Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid?

Ted_Hutchinson · � #1 � 11-01-2011, 03:36 AM

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study.

Quote:

Abstract
Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators.
These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms.
Total cholesterol is a frequently used variable in the risk estimates.
Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed.
Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline.
Methods
We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models.
The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Tr�ndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total).
Results
Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07).
The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) .
Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern.
Conclusion
Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines.
If our findings are generalizable,
clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised.
This is especially true for women, for whom (by current standards)
moderately elevated cholesterol* may prove to be not only harmless but even beneficial.

Ted_Hutchinson · � #2 � 01-24-2012, 12:23 PM

Integrity in Science” – who’s paying the piper?
The Ethical Nag Marketing Ethics for the Easily Swayed

Now when you read the article here
JANUARY 23, 2012
Should Healthy People Take Cholesterol Drugs to Prevent Heart Disease?

and then check up on Roger S. Blumenthal you find the guy proposing the use of statins has admitted conflicts of interest due to financial ties with Merck, Pfizer, Kos Pharmaceuticals, and Bristol-Myers Squibb - all drug companies that make statins.
While the doctor against Statin usage Dr. Redberg has no conflicts of interest to declare.

So who is most likely to be telling the truth?

Ted_Hutchinson · � #3 � 01-25-2012, 09:51 AM

Three Reasons to Abandon Low-Density Lipoprotein Targets An Open Letter to the Adult Treatment Panel IV of the National Institutes of Health
I won't have time to read this until tomorrow but the sub headings are

There Is No Scientific Basis to Support Treating to LDL Target

The Safety of Treating to LDL Targets Has Never Been Proven

Tailored Treatment Is a Simpler, Safer, More Effective, More Evidence-Based Approach

So I look forward to reading it. What makes me sick though is that the fundamental principle of medicine should be FIRST DO NO HARM and so knowing Statins increase Type 2 diabetes risk AND cause muscle damage should outweigh the hypothetical gains if you juggle the numbers for men and that still doesn't explain why any woman has ever been offered a statin let alone been bullied into taking them.

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