New Lipid guidelines to prevent CVD

Discussion in 'Synapse' started by Jason, Nov 13, 2013.

  1. Jason

    Jason Developer / Handyman Staff Member

  2. Jason

    Jason Developer / Handyman Staff Member

    The panel specifically was not impressed with "Treat to target" approaches.
    Ideally the Cardiologists stop quoting the "target" LDL they think applies to the patient.

    As usual, it seems the guys get the short stick:

    That seems at odds with Stats Canada data:
    In Ontario,
    The guy will live to 83.7 and the gal will live to 86.7
    This is because not all CVD is fatal :)
  3. Jason

    Jason Developer / Handyman Staff Member

    If you follow these cook book rules.
    Essentially every man age 62 and older would be on a statin.
    Essentially every woman age 70 and older would be on a statin.

    1) has CVD.
    2) LDL over 4.9
    3) Diabetes (ages 40-75)
    4) ages 40-75 with 10y risk > 7.5%.
    all men at age 62, (because of 4)
    all women at age 70, (because of 4)
    all male smokers age 52 and older.
    all female smokers age 62 and older.

    Average total cholesterol in Americans.
    Last edited: Nov 13, 2013
  4. Graham

    Graham Developer Staff Member

    I'm not sure what to make of these new guidelines. And I only just switched to using ESC guidelines because they have an app :)

    And I see that they have dropped the emphasis on a low fat diet, and now are pushing a Mediterranean diet. Perhaps this is a practical response to the perception that you can not get people to eat 10% fat diets. But Esselystyn says that the failure of the Mediterranean diets is that 25% of the patients in the Lyon Heart Study either died or had a coronary event after 4 years.
  5. Jason

    Jason Developer / Handyman Staff Member

    heh. Someone else noticed the age 62 for men and age 70 for women phenomenon.


    I think I will be using statins more as one of my favourite sources has moved from indifferent on their use to rather bullish.

    Statins for the primary prevention of cardiovascular disease

    Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, Ward K, Ebrahim S
    Published Online: May 31, 2013

    Cardiovascular disease (CVD), which comprises heart attacks (myocardial infarction), angina and strokes, is ranked as the number one cause of mortality and is a major cause of morbidity world wide. High blood cholesterol is linked to CVD events and is an important risk factor. Reducing high blood cholesterol, is thus an important way to reduce the chances of suffering a CVD event. Statins - cholesterol lowering drugs - (e.g. simvastatin, pravastatin, atorvastatin) are the first-choice treatments. Since the early statin randomised controlled trials were reported in the 1990s, several reviews of the effects of statins have been published highlighting their benefits particularly in people with a past history of CVD. Benefits include a reduction in CVD events. Statins have also been shown to reduce the risk of a first event in otherwise healthy individuals at high risk of CVD (primary prevention) but information on possible hazards has not been reported fully. The aim of this updated systematic review is to assess the effects, both in terms of benefits and harms of statins, for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE until 2011. We found 18 randomised controlled trials with 19 trial arms (56,934 patients) dating from 1994 to 2008. All were randomised control trials comparing statins with usual care or placebo. The mean age of the participants was 57 years (range 28 - 97 years), 60.3% were men, and of the eight trials that reported on ethnicity, 85.9 % were Caucasian. Duration of treatment was a minimum one year and with follow-up of a minimum of six months. All-cause mortality and fatal and non-fatal CVD events were reduced with the use of statins as was the need for revascularisation (the restoration of an adequate blood supply to the heart) by means of surgery (coronary artery bypass graft ) or by angioplasty (PTCA). Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease. Taking statins did not increase the risk of serious adverse effects such as cancer. Statins are likely to be cost-effective in primary prevention.

    - See more at:

    1.8% of statin users will benefit if treated for 5 years.
    I'm surprised about Cochrane saying all-cause mortality is reduced as well.
  6. Jason

    Jason Developer / Handyman Staff Member

    There has also been a lot of controversy over the risk calculator (see the calculator above) itself because it’s said to greatly exaggerate the risks. According to a commentary in the medical journal The Lancet, the calculator overpredicts the risk of a heart-related event by 75 to 150 per cent. The result is that it is recommended that virtually every senior citizen needs statins.

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