Friday, June 21, 2013

Follow-up to “Cholesterol-Lowering Medicines To Bite The Dust?”

I guess not.  Original post here, in which I quoted:

“By contrast, the ATP IV committee has pledged to hew strictly to the science and to focus on data from randomized clinical trials, says committee chairman Neil Stone, a cardiologist at Northwestern University School of Medicine in Chicago. If so, Krumholz argues, LDL targets will be cast aside because they have never been explicitly tested. Clinical trials have shown repeatedly that statins reduce the risk of heart attack and stroke, but lowering LDL with other medications does not work as well. The benefits of statins may reflect their other effects on the body, including fighting inflammation, another risk factor for heart disease....”

That would have the effect of killing the market for statins, and likely make doctors look a bit foolish. Hence the title of that post.

Today on Twitter I read:

The doctors’ guild has struck back: “NIH says ATP 4, JNC 8 guidance out "in a matter of months" (with a twist)”:

“…News that professional societies like the [American College Cardiology] and [the American Heart Association] will be involved was a surprise to many who have actively been working on the different guidance documents. Dr Roger Blumenthal (Johns Hopkins University, Baltimore, MD), who is a member of the National Program to Reduce Cardiovascular Risk (NPRCR), says the NPRCR has had two face-to-face fly-in meetings with the writing group over the past few years. He only learned of the NHLBI decision yesterday.

“"It's very unclear what the next step is. I think clinicians will be very disappointed by this decision because there is very strong need to synthesize all the information that is out there about risk assessment, cholesterol, high BP, and obesity, and we would have hoped that there would have been a well-laid out plan. I can understand politically if the NHLBI thought there were certain reasons why guidelines shouldn't be under their auspices, but it would have been better if the ACC and AHA would take the mature drafts of all the guidelines that have already been done and give us some kind of time frame."

“It's also unclear whether the AHA and ACC form separate panels for the four major guideline areas and just how the "state-of-the-art" reviews will be linked with recommendations and level of evidence in the guidelines, Blumenthal noted….”

Protecting the medical guild is of the utmost importance, and being forced to back down from cholesterol guidelines would have been humiliating.

Can’t have that.  Science, and patients, be damned…