How Science Continues to Mislead! A statins study.

Statistics 101 is NOT Required

How careful one needs to be interpreting a “science” paper. A new article popped up today: Journal of the American College of CardiologyImpact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring” DOI: 10.1016/j.jacc.2018.09.051 November 2018

In this article, the major findings are: CAC scan (Coronary Artery Calcium scan) can predict when statins can become of benefit to prevent heart disease. They write:

“… the presence and severity of CAC identified patients most likely to benefit from statins for the primary prevention of cardiovascular diseases.”

The CAC score evaluation is done by a special high-speed CT Scanner and heart monitoring device on the chest. The high speed is necessary to capture images for the instant when the heart is not beating. The images capture the amount of calcium deposits in the arteries leading into and out of the heart itself, which is considered to be the leading indicator of atherosclerosis degree. Atherosclerosis is considered to be a leading indicator of the chance for a cardiac event in the near future—typically within 5 or 10 years, depending on what academic paper one reads.

The Analysis

The below graphs take some explanation to see why whatever this article concluded is completely wrong.

Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring

Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring

There are 4 graphs that are ordered by the CAC score. The higher the score the worse it is in terms of the chance of ending up with a cardiac event. A cardiac event is defined in this paper as a non-fatal or fatal heart attack or stroke.

On the vertical axis of each graph you find the cumulative incidence of cardiac events and on the horizontal axis the number of years passing without cardiac event from the time the CAC score was taken. Note on the graphs that the greater the CAC score, the more people have cardiac events. Also note the difference graphed between those that received statins (red dashed line slope) and those that did not (blue slope). Based on the graphs, you would think that “OMG I need to run and get my statins filled” but stop and look at the number of participants.

Do The Number of Participants Matter?

It is very important to look at how many people were in each group (taking statins or not taking statins), since having vastly different number of people between treatment groups tends to give erroneous statistical results. The most striking difference between those who took statins or didn’t is in graph 3, which is CAC 101-400. Now let’s look at the numbers and then look at what the graph tells us.

Treatment Starting year 3rd year 6th year 9th year 12th year
No Statins 154 142 126 79 20
With statins 800 769 692 416 69

At starting point 154 people were not taking statins while 800 (over 5 times as many) took statins. This is a huge enough difference to skew the statistics. Next, look at the 12th year: how many people are still without a cardiac event 12 years after the initial CAC given that they were not on statins or that they took statins?

In the group where no one took statins, 87% of the participants had a cardiac event, meaning 13% did not have a cardiac event.

In the group where they took statins, 91.34% of the participants had a cardiac event, meaning 8.66% did not have a cardiac event.

So which group did better in your opinion? On or off statins? The answer is obvious: not taking statins was better: there were fewer cardiac events in percentages among the participants that didn’t take statins.

Now let’s look at the last group, the CAC 400+ group—this is the sickest group

Treatment Starting year 3rd year 6th year 9th year 12th year
No Statins 42 33 27 19 8
With statins 411 387 347 188 40

 

In the no-statin group 80.95% of the participants had a cardiac event, that is 19.05% didn’t have a cardiac event.

In the statins group 90.27% of the participants had a cardiac event, that is 9.73% didn’t have a cardiac event.

So, given no additional information, even in the really sick group with the highest CAC score, those who didn’t take statins, did better and ended up without a cardiac event.

Conclusion: don’t believe your eyes! Do the math!

My question: how does a paper like this pass peer review?

Comments are welcome, as always, and are moderated for appropriateness.

Angela

About Angela A Stanton, Ph.D.

Angela A Stanton, PhD, is a Neuroeconomist focusing on chronic pain--migraine in particular--physiology, electrolyte homeostasis, nutrition, and genetics. She lives in Southern California. Her current research is focused on migraine cause, prevention and treatment without the use of medicine. As a forever migraineur from childhood, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic variations of all voltage dependent channels, gates, and pumps that modulate electrolyte mineral density and voltage in the brain. In addition, insulin and glucose transporters, and several other variants, such as MTHFR variants of B vitamin methylation process and many others that are different in the case of a migraineur from the general population. Migraineurs are glucose sensitive (carbohydrate intolerant) and should avoid eating carbs as much as possible. She is working on her hypothesis that migraine is a metabolic disease. As a result of the success of the first edition of her book and her helping over 4000 migraineurs successfully prevent their migraines world wide, all ages and both genders, and all types of migraines, she published the 2nd (extended) edition of her migraine book "Fighting The Migraine Epidemic: Complete Guide: How To Treat & Prevent Migraines Without Medications". The 2nd edition is the “holy grail” of migraine cause, development, and prevention, incorporating all there is to know. It includes a long section with for medical and research professionals. The book is full of academic citations (over 800) to authenticate the statements she makes to be followed up by those interested and to spark further research interest. It is a "Complete Guide", published on September 29, 2017. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in NeuroEconomics at Claremont Graduate University, fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers, certification in LCHF/ketogenic diet from NN (Nutrition Network), currently working on her certification in physiology, and functional medicine. Dr. Stanton is an avid sports fan, currently power weight lifting and kickboxing. For relaxation (yeah.. about a half minute each day), she paints and photographs and loves to spend time with her family of husband of 44 years, 2 sons and their wives, and 2 granddaughters. Follow her on Twitter at: @MigraineBook, LinkedIn at https://www.linkedin.com/in/angelaastantonphd/ and facebook at https://www.facebook.com/DrAngelaAStanton/
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2 Responses to How Science Continues to Mislead! A statins study.

  1. chris c says:

    I suspect statins may have some benefits for some people in some circumstances, but then they are marketed to everyone else as well.

    It’s another thing I find hard to understand – we evolved the entire mevalonate pathway and all the complexity of lipid metabolism purely to kill ourselves? I think not . . . but then current medicine believes that somehow our intestines evolved wrong and need correcting with surgery. Yet another problem that only showed up in recent decades.

    Liked by 1 person

    • From what I read, 15 years of daily statin use–for someone deemed sick enough to take it–lengthens their life by 3 days–provided they are THE one statins help, given that the NNT for statins is not 1… I forget what it is now.. it changes by brand but I have seen NNTs in the hundreds and also in double digits. Regardless, it is not 1.

      I agree with evolutionary processes being somewhat more clever than modern science gives it credit. The current medicine also assumes that everyone is sick until proven healthy and that it can only be healthy by supplements and medicines. Then you look around and see millions living in poverty and without medicines in other countries, eating their native food, and they live a healthy life. I watched a 60-Minutes program that they repeated earlier this year about a prison somewhere in Africa. In the prison the prisoners get 1 bowl of what looked like cream of wheat with water instead of milk, or something similar, and not every day. No other food is given and these prisoners are there for years. They sleep on the floor in such sardine cramped environment that when one turns, they all must turn. Yet, they appear healthy, were singling, no medicine, no one was stooped over or limping or had even a cold.

      Nature has its miracles, we just have to let it reach us. 🙂

      Like

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