THE HEART
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$70,000 standard heart treatment per year following a MI

 

It sure has become big business: standard treatment following an heart attack (MI) costs $70.000 per year for just for the 3 drugs—none of which are worth the side effects.   Remember the marketing department of the drug company are as standard operating procedure manipulating the results to create a positive bias on an average of about 30%,  The doctors all have conflicts of interest, and the journal does not see the raw thus preventing a meaningful peer review.  The claim of significantly better results based on full compliance of a mere 2%.  In other don’t rely on the results, just consider significant the cost for what, in my father’s day (1953) was cost about $25 a year (he had nitroglycerin as his only medication, and he lived 23 years from his first major MI—nearly killed him.  And if you wonder why there is poor compliance (under 50%);  the two major reason are a skepticism about the integrity of the pharmaceutical industry and their sales people the primary care givers, and secondly the side effect.   

Full Coverage for Preventive Medications after Myocardial Infarction

Niteesh K. Choudhry, M.D., Ph.D., Jerry Avorn, M.D., Robert J. Glynn, Sc.D., Ph.D., Elliott M. Antman, M.D., Sebastian Schneeweiss, M.D., Sc.D., Michele Toscano, M.S., Lonny Reisman, M.D., Joaquim Fernandes, M.S., Claire Spettell, Ph.D., Joy L. Lee, M.S., Raisa Levin, M.S., Troyen Brennan, M.D., J.D., M.P.H., and William H. Shrank, M.D., M.S.H.S. for the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) Trial

N Engl J Med 2011; 365:2088-2097 December 1, 2011 http://www.nejm.org/doi/full/10.1056/NEJMsa1107913?query=OF

Background

Adherence to medications that are prescribed after myocardial infarction is poor. Eliminating out-of-pocket costs may increase adherence and improve outcomes.

Methods

We enrolled patients discharged after myocardial infarction and randomly assigned their insurance-plan sponsors to full prescription coverage (1494 plan sponsors with 2845 patients) or usual prescription coverage (1486 plan sponsors with 3010 patients) for all statins, beta-blockers, angiotensin-converting–enzyme inhibitors, or angiotensin-receptor blockers. The primary outcome was the first major vascular event or revascularization. Secondary outcomes were rates of medication adherence, total major vascular events or revascularization, the first major vascular event, and health expenditures.

Results

Rates of adherence ranged from 35.9 to 49.0% in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group (P<0.001 for all comparisons). There was no significant between-group difference in the primary outcome (17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group; hazard ratio, 0.93; 95% confidence interval [CI], 0.82 to 1.04; P=0.21). The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group (21.5 vs. 23.3; hazard ratio, 0.89; 95% CI, 0.90 to 0.99; P=0.03), as was the rate of the first major vascular event (11.0 vs. 12.8; hazard ratio, 0.86; 95% CI, 0.74 to 0.99; P=0.03).* The elimination of copayments did not increase total spending ($66,008 for the full-coverage group and $71,778 for the usual-coverage group; relative spending, 0.89; 95% CI, 0.50 to 1.56; P=0.68). Patient costs were reduced for drugs and other services (relative spending, 0.74; 95% CI, 0.68 to 0.80; P<0.001).

Conclusions

The elimination of copayments for drugs prescribed after myocardial infarction did not significantly reduce rates of the trial's primary outcome. Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs. (Funded by Aetna and the Commonwealth Fund; MI FREEE ClinicalTrials.gov number, NCT00566774.)

Supported by unrestricted research grants from Aetna and the Commonwealth Fund to Brigham and Women's Hospital.

Dr. Choudhry reports receiving consulting fees from Mercer Health and Benefits and grant support from CVS Caremark; Dr. Glynn, receiving consulting and lecture fees from Merck and grant support from AstraZeneca and Novartis; Dr. Schneeweiss, receiving consulting fees from WHISCON and grant support from Pfizer and Novartis; Ms. Toscano, Dr. Reisman, Mr. Fernandes, and Dr. Spettell, being employees of and having an equity interest in Aetna; Dr. Brennan, being an employee of, having an equity interest in, and receiving board membership fees from CVS Caremark; and Dr. Shrank, receiving consulting fees from United Healthcare and grant support from CVS Caremark and Express Scripts.

 

*this is double talk.  Not only are the standard not brought out, for major vascular events (which is obvious something other than MI), and this is paired with revascularization.  Thus the 4% higher compliance group has paired a good thing increasing blood flow (possible to the heart muscle) is paired with an adverse event, “vascular events”.  The normal pattern would be two good things such as fewer MIs and fewer strokes; not a good and bad event.    

Enter supporting content here

Those who have a financial interest in the outcome manipulate the results, Major study finds that all 37 journal articles positive effects over stated; the average was 32%. Statins cause erectile dysfunction, cognitive imparement, and cancer.  

Lipitor (2011) lifetime sales $131 billion, tops all drugs.  Plavix at $60 billion is second.

 

STATINS CANCER Link

52% short term

 

LA Times, Health section, July 21, 2008  --  excerpts

Vytorin, the combination drug (simvastatin (better known by its commercial name Zocor) and ezetimibe--known as Zetia) prescribed to lower cholesterol, sustained another blow today, when the author of a major clinical trial announced that the medication had failed to drive down hospitalization and death due to heart failure in patients with narrowing of the aortic valve. In the process, researchers in Norway detected a significant blip in cancers in the 1,800 subjects they followed

Today's findings suggested something more ominous: the incidence of cancer -- and of dying of cancer -- was significantly higher in the patients taking Vytorin. Altogether, 67 patients on placebo developed cancer during the trial. Among subjects on Vytorin, 102 developed cancers of various kinds.*  This is the second adverse press—the first being in March 08, when the ENHANCE trial found that Vytorin fared no better than a placebo at reducing plaque buildup on the walls of patients' arteries.* *

Comments by jk

Simvastatin (Zocor) is off patent.  Thus in a scramble for profits a combination drug (on patent) was introduced.  Direct to consumer market cost $155 in 07—mainly TV ads. 

*  The pressing issue is that since the development  of Statins, the very first animal studies in the 60s it has been known that Statins increase the incidents of cancer.  However, nearly all studies done thereafter have not included cancer. 

*  Several studies have failed to find a reduction in the build of plaque, even thought the statins including Zocor, reduce LDL and cholesterol.  Few studies include the principle reason for taking a statin, namely a reduction in the death rate.  Claims for such reduction probably entail a failure to control the contravening variable, aspirin usage.  Given a pile of evidence, including the very mechanism of plaque formation, which involves inflammation process, I must conclude that the use of statins is highly suspect.  Given the harm done including cognitive impairment, weakness, and cancer, if my skepticism is born out, the harm done by statins as a course of treatment will far surpass that of VIOXX which killed over 200,000 people world wide by accelerating atherosclerosis. 

 EXTENDED RELEASE NIACIN IS A SAFER, AND A MORE EFFECTIVE WAY TO LOWER MI RISK!