Thursday, September 7, 2017

Should You Take a Statin? Treatment Score = 0.055%, Number Needed to Treat = 1,818

Should you take a statin to prevent your death? Let’s assume you are a 66-year-old person with a normal cholesterol level (of about 186 mg/dl) and you want to know if you will live longer if you take a statin.

Let’s add the condition that you have an elevated high-sensitivity C-reactive protein level (of about 4.2 mg/liter). C-reactive protein is a measure of inflammation in the human body. High-sensitivity C-reactive protein (hsCRP) might be more highly associated with causing disease than regular C-reactive protein (CRP).

Under these conditions, if you take rosuvastatin (Crestor) 20 milligrams for 2 years, will you live longer? Will side effects bother you? Will you have a net positive benefit?


The Treatment Score = the net treatment benefit for the patient as summarized from the existing medical literature. Treatment Scores incorporate the ideals of treatment transparency, evidence-based medicine, shared-decision making, patient engagement, patient safety, personalized medicine, and patient empowerment. It’s especially important to personalize the Treatment Score to your preferences.

In order to solve the health illiteracy problem, we all need to start explaining treatments in three ways:

  1. The Treatment Score
  2. The proportion
  3. The Number Needed to Treat based on the Treatment Score

One way of looking at taking rosuvastatin (Crestor) 20 mg is this:

  1. The Treatment Score is less than 1%. In fact, the Treatment Score is less than 0.01%.
  2. Less than 1 person like me out of a 100 will benefit. In fact, only about 1 person out of 2,000 will benefit.
  3. The Number Needed to Treat for the net benefit is 1,818, which means you need to treat 1,818 patients to get 1 patient to benefit.

THE TREATMENT SCORE
I started with a gross overall survival treatment benefit of 0.55% from the Jupiter Trial. Then, after subtracting the negative side effects I arrived at a Treatment Score of 0.055% for someone with my preferences.


Note that I weighted the 8 negative side effects heavily before subtracting them, because of my personal experiences. Another person would weight them differently. That math is not being show here for simplicity’s sake, but personalized medicine is an important part of Treatment Scores.


THE NUMBER NEEDED TO TREAT
The Number Needed to Treat (NNT) was invented back in the 1980’s. However, it has always been a seriously flawed statistic because it is not what the patient needs to know. The Number Needed to Treat based on the Treatment Score is much more meaningful to the patient.


CANS OF FOOD
Medical treatments are like cans of food without labels. With Treatment Scores, we are putting labels on these blank cans so they can be better assessed. With Treatment Scores, we can organize lists of treatments with Treatment Scores, so that all the treatments are evaluated with the same outcome measure, over similar time periods, and with similar patient populations.

EXPERTS 
Other physicians have found concerns after reviewing the medical literature on statins. I want to recognize Malcolm Kendrick, M.D. for his blog post, “How much longer will you live if you take a statin?” In his blog, he writes:

“Results: 6 studies for primary prevention and 5 for secondary prevention with a follow-up between 2.0 and 6.1 years were identified. Death was postponed between −5 and 19 days in primary prevention trials and between −10 and 27 days in secondary prevention trials. The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.”

Basically, when you look at statins from the patients’ point of view, which is the important point of view, statins do not necessary do well in terms of their “net treatment benefit.”

You might want to read this by Charles Bankhead. “Should Healthy People Take Statins? New Studies Say No.”
https://www.medpagetoday.com/cardiology/prevention/20948

Michel de Lorgeril, MD and others wrote: “Clearly, the time has come for a critical reappraisal of cholesterol-lowering and statin treatments….”
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101

Also read: Ben Spencer, "Now MORE experts claim statins are a waste of time: They say studies show cutting bad cholesterol fails to slash heart risk. Millions being misled about the controversial drugs says group of doctors," The Daily Mail. 24 November, 2016.
http://www.dailymail.co.uk/health/article-3969692/Now-experts-claim-statins-waste-time-say-studies-cutting-bad-cholesterol-fails-slash-heart-risk.html#ixzz4rzpGMB58

From another article: "Students and pharmacists investing a small amount of time in 'studying a study' and applying the principles of interpreting clinical research could come up with markedly different views of the therapeutic value of a drug than that reported in the general media." [Typo fixed]
"Analysis of the Rosuvastatin (Crestor) Jupiter Trial."  April 6, 2009.
https://lecom.edu/analysis-of-the-rosuvastatin-crestor-jupiter-trial/

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DISCLAIMERS
You must always see a licensed physician for diagnosis and treatment. You cannot use Treatment Scores to diagnose or treat yourself. Treatment Scores are only an informational exercise. Death or permanent disability can result if you don't see your own medical physician. Death or permanent disability can result if you don’t call an ambulance or go to the emergency department immediately for emergency or urgent medical issues. We claim no accuracy for Treatment Scores, because the underlying medical studies can be wrong or the methods can be wrong. You must always see your own physician. We make no promises, claims, or warranties whatsoever.

REFERENCES & SOURCES:
Malcolm Kendrick, M.D. for his blog post, “How much longer will you live if you take a statin?”
https://drmalcolmkendrick.org/2015/10/27/how-much-longer-will-you-live-if-you-take-a-statin/

Charles Bankhead. “Should Healthy People Take Statins? New Studies Say No,”
MedPage Today, June 28, 2010.
https://www.medpagetoday.com/cardiology/prevention/20948

Michel de Lorgeril, MD; Patricia Salen, BSc; John Abramson, MD; et al Sylvie Dodin, MD; Tomohito Hamazaki, PhD; Willy Kostucki, MD; Harumi Okuyama, PhD; Bruno Pavy, MD; Mikael Rabaeus, MD. "Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy: A Critical Reappraisal." Arch Intern Med. 2010;170(12):1032-1036. doi:10.1001/archinternmed.2010.184.
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101

Ben Spencer. "Now MORE experts claim statins are a waste of time: They say studies show cutting bad cholesterol fails to slash heart risk. Millions being misled about the controversial drugs says group of doctors" The Daily Mail. 24 November, 2016.
http://www.dailymail.co.uk/health/article-3969692/Now-experts-claim-statins-waste-time-say-studies-cutting-bad-cholesterol-fails-slash-heart-risk.html#ixzz4rzpGMB58

Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., and Robert J. Glynn, Sc.D., for the JUPITER Study Group.
"Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein." N Engl J Med 2008; 359:2195-2207November 20, 2008DOI: 10.1056/NEJMoa0807646
http://www.nejm.org/doi/full/10.1056/NEJMoa0807646

"Analysis of the Rosuvastatin (Crestor) Jupiter Trial."  April 6, 2009.
https://lecom.edu/analysis-of-the-rosuvastatin-crestor-jupiter-trial/

FDA.gov Drug Data
https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021366s016lbl.pdf