In the Jan 9, 2012 issue of Archives of Internal Medicine in the Online First section an article appeared showing that women studied as part of the Women’s Health Initiative who were on statin drugs during the study developed diabetes at greater rates than those who were not on these drugs.  According to the statistical analysis of the authors, being on a statin increased the relative risk of developing diabetes by 48 percent!

These were observational studies and, as such, can’t be used to determine causality.  But they are interesting nonetheless because according to one of the authors there have been other clinical trials showing the same thing.  One of the authors of the study, Dr. JoAnn Manson, Professor of Medicine and Harvard Medical School commented on the findings of this study and what they mean to doctors who put patients on statins.  Dr. Manson’s commentary was provided by Medscape, a site for physicians to go to learn about the latest in medical wizardry.  The site requires registration, but if you are interested, you are allowed to register even if you aren’t a physician.

I decided that instead of commenting on Dr. Manson’s video after the fact, I would do it in real time right on the video.  This is my first effort at anything like this, so you can let me know what you think of it.  If you find it enjoyable and/or helpful, please drop a note in the comments, and I may be inspired to try it again.

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In 1976 the classic film Network starred Peter Finch as crazed anchorman Howard Beale who launched into his now-famous rant “I’m mad as hell…” on air and galvanized movie goers everywhere.  Even though Howard Beale is fictional, I often share his sentiments.

I got a call yesterday from an acquaintance who wanted to get together and talk to me “face to face.”  I’ve played golf and had a few drinks with this guy over the last couple of years, but that’s about it.  I agreed to meet him at a local coffee shop.

When we had our coffees in front of us – I, a full-strength, scalding hot Americano; he, a non-fat, decaf, double shot latte, just in case you’re wondering – we made small talk for a few minutes then he cut to the chase.  A look of despair came over him, and he confided to me that he was a type II diabetic and was in real trouble.  His doctor had been monitoring his HgbA1c levels for a couple of years, and lately they had been inexorably on the rise to the point at which drastic action was required.  What drastic action?  His doctor told him he was going to have to start insulin injections.

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Pity the poor lipophobes and statinators.  They’ve just taken another grievous wound to their favorite theory and haven’t even got sense enough to know it.  In fact, not only do they not have sense enough to realize they’ve taken the hit, they’re actually crowing about it.

The current issue of the Journal of the American Medical Association (JAMA) has an article titled Trends in High Levels of Low-Density Lipoprotein Cholesterol in the United States, 1999-2006 that puts another major dent in whatever validity remains of the lipid hypothesis of heart disease.

I’m going to start categorizing the types of findings published in this paper under the rubric of The Statinator Paradox.  I find it interesting that whenever scientists discover data that shows the opposite of what their hypotheses predict, they don’t conclude that their hypotheses might be wrong; instead they deem the contradiction a ‘paradox’ and bumble on ahead with their hypotheses intact.

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Oftentimes people become so fixed in their thinking – and in their belief that everyone else thinks the same way – that they unwittingly raise the curtain and expose the wizard of their flawed thinking, showing it for what it really is.  Statinators have done just that in an article in the current issue of the Journal of the American College of Cardiology (JACC).

The study, Effects of High-Dose Modified-Release Nicotinic Acid on Atherosclerosis and Vascular Function, compares the increase in carotid artery plaque over a 12-month period in subjects taking niacin versus those taking a placebo.  It turns out that those subjects taking the niacin experienced a shrinkage of their plaque whereas plaque grew larger on those taking the placebo. The revealing hitch in this study is that both groups were on statins, which means the group on statins alone was the placebo group.  Therefore the data from this study shows that statins alone do not reverse the growth of plaque (at least not plaque in the carotid arteries) despite lowering LDL levels.  Taking the logic a little further, the data from this study gives weight to the idea that a lowered LDL doesn’t reduce plaque growth.

There is a lot we can glean from this study and the from the authors’ commentary on it.

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As if trying to pull meaning out of the medical literature weren’t difficult enough as it is, a new study demonstrates yet another obstacle to easy understanding: the adherer effect.

We’ve all seen the headlines.  Statins improve bone health.  Statins prevent cancer.  Statins make us smarter.  Low-fat diets improve longevity.  All these headlines and others like them are followed by articles describing studies seeming to show that subjects taking certain medications (usually statin drugs, it seems) or following a particular diet have improvements in health and/or longevity.  The promise of these articles is that if we all take the medication or follow the lifestyle choice, we, too, will reduce our risk of [fill in the blank] or live longer.  But will we?

Maybe so.  But not for the reason most people think.

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