Last month BusinessWeek had a fascinating article about cholesterol-lowering medications. The article also teaches us how we should calculate a specific medication’s benefit and harm, and how pharmaceutical companies manipulate our opinions by reporting benefits in percentages but side effects in absolute numbers. If you want an interesting lesson in evidence-based medicine, or just in cholesterol treatment, take the time to read it. (My only major objection to the article is the headline, “Do Cholesterol Drugs Do Any Good?” Of course they do, and the article doesn’t even argue that they don’t. A more accurate headline would have been “How Much Good Do Cholesterol Drugs Do?”)
Here are the take-home points.
- Statins definitely prevent strokes and heart attacks in people at high risk for strokes and heart attacks.
- Statins also lower cholesterol, but no one knows if that’s how they prevent strokes and heart attacks, or if they prevent strokes and heart attacks through some other mechanism.
- The greater a patient’s risk for stroke and heart attacks, the greater the benefit she derives from a statin.
- Patients who have no heart disease and no risk factors for heart disease (these are non-smoking men under 45 or women under 55 without high blood pressure, diabetes, or first-degree relatives with heart disease) are at such low risk from heart disease (regardless of their cholesterol) that their benefit from taking a statin is likely to be very small, and only realized after taking a statin for many years. At that point the side effects of a statin, even if mild and rare, may actually be more significant than the tiny benefits.
(Thanks to Harriet E. for pointing me to the BusinessWeek article.)
At the risk of horrible immodesty, I just have to brag for a second about electronic medical records (EMR). After my post a few weeks ago about the bad news about Zetia and Vytorin I wanted to review all of my patients who were taking the medications to make sure that they were on it for appropriate reasons. With our EMR I was able to generate a list of every patient on Zetia or Vitorin in a few minutes. Try that with paper charts.