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No Evidence for Treating to Specific Targets of LDL
Gone are the recommended LDL- and non-HDL–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL. According to the expert panel, there is simply no evidence from randomized, controlled clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease. Instead, the new guidelines identify four groups of primary- and secondary-prevention patients in whom physicians should focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate "intensity" of statin therapy in order to achieve relative reductions in LDL cholesterol.
Unfortunately I can't see the paper without a "log in." Sounds an interesting paper, have you got another link ?
In reality, "treating to target" is always difficult to achieve, but, it would appear, that we (the population), are living better, and longer, as a result of striving to achieve targets. Of course, there are other factors, smoking less,
Personal opinion-pour a bit of statin, ACE inhibitor and a few aspirins in the water supply, and spend the money we save on prescribing and monitoring on something we know makes a difference to health- pre-school education anyone ?
just read a snippet in one of the broad sheets, it seems that the American's are discussing treating those with a 7.5% 10 yr risk. We always knew that the risk/benefit equation tipped at about 7%, in the UK we treat at 20%, but that's more to do with money than effectiveness.
Diet such as yours may help, and some people will get more benefit than others. But your risk of a cardiovascular event remains higher than if you took statins. It is your choice and you are welcome to it but others should make their decision on the facts.
Most statins are off patent, generic, and cost pennies. Drug companies don't make money out of them. Your GP doesn't benefit one way or another.
This change is about the number of people in a community it is worth treating and in the main comes down to the cost of treating cardiovascular events vs the cost of the drug and complications. It is falling as the drugs get cheaper, we understand how to prevent complications, and appreciate additional benefits such as prevention of some types of dementia. I suspect it will fall further
However I gather in the UK you can buy these drugs over the counter. Although I believe they should be monitored by a doctor, there is therefore nothing to stop every individual deciding for themselves.
Simvastatin can be bought OTC, but it's only available in 10mg tabs/caps which is probably a sub-therapeutic dose. I can't find any evidence base for this dose, (like a lot of things you can buy in a pharmacy.)
I'm as cynical as everyone else, and I have some sympathy with the cause for Danecol, Red Rice and the such like, no funding there for the basic question- will it make me live longer and / or better.
Questions one should ask one's self before writing a prescription....
Is there evidence of effect? Is there evidence of no effect ? Is there no evidence of effect ?
Who said you could only take one tablet at a time????
There is evidence that you reduce sudden death and cardiovascular event frequency even if the lipid levels do not change. There is far stronger evidence that there is no ideal level and that lowering it from normal levels is still beneficial. Extrapolating this suggests your small dose may well reduce risk but as I said I believe these drugs should be prescribed and monitored
I'm not sure the "monitoring by a doc" is always required Radg. And yes, it's possible to visit the pharmacist and take 4 times the dose on the bottle-this probably discriminates against those at most need though. (The old "inverse care law.")
Extrapolating the cost of monitoring the 6 million or so people who take a statin in the UK, would cost a fortune-? and perhaps could be spent on something more worthwhile (free sardines for example :-) ) How much does a practice nurse and blood test cost ?
Certainly for secondary and tertiary prevention, monitoring is required. (Concordance is often the main problem.)
For primary prevention, I've come across 3 models,
-make an assessment, if at risk, bung 'em on a statin, and then forget 'em.(The bucket in the water approach.)
-put them on a statin, and check the lft's at 0, 1, 3 and 12 months. Checking lipids again is futile, if they are still raised, what else are you going to do? (And what evidence is there for further intervention.)
-monitor them almost as you would if they had established disease. - some nurses love this approach as the "just don't get it."
I currently practice the second approach.
I'd agree, it's not always about the levels, it's the "magic" effect of actually taking the statin that does the trick.......some effect that we currently don't know about.
Yes the second approach is what we do. That is my concern with OTC - these people don't check their LFTs and the small proportion who get liver dysfunction may get permanent damage if it isnt picked up.
If everyone in the Uk has a GP don't see the point if they can't establish them safely on such important drugs. Far cheaper than dealing with the consequences otherwise. The incidence of heart attacks has plummeted so wouldn't it be nice if the time and logistics saved could be used for this instead of the other issues I read about in the Daily Mail
Just for interest, I had been putting off taking statins for years. Finally, doc convinced me and so I started on Crestor. He prescribed 10mg, but being my normal sceptical self, started on 2.5mg and got tested after 1month. LDL had dropped from 159 to 100. So, I guess I'll see what his reaction is when I go back.