low protein diet (HR 4.33, 95% CI 1.96 to 9.56).

The results were similar once the researchers took into account the proportion of calories consumed from fat and carbohydrates. Further analyses suggested that animal protein was responsible for a considerable part of this relationship, particularly for death from any cause.

However, the opposite effect of high protein intake was seen among those aged over 65. In this age group high protein intake was associated with:

  • a 28% reduction in the risk of death during follow up (HR 0.72, 95% CI 0.55 to 0.94)
  • a 60% reduction in the risk of death from cancer during follow up (HR 0.40, 95% CI 0.23 to 0.71)

How did the researchers interpret the results?

The researchers concluded that low protein intake during middle age followed by moderate to high protein consumption in older adults may optimise health and longevity.


This study has found a link between high protein intake and increased risk of death among people aged 50-65, but not older adults. There are some important points to bear in mind when thinking about these results:
The human data used was not specifically collected for the purpose of the current study. This meant that the researchers had to rely on the completeness of, for example, national data on deaths and causes of death. This may mean that deaths of some participants may have been missed.

Information on food intake was only collected for one 24-hour period, and this may not be representative of what people ate over time. Most people (93%) reported that it was typical of their diet at the time, but this may have changed over the 18 years of follow up.

The researchers took into account some factors that could affect results, but not others, such as physical activity.

Although the study was reasonably large, numbers in some comparisons were relatively low, for example, there were not many diabetes-related deaths and only 437 people overall ate a low protein diet. The broad confidence intervals for some of the results reflect this.

Many news sources have suggested that a high protein diet is “as bad for you” as smoking. This is not a comparison that is made in the research paper, therefore its basis is unclear. While we do need some protein in our diets, we don’t need to smoke, so this is not a helpful comparison.

While the authors suggested that people eat a low protein diet in middle age and switch to a high protein diet once they get older, it is not possible to say from the study whether this is what the older participants actually did, as their diets were only assessed once.

Ideally the findings need to be confirmed in other studies set up to specifically address the effects of higher protein diets, particularly the strikingly different results for different age groups.

While certain diet plans, such as the Atkins diet or the “caveman diet” have promoted the idea of eating a high-protein diet for weight loss, relying on a single type of energy source in your diet is probably not a good idea. Consumption of some high-protein foods such as red meat and processed meat is already known to be associated with increased risk of bowel cancer.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines

High-protein diet 'as bad for health as smoking'. The Daily Telegraph, March 4 2014
Diets high in meat, eggs and dairy could be as harmful to health as smoking. The Guardian, March 4 2014
Eating too much meat and eggs is ‘just as bad as smoking’, claim scientists. The Independent, March 4 2014
Eating lots of meat and cheese in middle age is 'as deadly as SMOKING'. Daily Mail, March 4 2014
Eating lots of meat and cheese could be as bad for you as smoking, report reveals. Daily Mirror, March 4 2014
Meat And Cheese 'As Bad For You As Smoking'. Sky News, March 4 2014

Links to the science

Levine ME, Suarez JA, Brandhorst S, et al. Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism. Published online March 4 2014. (Open Access = FREE!)

Further reading

Press release
University of Southern California. Meat and cheese may be as bad as smoking. Published March 5 2013

Results from Paper
I've copied the Highlights and Summary from the paper.

Authors: Morgan E. Levine, Jorge A. Suarez, Sebastian Brandhorst, Priya Balasubramanian, Chia-Wei Cheng, Federica Madia, Luigi Fontana, Mario G. Mirisola, Jaime Guevara-Aguirre, Junxiang Wan, Giuseppe Passarino, Brian K. Kennedy, Min Wei, Pinchas Cohen, Eileen M. Crimmins, Valter D. Longo

  • High protein intake is linked to increased cancer, diabetes, and overall mortality
  • High IGF-1 levels increased the relationship between mortality and high protein
  • Higher protein consumption may be protective for older adults
  • Plant-derived proteins are associated with lower mortality than animal-derived proteins


Mice and humans with growth hormone receptor/IGF-1 deficiencies display major reductions in age-related diseases. Because protein restriction reduces GHR-IGF-1 activity, we examined links between protein intake and mortality. Respondents aged 50–65 reporting high protein intake had a 75% increase in overall mortality and a 4-fold increase in cancer death risk during the following 18 years. These associations were either abolished or attenuated if the proteins were plant derived. Conversely, high protein intake was associated with reduced cancer and overall mortality in respondents over 65, but a 5-fold increase in diabetes mortality across all ages. Mouse studies confirmed the effect of high protein intake and GHR-IGF-1 signaling on the incidence and progression of breast and melanoma tumors, but also the detrimental effects of a low protein diet in the very old. These results suggest that low protein intake during middle age followed by moderate to high protein consumption in old adults may optimize healthspan and longevity.

