This is a common problem in CHD studies. All cause mortality is almost never affected - maybe never. The change in CHD mortality is typically small and lost in the noise of total death.
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Replying to @LDLSkeptic @AmirWeiss1 and
These studies are not powered to detect changes in ACM and maybe not CVM and are of a short duration. Meta-analyses show clear reduction in ACM and CVM. In 2019, MI creates much more disability in the short-term than death. That's what the drugs are preventing in these studies.
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Replying to @kevinnbass @AmirWeiss1 and
We're just going to have to agree to disagree as to the value of these findings. I'm not excited about a small benefit under very controlled conditions with potentially substantial adverse effects, which even Nissen et al say could occur in up to 40% of patientspic.twitter.com/fsGwHrD2KJ
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Replying to @LDLSkeptic @AmirWeiss1 and
Nearly 30% reduction in heart attack incidence (FOURIER) is not a "small benefit" given the cost to QOL of permanent disability from MI, and a 40% substantial adverse side effects figure is one person's opinion. What is the evidence?
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Replying to @kevinnbass @LDLSkeptic and
Placebo-controlled RCT shows side effects rarely above placebo (nocebo) for statins. I don't know PCSK9 well. If you don't want to argue anymore, up to you certainly.
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Replying to @kevinnbass @AmirWeiss1 and
The nocebo work is flawed, and addressed only muscle issues, but I won't bother with that now. There are many other side effects measured physiologically, not subject to nocebo, such as the statin time/dose
in new onset T2D.pic.twitter.com/Hoh1jiNg2M
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Replying to @LDLSkeptic @AmirWeiss1 and
Insulin resistance side effect is important and risk of T2DM complications needs to be weighed against benefits (as with all medications). That said, one of the most important complications of T2DM is CVD and statins treat CVD. Medications are a balancing act.
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Replying to @kevinnbass @AmirWeiss1 and
It's not just T2D. Statin side effects are more extensively documented than most are aware. We included 60 peer-reviewed papers documenting statistically sig findings of statin side effects in >dozen categories https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205138 … - see below
@IMWHorvitzpic.twitter.com/10KX3l3epV
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Replying to @LDLSkeptic @kevinnbass and
Having a look through those references - I'm not sure the phrase "statistically significant" applies actually. For example, the reference for "severe irritability" links to this 2004 case series of 6 patientspic.twitter.com/bhAWL2lB1W
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Replying to @GidMK @LDLSkeptic and
The references for "fatigue" (38,39) are a perspective piece and a conference abstract that was never written up as a paper as far as I can tell. The conference abstract, funnily enough, didn't show a "statistically significant" reduction from statinspic.twitter.com/FX4WM2OoSp
2 replies 0 retweets 1 like
The reference for "exertional fatigue" is another publication from the same study as the previous conference abstract, which found a statistically (although arguable clinically) significant drop in energy of ~2% associated with statin usepic.twitter.com/RxBPUacHRn
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Replying to @GidMK @kevinnbass and
This is not a 2% drop. Subjects rated energy level on a 5 point scale.pic.twitter.com/Ypwn8dncvi
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Replying to @LDLSkeptic @kevinnbass and
Was it not a 10-point scale? A drop of ~0.2 out of 10 points would represent a 2% difference, if it was a 5-point scale it would be 4%
2 replies 0 retweets 0 likes - Show replies
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