Re: The unstable plaque (vulnerable plaque)

"Al. Lohse" schrieb:

Quoted message said:

Patrick Blanchard said:

I found this to be a great review on the progress had so far in the
scientific community.

Volume 5, Number 6: November 2003 • Invited Commentary • pp. 423-424

Can We Stabilize Unstable Plaque?

by Rodolfo Paoletti, MD and Andrea Cignarella, PhD

Quoted message said:

>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Conclusions

From these considerations, successful therapeutic approaches should control
multiple aspects of plaque stabilization. Statins fulfill such a
requirement, yet combination therapy may be of use in specific clinical
settings. Despite remarkable therapeutic achievements in the management of
acute coronary syndromes, mortality rates for this disease worldwide still
rank first. This means that further effort is needed to extend clinical
benefit to a larger proportion of patients.

Quoted message said:

>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Are these conclusions borne out by the
results of the clinical trials? Don't think
so.

A reasonable person, with all the information
available, would have to conclude that the
benefits of statin treatment are, at best,
feeble.

If statin treatments were very beneficial,
those benefits would be celebrated in large,
publicly funded clinical trials and
cholesterol skeptics would be silenced.

They are not, therefore, they are not.

They are celebrated in a multitude of small
illusive articles which do not present
numerical data.

Shame.

A.L.

P.S. How many MD's can sit down, review the
literature, and write a cogent treatise on
any topic? Where would they find the time?
What might compel them to do so?

The Scandinavian Simvastatin Survival Study (4S) showed that statins (or
at least simvastatin) lower coronary deaths (relative risk for the
treatment group 0,58) as well as death by all causes (relative risk
0,70). In other words, simvastatin prevented more than 40 % of all
coronary deaths. That is quite a benefit, ime.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7968073&dopt=Abstract

(http://tinyurl.com/t79l)

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)

Al. Lohse said:

Patrick Blanchard said:

I found this to be a great review on the progress had so far in the
scientific community.

Volume 5, Number 6: November 2003 • Invited Commentary • pp. 423-424

Can We Stabilize Unstable Plaque?

by Rodolfo Paoletti, MD and Andrea Cignarella, PhD

Quoted message said:

>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Conclusions

From these considerations, successful therapeutic approaches should control
multiple aspects of plaque stabilization. Statins fulfill such a
requirement, yet combination therapy may be of use in specific clinical
settings. Despite remarkable therapeutic achievements in the management of
acute coronary syndromes, mortality rates for this disease worldwide still
rank first. This means that further effort is needed to extend clinical
benefit to a larger proportion of patients.

Quoted message said:

>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Are these conclusions borne out by the
results of the clinical trials? Don't think
so.

A reasonable person, with all the information
available, would have to conclude that the
benefits of statin treatment are, at best,
feeble.

This reasonable person disagrees.

Quoted message said:

If statin treatments were very beneficial,
those benefits would be celebrated in large,
publicly funded clinical trials and
cholesterol skeptics would be silenced.

They have been, but you don't believe them.

Quoted message said:

P.S. How many MD's can sit down, review the
literature, and write a cogent treatise on
any topic?

ones who work in the area professionally.

Quoted message said:

Where would they find the time?

by working hard.

Quoted message said:

What might compel them to do so?

when it is their job.

Thorsten Schier schrieb:

Quoted message said:

"Al. Lohse" schrieb:

Quoted message said:

Patrick Blanchard said:

I found this to be a great review on the progress had so far in the
scientific community.

Volume 5, Number 6: November 2003 • Invited Commentary • pp. 423-424

Can We Stabilize Unstable Plaque?

by Rodolfo Paoletti, MD and Andrea Cignarella, PhD

>>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Conclusions

From these considerations, successful therapeutic approaches should control
multiple aspects of plaque stabilization. Statins fulfill such a
requirement, yet combination therapy may be of use in specific clinical
settings. Despite remarkable therapeutic achievements in the management of
acute coronary syndromes, mortality rates for this disease worldwide still
rank first. This means that further effort is needed to extend clinical
benefit to a larger proportion of patients.

