Evidence for blood pressure, cholesterol medicines

Kurtosis

Damien M wrote: »

dexter_morgan wrote: »

I notice that a lot of the anti vaccine types are also anti medicine in general. They rant about blood pressure meds, cholesterol meds, pain meds, antibiotics etc. They will do their research and find the information that they WANT to find. They will always be against vaccines and no amount of proof otherwise will be accepted by them. The decision to vaccinate should be taken away from them for the safety of their children.

Try not to go off topic or you might draw the ire of the mods, keep it to vaccines I was told.

But which blood pressure meds are you referring to? I mean, you are aware that Cochrane found little to no benefit of blood pressure meds having any effect on overall mortality etc? And if you still believe in the cholesterol hypothesis, you'd need to keep up with scientific literature, you're not aware the largest studies ever carried out have found no link between saturated fat/cholesterol and heart disease? No? Link below (1).

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease

http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract

See! I can Science as well! I give seminars awakening the public to this 'censored' knowledge, all ilks welcome

(taken from the thread on vaccinations)

Thanks for providing a link, though you didn't link to the Cochrane review you refer to. I am guessing it would be this one (Pharmacotherapy for mild hypertension)? I think you may be oversimplifying when you suggest Cochrane found little/no benefit of blood pressure medicine on mortality and morbidity. The authors of that review conclude:

Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.

So based on currently available trials, there's no evidence of a benefit on mortality or morbidity in people with mild hypertension and no previous CV disease. I definitely think there's overtreatment of people at low risk of cardiovascular events and that many such individuals would decide not to take BP medicines if they were aware of the probabilities involved.

So low-risk people may not benefit, but reducing that to blood pressure medicines do not work is overly simplistic. There are several other reviews which you can also find in the Cochrane library that show benefits of antihypertensives on fatal and non-fatal myocardial infarction in hypertensive individuals, on total mortality and on cardiovascular mortality and morbidity in people 60 years and over with hypertension, and on all-cause mortality and development of kidney disease in diabetics regardless of their blood pressure.


Moving on to your point about cholesterol, you went for a bit of a strawman. The other poster mentioned cholesterol medications, and you then decided to link to a study on dietary saturated fat intake and cardiovascular disease. Ignoring the weaknesses of epidemiological studies in assessing causality (particularly those relating to nutrition and based on self-reported consumption), this tells us nothing about whether it of benefit or not to treat individuals with high cholesterol. And surprise, surprise, the answer to that is not clear cut.

In people with existing cardiovascular disease, evidence shows a clear benefit of using a statin on risk of major vascular events. In people with no history of previous cardiovascular event, the evidence again seems to suggest a benefit in major vascular events and other outcomes, however because such people are at low risk, it is clear whether the absolute benefit statins provide for these patients outweighs the risk of adverse events such as muscle pain and the increased incidence of diabetes. This is compounded because of the way some trials measured adverse events (i.e. if participants were only enrolled in the trial if they tolerated the treatment/placebo for at least a number of weeks) which may lead to some under reporting or under detection. There has been some good discussion of these issues in the published literature in the last few months, particularly in the BMJ.

So, in my opinion, these topics are a bit more complex and nuanced than you suggest.

Nonoperational

The HOPE-3 trial showed some very nice evidence of the benefit of statins in intermediate risk population without established cardiovascular disease. In my own practice I don't prescribe statins for primary prevention in low risk populations, but I do if elevated cholesterol and of an intermediate risk. Generally I use QRISK >10%. http://www.nejm.org/doi/full/10.1056/NEJMoa1600176#t=article

BP lowering is shown to be beneficial in high risk populations as reported in the SPRINT trial, and that fits with what is intuitive in my head.
http://www.nejm.org/doi/full/10.1056/NEJMoa1511939

Interesting there was a very recent trial published looking at primary prevention using aspirin in a T2DM population in Japan which showed no benefit. I think aspirin is pretty much done in primary prevention now, even in diabetes.

http://circ.ahajournals.org/content/early/2016/11/09/CIRCULATIONAHA.116.025760

Secondary prevention is a different ball game. I think statin, ACEi, BB, ASA isn't a bad starting point in almost everyone.

