Monday, February 02, 2009

Figure This One Out...

Two new medical studies suggest that most everybody and certainly their grandma should be put on statins:

Two new studies indicate that the threshold of what doctors consider "normal" levels of bad cholesterol, or LDL, may be too high, leaving thousands of people vulnerable to heart attacks and strokes.

One of the studies, led by Gregg Fonarow of UCLA, examined 131,000 hospital admissions for heart disease and found that at least half of the patients had normal LDL levels. The other study, called JUPITER, involved 18,000 people. It showed that giving a cholesterol-lowering statin to older people with normal LDL cut their risk of heart attack and stroke in half.

Taken together, doctors say, the studies suggest that accepted notions of normal LDL are wrong — and that current treatment guidelines miss at least half of those who should be getting a statin.

Millions untreated

JUPITER suggests that millions more older people — as many as 11 million, Yale researcher Erica Spatz reported this month — should be getting statins. That would bring the total to about 45 million people, or 80% of all men older than 50 and all women older than 60.

There ya go! Note that 'normal' no longer has the meaning of 'average' in medical literature, not even of 'average among healthy individuals.' I'm not quite sure what it now means. Perhaps values corresponding to 'perfect health?' Anything else is a medical problem.

That doesn't make sense. If all women over sixty should be on statins then the use of statins is prevention, not treatment. The alternative is to view all women over sixty (and probably all men, too?) as sick and in need of treatment. That takes the medicalization of reality too far for me.

Then there is this quote from the original article:

But UCLA's Fonarow, whose study was published in the American Heart Journal, says there's another possibility. "There are two potential implications," he says. "Either the threshold of what was set as an ideal LDL was set outrageously high, thus allowing the vast majority of patients to be missed, or LDL isn't much of a risk factor.

"It's got to be one of the two."

The mind boggles. It would seem to be of utmost importance to know which of the two potential implications applies. We test people for bad cholesterol. We tell them to modify their diet to avoid it. We give them medications to take if the values are too high. And so on.