>>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Are these conclusions borne out by the
results of the clinical trials? Don't think
so.

A reasonable person, with all the information
available, would have to conclude that the
benefits of statin treatment are, at best,
feeble.

If statin treatments were very beneficial,
those benefits would be celebrated in large,
publicly funded clinical trials and
cholesterol skeptics would be silenced.

They are not, therefore, they are not.

They are celebrated in a multitude of small
illusive articles which do not present
numerical data.

Shame.

A.L.

P.S. How many MD's can sit down, review the
literature, and write a cogent treatise on
any topic? Where would they find the time?
What might compel them to do so?

The Scandinavian Simvastatin Survival Study (4S) showed that statins (or
at least simvastatin) lower coronary deaths (relative risk for the
treatment group 0,58) as well as death by all causes (relative risk
0,70). In other words, simvastatin prevented more than 40 % of all
coronary deaths. That is quite a benefit, ime.

To my recollection, 96.5% of patients taking
the drug did not benefit at all over five
years. The drug taking population had an
average increase of life expectancy of about
three weeks in five years. Feeble, in my
opinion.

After about 18 months, the drugged group had
a nearly constant mortality rate; There was
no increase in rate due to aging. Why?

The authors of the study proclaimed to us
that the sponsor of the study had an insider
in the study group. Why has no one ever
questioned what s/he was doing there and/or
whether s/he had access to the data.

4S is an outlier in that it presents the best
outcome possible with statin therapy. It
should be repeated with a large, publicly
funded clinical trial, or at the very least,
have its raw data audited.

It may be hasty to take, at face value, trial
results which would confer a massive
financial benefit to its sponsor, IMHO. It
may have similarities with buying a used car.

Thanks,
A.L.

Quoted message said:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7968073&dopt=Abstract

(http://tinyurl.com/t79l)

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)

Dr Chaos said:

Al. Lohse said:

Patrick Blanchard said:

I found this to be a great review on the progress had so far in the
scientific community.

Volume 5, Number 6: November 2003 • Invited Commentary • pp. 423-424

Can We Stabilize Unstable Plaque?

by Rodolfo Paoletti, MD and Andrea Cignarella, PhD

>>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Conclusions

From these considerations, successful therapeutic approaches should control
multiple aspects of plaque stabilization. Statins fulfill such a
requirement, yet combination therapy may be of use in specific clinical
settings. Despite remarkable therapeutic achievements in the management of
acute coronary syndromes, mortality rates for this disease worldwide still
rank first. This means that further effort is needed to extend clinical
benefit to a larger proportion of patients.

>>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Are these conclusions borne out by the
results of the clinical trials? Don't think
so.

A reasonable person, with all the information
available, would have to conclude that the
benefits of statin treatment are, at best,
feeble.

This reasonable person disagrees.

By choice of your moniker, there is no reason
to consider you to be anything but playful...
named after an international organization of
evil in "Get Smart," indeed.

If you are reasonable, please critique some
or all of the books and internet articles
which tend to downplay cholesterol
considerations. Have a run at the cholesterol
skeptics. Help us to discover where they have
erred since they are, seriously, at odds with
the medical establishment. Help us discover
the truth. Help us with the underlying
science. Help us to reject falsehoods. Give
us a start.

Quoted message said:

Quoted message said:

If statin treatments were very beneficial,
those benefits would be celebrated in large,
publicly funded clinical trials and
cholesterol skeptics would be silenced.

They have been, but you don't believe them.

Where? Thought you were a scientist... Let us
leave beliefs for matters of the soul!

Quoted message said:

Quoted message said:

P.S. How many MD's can sit down, review the
literature, and write a cogent treatise on
any topic?

ones who work in the area professionally.

Also, ones who had uncredited help in writing
the articles?

Quoted message said:

Quoted message said:

Where would they find the time?

by working hard.

Why not simply focus on the bottom line, the
net benefit, rather than a biological process
which few understand? Understanding a complex
process is meaningless unless it leads to a
net benefit. Furthermore, in ALLHAT-LLT there
was no evidence whatsoever of plaque
stabilization. Was there?