Kurtosis

Nonoperational wrote: »

The HOPE-3 trial showed some very nice evidence of the benefit of statins in intermediate risk population without established cardiovascular disease. In my own practice I don't prescribe statins for primary prevention in low risk populations, but I do if elevated cholesterol and of an intermediate risk. Generally I use QRISK >10%. http://www.nejm.org/doi/full/10.1056/NEJMoa1600176#t=article

Although the relative reduction in cardiovascular outcomes was 25%, because these people don't have a high baseline risk, the absolute reduction in events is only a little over 1%. That gives a number needed to treat of 73-91 to prevent one cardiovascular event/death in such patients over 5-6 years. As I said, compared to secondary prevention or primary prevention, that magnitude of benefit needs to be weighed up more carefully against the risk of side effects for people who are at low/intermediate risk and are considering starting to take a statin.

BP lowering is shown to be beneficial in high risk populations as reported in the SPRINT trial, and that fits with what is intuitive in my head.
http://www.nejm.org/doi/full/10.1056/NEJMoa1511939

The interesting thing about the SPRINT trial was it showed the benefit of intensive treatment of blood pressure (systolic blood-pressure target of <120 mmHg compared to a target of <140 mmHg), although with drawback of more adverse events as a result. Translating this into clinical practice however may justify using a higher target as the way used to measure blood pressure in this (and other) trials gives results about 5-10 mmHg lower than more "real life" measurement (it's well discussed here).

Secondary prevention is a different ball game. I think statin, ACEi, BB, ASA isn't a bad starting point in almost everyone.

Very much agreed, it's the debate about what point to start treating people who are essentially free from disease that's a lot more contentious...and interesting!

Nonoperational

Good post. I agree completely.

Damien M

dexter_morgan wrote: »

I notice that a lot of the anti vaccine types are also anti medicine in general. They rant about blood pressure meds, cholesterol meds, pain meds, antibiotics etc. They will do their research and find the information that they WANT to find. They will always be against vaccines and no amount of proof otherwise will be accepted by them. The decision to vaccinate should be taken away from them for the safety of their children.

Nope, just to reiterate-I'm not anti-med, and if you strawman me you'll be left with a lot of egg on your face, as believe it or not I'll science right back at ya!!!! :pac:

Blood Pressure Meds-cochrane found no evidence they do anything!
Cholesterol Meds-no evidence they do anything, ample evidence they cause diabetes (17 different studies), memory loss (Rosuvastatin), cancer (Pravastatin, Simvastatin)

<Mod Edit, off topic>

You're not very well clued up on the literature, eh?
At least Sullivlo is still the only one left in the fight!

dexter_morgan

Damien M wrote: »

Blood Pressure Meds-cochrane found no evidence they do anything!

Can you provide a link to a study to back up that statement?

RobFowl

Mod note
Any more off topic posts will result in an infraction as well as post being deleted
Rob

Nonoperational

Damien M wrote: »

Nope, just to reiterate-I'm not anti-med, and if you strawman me you'll be left with a lot of egg on your face, as believe it or not I'll science right back at ya!!!! :pac:

Blood Pressure Meds-cochrane found no evidence they do anything!
Cholesterol Meds-no evidence they do anything, ample evidence they cause diabetes (17 different studies), memory loss (Rosuvastatin), cancer (Pravastatin, Simvastatin)

<Mod Edit, off topic>

You're not very well clued up on the literature, eh?
At least Sullivlo is still the only one left in the fight!

I'm sorry. But there is significant evidence that blood pressure control improve outcomes in certain patient groups. There is ample evidence that statins improve outcomes in certain patient groups. To be honest your posts don't belong on a health sciences forum. It is simply not acceptable to post downright untrue and dishonest statements as if they are fact when you are completely clueless. There may be an argument for restraint in primary prevention. Not secondary. But I suspect you don't even know what those terms mean.

Post the trials you speak of or clear off.

RobFowl

Yet more mod notes !
Talk of others being "left in the fight" or telling others to "clear-off" has no place in a scientific forum.
I note neither of the posters using these terms actually used any references to support their claims !
Use references and be civil or else don't come crying when you get banned or warned.
Rob

jh79

Damien M wrote: »

Nope, just to reiterate-I'm not anti-med, and if you strawman me you'll be left with a lot of egg on your face, as believe it or not I'll science right back at ya!!!! :pac:

Blood Pressure Meds-cochrane found no evidence they do anything!
Cholesterol Meds-no evidence they do anything, ample evidence they cause diabetes (17 different studies), memory loss (Rosuvastatin), cancer (Pravastatin, Simvastatin)

<Mod Edit, off topic>

You're not very well clued up on the literature, eh?
At least Sullivlo is still the only one left in the fight!