Friday, 7 March 2014

Statins for practically everyone over 60?

I quote directly Fergus Walsh from his post ' A nation of pill poppers' from his column dated 12th February 2014:-
"A sensible step that will cut deaths and disability or a mistake that will medicalise millions? 
There are starkly opposing views of proposals from the health watchdog the National Institute for health and Clinical Excellence (NICE) to dramatically increase the numbers offered statins. 
They are already the most commonly prescribed medicines in the UK, which work by lowering the level of cholesterol in blood. Around seven million people are on the tablets which cost less than 10p a day. It is estimated they prevent around 7,000 deaths a year from heart attacks or strokes. Add to that the tens of thousands of people who are saved from disabling non-fatal attacks and you can see why health experts are keen on statins. 
A generation ago cardiovascular disease was common in early middle age. As a result of statins and treatments for reducing blood pressure, the condition has been delayed by around 20 years. 
That means two decades more of healthy life for millions of people. 
The current guidance from NICE says adults with at least a 20% chance of having a heart attack or stroke in the next 10 years should be offered statins. 
That is being lowered to a 10% chance of cardiovascular disease over 10 years. 
So how is the risk calculated? You can work out your individual risk by going online to the QRISK2 calculator
Input factors like your age, sex (men are at greater risk), ethnicity, blood pressure, Body Mass Index, family history, cholesterol level and so on. 
It also includes your postcode: heart disease is strongly linked to poverty and deprivation so that will alter your risk too (though clearly you would expect your doctor to take account of your background, rather than just relying on your address). 
My risk was well below the 10% trigger for statins. But any smug feeling was quickly despatched when I added a decade to my age. 
Once you hit your sixties you can virtually guarantee that your 10-year risk will place you in the statins category no matter how healthy you are. 
The effect of the proposals - which have gone out for consultation in England - would be to add millions to the numbers already on statins. 
Mark Baker, from NICE, who helped draw up the guidelines said: "You'd probably need to treat about 60 people with statins for 10 years to prevent one heart attack or stroke." 
That might not sound like it is worth it, but let's say you treated another six million people, that would prevent 100,000 heart attacks or strokes over a decade. 
Diet & exercise
Estimating the health benefits of statins is difficult, and those figures could be an over-estimate. But you can see that - taken over an entire adult population - the potential health benefits are enormous. 
So that's the argument in favour. Now the opposite view.
Putting people onto statins is akin to medicalising them for life. Rather than taking a pill to lower cholesterol, the same effect can be achieved through changing their diet and exercise levels.
Even small modifications to lifestyle - taking the stairs or getting off the bus one stop further from your destination - can make positive changes. 
Offering sedentary patients a quick fix may simply store up problems for later.
"It's a very bad idea", said Dr Aseem Malhotra a London cardiologist. "Eighty per cent of cardiovascular disease is due to lifestyle and NICE should be concentrating on that aspect rather than offering pills to millions." 
Dr Malhotra believes up to one in five people on statins will suffer side effects such as muscle pains, stomach pains or increased risk of diabetes. 
NICE says the figure is far lower and serious problems with statins are rare. NHS Choices says "statins are generally well tolerated and most people will not experience any side effects." It lists the range of possible adverse reactions. 
Ultimately it will be up to patients to decide, following consultation with their GP. One likely option for many will be to try statins and see whether they trigger any ill-effects. 
Statins are saving lives and preventing disability every day. So they are a powerful tool in promoting good health. But people will need to consider carefully before deciding to take a daily pill for decades to come."
reposted from:
crabsallover highlightskey pointscomments / links.

WHO says halving sugar target has extra benefit

I quote:-
"“Halve sugar intake, say health experts,” The Daily Telegraph reports, while The Guardian tells us that “a can of coke a day is too much sugar”.
The widespread media reports follow new draft international guidelines looking at the healthy maximum recommended levels of sugars in the diet.
Currently, people are advised to have less than 10% of their total energy intake from sugars. However, the new draft guidelines from the World Health Organization (WHO), state that a reduction to below 5% of total energy intake would have “additional benefits”.
An intake of 5% is equivalent to around 25 grams (six teaspoons) of sugar a day for a healthy adult. The WHO’s suggested limits apply to all sugars, including “hidden” sugars added to foods by manufacturers, as well as sugars that are naturally present in fruit juices and honey."


crabsallover highlightskey pointscomments / links.