The British Heart Foundation (BHF) is the UK’s largest and best-known ‘heart’ charity and, on the surface at least, appears devoted to doing what it can to reduce the burden of ‘cardiovascular’ issues such as heart attacks and strokes. The BHF website offers a number of stories of people which appear to highlight pertinent issues in the area and the importance of good medical care. Here’s an example.
There’s not much detail to go on here, but but from what I can make out, Jill is a 53-year-old long-term diabetic. Some time ago she was diagnosed with ‘high cholesterol’ but initially resisted the idea that she needed medication for this. But her doctor was “absolutely straight with [her]”, and she concluded that, no matter what her own feelings were on the subject, she simply “had to” take the statins.
Then we learn that: “It was a massive shock when I had my heart attack a few years later. That was a real wake-up call and I find it really hard to imagine that people wouldn’t take their cholesterol or blood pressure medicine if they knew what it was like to live with heart disease.”
It seems to me that the BHF is using Jill’s experience to help persuade individuals to take their medication. Some might call it scare tactics. If the BHF’s intention is to use Jill as a prime example of why individuals should take their medications as they’re told to by their doctors then I think the exercise has failed. After all, despite taking her medication, Jill still went on to have a heart attack: this is not exactly a ringing endorsement for the effectiveness and indispensable nature of statins.
But never mind this inconvenient fact, because we’re informed by Jill that: “My doctor told me if I hadn’t stuck to taking my medicines, my heart attack would have happened a lot sooner.” The reality is, though, there is simply no way Jill’s doctor (or anyone else) can legitimately make such a claim, as he or she has no way of knowing if it’s true or not. It’s an opinion, and a highly speculative one at that.
Of course, some might feel that at least Jill is at least alive to tell her tale, and perhaps the statins she took had some value here. However, we know from recent research discussed here that statins do not reduce the risk of death in women, even those who are at high risk of cardiovascular events such as heart attacks and strokes.
The BHF is an organisation that some would look to for balanced and impartial information and advice about the prevention and management of cardiovascular disease. And I think case studies such as this do the general public a huge disservice. Bereft of science, Jill’s story does not truly inform us at all, and perhaps only serves to scare people into taking their medication. Personally, I’d like to see the BHF stick to the facts: the scientific facts. If they did, though, we could all see just how ineffective many of the medications we ‘rely on’ really are.
That heart attack was a RESULT of the medication.
As an elderly female, high cholesterol is the biggest predictor of life expectancy, last thing you want to do is lower it!
I wonder which pharmaceutical company paid for that story to go on the BHF website?
DePaw Can you explain what yu wrote above please.
If you read/Google the work of Uve Ravnskov, Malcolm Kendrick and Anthony Colpo you will find reference to research that supports what De Paw says. As a layperson I found the evidence that demonises cholesterol exposed by these commentators and their work refers to plenty of other evidence/clinical trials (particularly for women) that suggests the issue of cholesterol is far more complex than is currently presented by ‘mainstream’ medical opinion.
It’s interesting that they used a woman as an example; everybody knows that women generally have a lower risk of heart attack than men, so using a woman as an example hammers their point home. The recent report highlighted by Dr. John re women not benefiting from statins only goes to confirm the findings reported in The Lancet as long ago as 2007 (I quote from the study): “Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years. High-risk men aged 30–69 years should be advised that about 50 patients need to be treated for 5 years to prevent one event. In our experience, many men presented with this evidence do not choose to take a statin, especially when informed of the potential benefits of lifestyle modification on cardiovascular risk and overall health. This approach, based on the best available evidence in the appropriate population, would lead to statins being used by a much smaller proportion of the overall population than recommended by any of the guidelines.” The American authors stated that US guidelines for the prescription of statins cited a total of 16 trials as evidence, yet “not one of the studies provides such evidence”!
(J Abramson and J M Wright (20-26 January, 2007). Are lipid-lowering guidelines evidence-based? THE LANCET, Vol. 369, Issue 9557, pages 168-169.)
Hilda, if you read this it might help – http://www.drbriffa.com/2011/10/06/why-a-raised-cholesterol-level-may-be-a-cause-for-celebration/
“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 moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.”
J Eval Clin Pract. 2012 Feb;18(1):159-68. doi: 10.1111/j.1365-2753.2011.01767.x. Epub 2011 Sep 25. http://www.ncbi.nlm.nih.gov/pubmed/21951982
However please note this study has sunk like a stone. Google scholar says it has exactly 1 cite. It’s been completely ignored.
to ‘irememberwhen’ – Dr Briffa has pointed out that epidemiological studies don’t necessarily show ’cause and effect’, just associations. I haven’t had time to read the whole thing, but one should be wary of these studies in any case, although I’d be pleased to accept the findings if only to indicate that more research should be done.
Here is another new paper showing that women do not ultimately benefit from Statin use.
Statin Therapy in the Prevention of Recurrent Cardiovascular Events: A Sex-Based Meta-analysisStatin Therapy to Prevent Recurrent CV Events. CONCLUSIONS Statin therapy is an effective intervention in the secondary prevention of cardiovascular events in both sexes, but there is no benefit on stroke and all-cause mortality in women.
I’d also like to draw Dr Briffa’s attention (and other reader’s) to this new paper Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity The full text of this paper downloads as a free pdf if you follow the link to DOWNLOAD ARTICLE.
I hope you all will read and enjoy it.
Why doesn’t the BHF publish a list of directors and trustees who are also paid by drug companies? Why isn’t there a list of drug company donors on its website?
I wonder…
A more conservative approach is evolving among many cardiologists concerning statin use in primary prevention. It does happen slowly, but many clinicians now realize that the scientific data is very soft. We also know that there may be more problems with long-term statin therapy than previously thought. Therefore, “scare tactics” are not warranted in this situation. Informing patients on the possible benefits, the amount of benefit (number needed to treat approx. 50 – 100 – depending on risk – to prevent one event in five years) and possible side effects, should be the way to go.
I recently discussed statin use in primary prevention on my blog from the perspective of the practicing clinician.
Professor Eric Topol also wrote an interesting article on the issue recently http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html?_r=1
Organized medicine abandon their confabulated evidence based treatments and instead offer treatments based on the scientific facts? Not bloody likely!