Is this the Cochrane Review you are referring to? It only refers to cases of mild hypertension.

http://www.cochrane.org/CD006742/HTN_benefits-of-antihypertensive-drugs-for-mild-hypertension-are-unclear

Damien M

Kurtosis wrote: »

Although the relative reduction in cardiovascular outcomes was 25%, because these people don't have a high baseline risk, the absolute reduction in events is only a little over 1%. That gives a number needed to treat of 73-91 to prevent one cardiovascular event/death in such patients over 5-6 years. As I said, compared to secondary prevention or primary prevention, that magnitude of benefit needs to be weighed up more carefully against the risk of side effects for people who are at low/intermediate risk and are considering starting to take a statin.



The interesting thing about the SPRINT trial was it showed the benefit of intensive treatment of blood pressure (systolic blood-pressure target of <120 mmHg compared to a target of <140 mmHg), although with drawback of more adverse events as a result. Translating this into clinical practice however may justify using a higher target as the way used to measure blood pressure in this (and other) trials gives results about 5-10 mmHg lower than more "real life" measurement (it's well discussed here).



Very much agreed, it's the debate about what point to start treating people who are essentially free from disease that's a lot more contentious...and interesting!

Not if you're a shareholder. Treat away-just invent a new disease. Especially great if a blockbuster is coming off patent and you are worried the shareholders are revolting. (If you ask me it's the companies themselves that are revolting but...ok I'll stop). Treating people that are free from disease with a drug never properly tested, never independently tested, foisting the drug on unsuspecting kids. Then they kill themselves. Yeah, I'll leave this thread to you. I know the time I put into my seminar slides has greater return on people's health.

Disease mongering and drug marketing
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1369125/

Disease Mongering in Drug Promotion: Do Governments Have a Regulatory Role?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434509/

Damien M

RobFowl wrote: »

Yet more mod notes !
Talk of others being "left in the fight" or telling others to "clear-off" has no place in a scientific forum.
I note neither of the posters using these terms actually used any references to support their claims !
Use references and be civil or else don't come crying when you get banned or warned.
Rob

Yes chief, but it pains me that I have to use references for stuff that's in the public domain. Ignorance is just a trait I detest. You told me I'd get done for libel for posting historically factual stuff. You should come to my seminars dude. Be an awakening!

Kurtosis

Damien M wrote: »

Yeah, I'll leave this thread to you. I know the time I put into my seminar slides has greater return on people's health.

This sounds like you're not able to back up your claims. You posted:

Damien M wrote: »

Blood Pressure Meds-cochrane found no evidence they do anything!
Cholesterol Meds-no evidence they do anything, ample evidence they cause diabetes (17 different studies), memory loss (Rosuvastatin), cancer (Pravastatin, Simvastatin)

<Mod Edit, off topic>

You're not very well clued up on the literature, eh?
At least Sullivlo is still the only one left in the fight!

Both of your claims are false, plenty of evidence from the literature linked above to demonstrate this. I would hope you provide more evidence to back up statements you make during your seminars.

Damien M

Kurtosis wrote: »

This sounds like you're not able to back up your claims. You posted:



Both of your claims are false, plenty of evidence from the literature linked above to demonstrate this. I would hope you provide more evidence to back up statements you make during your seminars.

Absolutely, 16 pages of references at one point. Thing is, there's too many closed minds on here. Why would I waste time and effort? You're other moderator in cri...ok sorry, the other mod rebuked me for saying that two companies knowingly sold summat they shouldn't have. It's not defamatory if it's true/convicted in court or in the public domain(1), remember this is the information age, and in the age of information, ignorance is a choice....I can't spoonfeed you references, but I can give you a spoon!

'A division of the German pharmaceutical company Bayer knowingly sold blood-clotting agents infected with HIV to Asia and Latin America months after withdrawing them from Europe and the US, an American newspaper claimed yesterday.
Cutter Biological continued to dump stocks of the factor VIII blood-clotting agent for haemophiliacs on poor countries for nearly a year after introducing a safer alternative, the report in the New York Times said.'

