Comment by haldujai | Hacker News Reader

Comment by haldujai | Hacker News Reader

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What patient population are you talking about? Statins have excellent evidence behind them.

> - Absolute risk reduction in CVD-caused mortality is mild at best (<1-2% absolute risk reduction)

It depends what your baseline risk is and what time point you're looking at.

> - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic

This is just completely false, even from 2013 data[0] (which overestimates diabetes) but is better addressed in a subsequent review [1].

The side effects, if they do happen, are also self-limiting and stop with cessation or changing agents.

> - Generic lipid panels that the vast majority of people take are generally worthless for estimating lipid health ... and only loosely correlated with cardiovascular health

See reference [1] and [2].

[0]https://thennt.com/nnt/statins-for-heart-disease-prevention-...

[1]https://www.thelancet.com/article/S0140-6736(16)31357-5/full...

[2]https://www.onlinecjc.ca/article/S0828-282X(21)00165-3/fullt...

All adult patient populations: those without a history of cardiovascular events, and those with.

Baseline risk is something like ~35% for men, and ~20% women. Time point is from 50 to 75 years of age.

Statins -- at most -- reduce your absolute risk from 35% to 33% (for men) and from 20% to 18% (for women).

If you do not smoke, your absolute risk drops by ~7%, from 35% to 28%. If you're diabetic, your risk jumps an absolute ~30% to 65%.

See: https://www.ahajournals.org/doi/full/10.1161/circulationaha.... (table 2 & table 3).

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Your article has this caveat: "Virtually all of the major statin studies were paid for and conducted by their respective pharmaceutical company. A long history of misrepresentation of data and occasionally fraudulent reporting of data suggests that these results are often much more optimistic than subsequent data produced by researchers and parties that do not have a financial stake in the results."

Ignoring that, 2% (absolute) of the population on statins develop diabetes and 10% (absolute) develop muscle pain/rhabdo (in one experiment). This is also ignoring all of the serious adverse events from gen-1 and gen-2 statins.

As a whole, they on average achieve a 1.2% reduction in absolute mortality (all-cause or only from heart disease?).

While I have just read it, I'm going to discount [1], because of what's inside "Declaration of interests."

And on principle, I'm not going to read [2], unless you quote the relevant sections (as is good form when referencing).

As stated thennt is from 2013, many statin trials have come out since.

2% diabetes is overstated as in link 1 except you discount it because of declared disclosures despite the fact that it’s one of the most highly cited papers on the subject in the last 10 years and the study was a review.

You also discount a well respected guideline on lipids out of principle.

Then you cite unrelated data from 2006 as a good reference for an unknown reason?

Finally, you disregard the opinions of a Cochrane review in an unrelated patient population which directly contradicts your misinterpretation of the data (clearly have no concept of NNT/NNH as you just make capricious interpretations of ARR) yet cite yourself as more of an expert than the Cochrane authors.

For what it’s worth since you focus on conflicts it’s to my financial benefit if you don’t take your statins (and pharma pays me nothing), so by all means skip the statin at your own risk.

This really doesn’t seem like an open discussion so I’ll stop engaging. But you’re spreading misinformation for any reader, statins save lives.

I cannot make it anymore clearer: statins reduce your absolute risk of mortality by at most 2%; not smoking reduces your absolute risk by 7%. Statins provide meager benefit for the associated risks. It does not take an expert to do math.

I must have missed the clinical practice guideline that said keep smoking just take a statin instead.

Long term damage to liver. You use it long enough your liver will die. But it's too hard to do a causal analysis on this as the timelines are measured in decades.

I have never heard of or seen statin-induced cirrhosis practicing in a liver transplant center so if this is real it’s a case report.

Google it. Its well known.

“However, the rate of true statin-induced hepatotoxicity is exceedingly low. Moreover, multiple retrospective studies have shown that statins are not only safe for use in patients with cirrhosis, but are also likely beneficial in reducing liver decompensation, hepatocellular carcinoma, infections, and death.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170890/

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