Definitely Paul. I’m just skeptical of the results as a whole. If we assume it to be accurate, then absolute risk has to be taken into consideration also as you say.

or another way to put it (if you totally believe in Dr Collins HPS study data) is that if you take simvastatin 40 mg for 6 years, your chance of being alive is 87.1% and if you take nothing your chance is 85.3%…….Dr Collins have obviously avoided mentioning these numbers…..

To Z.M., I totally agree with you, however the 13% decrease in mortality is the relative risk. The absolute risk decrease is 1.8% (14.7% on placebo minus 12.9% on statin) for the duration of 6 years, thus the 6-year NNT is 55 pt-years or an annualized NNT of 333 pt-years; therefore if 333 pts take simvastatin 40 mg for onr year , they will live on average 26 hours more ((but probably with myalgia, diabetes, loss of memory,….)

There are also other points that make me suspicious of the HPS results:

The HPS trial never reported the results for all four groups separately which is imperative in a factorial trial. For example, look at how the results of GISSI-P were reported compared to HPS.

A pre-randomization phase was used in HPS which excluded a ton of people (Dr. Briffa’s point 2).

The alleged benefits that were found in numerous subgroups have never been confirmed. The 13% reduction in mortality would be expected to apply to all subgroups, yet such benefits are not seen in properly conducted trials (non-truncated) directly testing the relevant hypotheses.

The HPS has bias written all over it and this would include Professor Collins.

3. And why do Professor Collins and colleagues always refused to show the Kaplan Meier MORTALITY CURVES (not the total number only) of the HPS study if he is so confident about the benefits of the simvastatin ?
|”Something rotten in the kingdom of Dr Collins ?*

You really think that the British Heart Foundation and related organisations have no conflicts of interests? Take a look at some of the “partners” of these organisations!

http://heartuk.org.uk/partners/our-partners

As for point 2: considering the data-hiding and trial manipulations that the industry has frequently been caught doing, your question is fallacious. Merely because we might resent paying for the trials out of public funds does not suddenly make them valid.

yours most sincerely
margaret

1. CTT is funded by organisations with no conflicts of interest; organisations such as the Medical Research Council, the British Heart Foundation, and Cancer Research UK. CTT produce high quality evidence to help inform healthcare decisions, they are not a lobby group.

2. Of course many of the statin trials were industry-funded. Do we expect the public or charities to pay for studies when the statins in question were still under patent? To avoid the issues of conflicts of interests many statin studies have been funded by industry but performed and analysed by independent clinical trials units (which don’t have conflicts of interest).

3. Professor Collins works for Oxford University’s Clinical Trial Service Unit (CTSU). He was a lead investigator on the Heart Protection Study (HPS) where over 20,000 patients took simvastatin 40mg or placebo for over five years, and were then followed up afterwards to give a total follow up of around 11 years. Not exactly one of these ‘short studies or studies that have been terminated early’. There are many HPS-related publications. Most papers can be found here:
http://www.ctsu.ox.ac.uk/~hps/
And here’s the one which relates to the long-term follow up, after the trial treatments finished:
http://www.sciencedirect.com/science/article/pii/S0140673611611252

If the your doctor wants you to take a statin then he should give you the test which measures what types of LDL you have then you both will have some sort of basis for discussion.

I mention this somewhat jokingly, but over the years the impression I’ve gathered is that for many visiting a doctors office is an event. The different tests doctors order, results given, and prescriptions written are often items to discuss with family and friends. Little thought is often given for the value of these tests. The joking part I have is that sometimes when I hear these discussions, it is almost as if people are reliving childhood school days. Doctors could do well if they placed gold stars on test result papers providing a grade. Of course a red stamped frown face would be a big disappointment.

What other heart disease tests can be arranged that people can talk about? What life style changes, diet, supplements, even prescriptions can be made that would be helpful? I think many are looking to take charge of their health further, beyond the typical. Just some thoughts had this evening.

My first advice would be to try to change your doctor.

My second advice would be to have a good look at Dr Malcolm Kendrick’s web site – you will find a lot of useful information about cholesterol and statins, all of it backed up with research references.