(1)https://www.theguardian.com/world/2003/may/23/aids.suzannegoldenberg

Damien M

Kurtosis wrote: »

This sounds like you're not able to back up your claims. You posted:



Both of your claims are false, plenty of evidence from the literature linked above to demonstrate this. I would hope you provide more evidence to back up statements you make during your seminars.

When I get a half hour during the week, I'll expose them blood pressure trials, all the stuff that other gentleman doctor said, howzat? All the fines and fakery that have since come to light, how the 9 out of 10 doctors on the panel that regulates blood pressure meds all had million dollar ties to the drug companies that make the blood pressure meds, how one day blood pressure went from normal to high, and encapsulated 40 million new customers...

How's that sound chief? You're not doubting me now I hope?

Nonoperational

RobFowl wrote: »

Yet more mod notes !
Talk of others being "left in the fight" or telling others to "clear-off" has no place in a scientific forum.
I note neither of the posters using these terms actually used any references to support their claims !
Use references and be civil or else don't come crying when you get banned or warned.
Rob

<Mod edit>

Damien M wrote: »

Absolutely, 16 pages of references at one point. Thing is, there's too many closed minds on here. Why would I waste time and effort? You're other moderator in cri...ok sorry, the other mod rebuked me for saying that two companies knowingly sold summat they shouldn't have. It's not defamatory if it's true/convicted in court or in the public domain(1), remember this is the information age, and in the age of information, ignorance is a choice....I can't spoonfeed you references, but I can give you a spoon!

'A division of the German pharmaceutical company Bayer knowingly sold blood-clotting agents infected with HIV to Asia and Latin America months after withdrawing them from Europe and the US, an American newspaper claimed yesterday.
Cutter Biological continued to dump stocks of the factor VIII blood-clotting agent for haemophiliacs on poor countries for nearly a year after introducing a safer alternative, the report in the New York Times said.'

(1)https://www.theguardian.com/world/2003/may/23/aids.suzannegoldenberg

Damien. Nobody is denying drug companies can be ethically questionable at times. That is a separate issue to posting completely inaccurate statements as if fact. I am not asking for spoon-feeding. I'm asking for discussion on the health science forum to be of a little higher standard than hearsay and borderline illegible grammar.

Damien M wrote: »

When I get a half hour during the week, I'll expose them blood pressure trials, all the stuff that other gentleman doctor said, howzat? All the fines and fakery that have since come to light, how the 9 out of 10 doctors on the panel that regulates blood pressure meds all had million dollar ties to the drug companies that make the blood pressure meds, how one day blood pressure went from normal to high, and encapsulated 40 million new customers...

How's that sound chief? You're not doubting me now I hope?

Oh yes I am doubting you. I wouldn't go to one of your "seminars" if it was the last event on earth. You can't put forward a coherent argument when you have time to do it here, goodness knows what sort stuff you would come out with.

We do agree on one thing. I also have no time for ignorance.

http://circres.ahajournals.org/content/116/6/1058

Blood pressure treatment works particularly in secondary prevention. That's a fact, chief.

Nonoperational

https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

Interesting reed actually.

echo beach

Nonoperational wrote: »

https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

Interesting reed actually.

Fascinating. Very few of us can accept that the best option is usually to do nothing.
If I'm reading it right then the people in Waterford are better off without a second cath lab.

Nonoperational

It depends I suppose. Generally we only stent people who are symptomatic or had/are having an acute coronary syndrome. In the article the patient did have ecg changes and chest pain. We don't know if he made troponin. Some people have fantastic symptomatic relief from PCI and it has merit using it in these people.

But it is hard to do nothing. The ischaemia trial will be interesting. Courage and BARI 2D tell us PCI doesn't prolong life in stable patients.

echo beach

Nonoperational wrote: »

But it is hard to do nothing. The ischaemia trial will be interesting. Courage and BARI 2D tell us PCI doesn't prolong life in stable patients.

I agree about how difficult it is to do nothing, not least because it is the opposite of what is expected and even demanded. That could be why so many antibiotics are prescribed to patients who probably don't need them.
What many patients want HCPs to do is listen but that is often more difficult than writing a prescription or even doing an operation.