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Old 04-16-2005, 06:26 AM   #1
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Combining All the STUDIES

I found an article from this week's ARCHIVES OF INTERNAL MEDICINE that I'm sure most of you will find interesting.

Quote:
Statins and omega-3 fatty acids 'benefit cardiovascular mortality best'Statins and omega-3 fatty acids 'benefit cardiovascular mortality best'
Thursday, April 14, 2005
Arch Intern Med 2005; 165: 725-730

A systematic review of data from 97 trials reveals that statins and ω-3 fatty acids are the most favorable lipid-lowering interventions for reducing overall and cardiac mortality.

The findings also suggest that any potential reduction in cardiac mortality from fibrate therapy is cancelled by an increased risk of death from non-cardiovascular causes.

Marco Studer from the Basel Institute for Clinical Epidemiology in Switzerland and team investigated the efficacy and safety of different lipid-lowering interventions in the prevention of coronary heart disease (CHD) based on trial mortality data.

To do this, they systematically searched for all randomized controlled trials published up to June 2003 that compared any lipid-lowering intervention with placebo or usual diet and how this affected mortality.

Studer et al identified 97 studies that met their criteria, involving 137,140 individuals who were given a lipid-lowering treatment and 138,976 volunteers who functioned as controls.

Writing in the Archives of Internal Medicine, the researchers report that, compared with control individuals, risk ratios for overall mortality were 0.87 for those individuals prescribed a statin, and 1.00, 0.84, 0.96, 0.77, and 0.97 for those given a fibrate, resin, niacin, ω-3 fatty acid, or dietary intervention, respectively.

Of these interventions, risk ratios for cardiac mortality were most beneficially altered compared with placebo treatment by statin therapy , resins , and ω-3 fatty acids, with corresponding risk ratios of 0.78, 0.70, and 0.68.

Of note, the risk ratios for non-cardiovascular mortality of any intervention indicated no association when compared with control groups, except in the case of fibrate therapy, which gave a significant risk ratio of 1.13.

"In conclusion, this systematic review suggests that statins and ω-3 fatty acids offer the most favourable benefits by reducing the risk of cardiac and overall mortality," the authors comment.

"Future trials should explore whether ω-3 fatty acids in combination with statins lead to additional reduction in CHD mortality, especially in patients with metabolic syndrome."
It looks the Omega-3 oils did VERY well and the fibrates extremely poorly...niacin gave a miserable showing also.

 
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Old 04-16-2005, 10:19 AM   #2
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Re: Combining All the STUDIES

Well, this is a most interesting study indeed! And it looks like my doctor was right on when her first recommendation was to take 3 grams of fish oil daily.

What I wonder, though, is how each group's results were affected by the extent to which they reached a given cholesterol-lowering goal. Would the results have been different, for example, if only those who were able to achieve an LDL of 100 or less (or some other given number) in each group were considered? Depending upon how the individual studies were set up, I'm thinking that those taking niacin or fibrates may have been less compliant than those taking statins or fish oil, and as a group may not have received the same level of success in lowering cholesterol levels.

I've been taking both fish oils and niacin. Now I'm wondering if taking the fish oil alone would be enough, with no regard for the fact that it didn't lower cholesterol all that much, if at all. From the theories I've read, the fish oil might be doing some things differently from the others, such as helping to keep cell walls more elastic. And whatever it is the fish oil does may be far more important than just lowering cholesterol.

I've also read theories that it is not the cholesterol-lowering effect of statins that is important in lowering deaths, but something else they do which isn't yet recognized. Maybe they have some of the same effects as does fish oil, and lowering cholesterol isn't the main factor. Hmmmmmm.

Thanks for finding that abstract, Lenin.

 
Old 04-16-2005, 10:58 AM   #3
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Re: Combining All the STUDIES

Uff-da,
I think that the analysis of all the studies considered ONLY mortality. I don't thin "reaching 100 LDL" was considered at all.
Basically what they are saying is that people in all studies died at 87% of the placebo rate while taking statins, 77% while taking n-3's and so on.

I think that given the MORTALITY data, there's no concern HOW the agents achieved their numbers, good or bad.
Personally I think the non-cholesterol benefits of statins are uniquely uninteresting. If they are THERE, so much the better for those taking statins. Waiting til the people who are looking for the thing they can't seem to find seems to me only of interest to THEM...though God knows why they're interested. I think these people don't really exist in fact:!
Sorta like the cigarette manufacturers who wring their hands and say: "We'll NEVER know the TRUE cause of lung cancer!"

Last edited by Lenin; 04-16-2005 at 11:01 AM.

 
Old 04-16-2005, 12:00 PM   #4
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Re: Combining All the STUDIES

Quote:
Originally Posted by Lenin
I think that given the MORTALITY data, there's no concern HOW the agents achieved their numbers, good or bad.
I can't agree with you on that one. It is completely true, for the doctors in looking at the overall results to see that fish oil is the best, with statin coming in second on these results for the population as a whole. But looking at it from someone taking niacin and considering should I continue or not, it becomes very important as to whether those taking niacin in the studies did achieve a given level of cholesterol reduction or not. If half the people in the niacin studies didn't get their cholesterol down far enough to benefit, naturally that would affect the mortality of that population, if in fact it is the cholesterol that is important. But since I got mine down to achieve a TC/HDL ratio of 2.6 (before I added the 14 eggs a week ), I don't know if I should be comparing myself with that population or not. See what I mean?

Quote:
Personally I think the non-cholesterol benefits of statins are uniquely uninteresting. If they are THERE, so much the better for those taking statins. Waiting til the people who are looking for the thing they can't seem to find seems to me only of interest to THEM...though God knows why they're interested. I think these people don't really exist in fact:!
Sorta like the cigarette manufacturers who wring their hands and say: "We'll NEVER know the TRUE cause of lung cancer!"
What matters is that apparently statins work in lowering mortality. But I believe that the reason they work is extremely important. If it does turn out that something other than cholesterol-lowering is a major factor, that might help people to discover other drugs or even natural products which would also have the same impact, hopefully with fewer side effects. I can dream, can't I?

 
Old 04-16-2005, 02:25 PM   #5
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Re: Combining All the STUDIES

Uff-da it's sort of like this: If a study shows low cholesterol, some peoplw will say: Yeah, but overall mortality wasn't shown to increase.
You are saying the opposite: These numbers show mortality and you are saying: What about cholesterol.
All studies cannot show all things to all people.

This compendium of studies deals only with mortality...that doesn't make it poor, only limitted in scope.
For results of cholesterol control other studies will have to be viewed.

 
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