Quoted message said:

Quoted message said:

What might compel them to do so?

when it is their job.

Rodolfo Paoletti, MD could be a dermatologist
or brain surgeon, for all we know. We are
only trusting that he is an MD. If he were a
cardiologist, he would say so.

A.L.

"Al. Lohse" schrieb:

Quoted message said:

Thorsten Schier schrieb:

Quoted message said:

"Al. Lohse" schrieb:

Quoted message said:

"Patrick Blanchard, M.D." wrote:
>
> I found this to be a great review on the progress had so far in the
> scientific community.
>
> Volume 5, Number 6: November 2003 • Invited Commentary • pp. 423-424
>
> Can We Stabilize Unstable Plaque?
>
> by Rodolfo Paoletti, MD and Andrea Cignarella, PhD
>
>>>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
> Conclusions
>
> From these considerations, successful therapeutic approaches should control
> multiple aspects of plaque stabilization. Statins fulfill such a
> requirement, yet combination therapy may be of use in specific clinical
> settings. Despite remarkable therapeutic achievements in the management of
> acute coronary syndromes, mortality rates for this disease worldwide still
> rank first. This means that further effort is needed to extend clinical
> benefit to a larger proportion of patients.
>
>
>>>>>>>>>>>> Snipped >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Are these conclusions borne out by the
results of the clinical trials? Don't think
so.

A reasonable person, with all the information
available, would have to conclude that the
benefits of statin treatment are, at best,
feeble.

If statin treatments were very beneficial,
those benefits would be celebrated in large,
publicly funded clinical trials and
cholesterol skeptics would be silenced.

They are not, therefore, they are not.

They are celebrated in a multitude of small
illusive articles which do not present
numerical data.

Shame.

A.L.

P.S. How many MD's can sit down, review the
literature, and write a cogent treatise on
any topic? Where would they find the time?
What might compel them to do so?

The Scandinavian Simvastatin Survival Study (4S) showed that statins (or
at least simvastatin) lower coronary deaths (relative risk for the
treatment group 0,58) as well as death by all causes (relative risk
0,70). In other words, simvastatin prevented more than 40 % of all
coronary deaths. That is quite a benefit, ime.

To my recollection, 96.5% of patients taking
the drug did not benefit at all over five
years.

They all had a reduced risk of dying, according to the study.

Quoted message said:

The drug taking population had an
average increase of life expectancy of about
three weeks in five years. Feeble, in my
opinion.

This reasoning is a bit odd. You seem to assume that all patients
dropped dead the moment the study was completed, which is rather
unlikely, ime.

Quoted message said:

After about 18 months, the drugged group had
a nearly constant mortality rate; There was
no increase in rate due to aging. Why?

The authors of the study proclaimed to us
that the sponsor of the study had an insider
in the study group. Why has no one ever
questioned what s/he was doing there and/or
whether s/he had access to the data.

4S is an outlier in that it presents the best
outcome possible with statin therapy. It
should be repeated with a large, publicly
funded clinical trial, or at the very least,
have its raw data audited.

I agree. However, I think that the results of the study cannot be
dismissed only because it was sponsored by a drug producer.

Quoted message said:

It may be hasty to take, at face value, trial
results which would confer a massive
financial benefit to its sponsor, IMHO. It
may have similarities with buying a used car.

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)

Thorsten Schier <[email hidden]> wrote in part:

Quoted message said:

Quoted message said:

The drug taking population had an
average increase of life expectancy of about
three weeks in five years. Feeble, in my
opinion.

This reasoning is a bit odd. You seem to assume that all patients
dropped dead the moment the study was completed, which is rather
unlikely, ime.

Check the archives. I've gone though this explanation at least twice myself
with A.L. He is now kill-filtered.
--
Jim Chinnis Warrenton, Virginia, USA

Al. Lohse said:

It happens to be identical to saying the treated group
enjoyed (21*24*2222=) 1,119,888 hours of additional life
over a five year period. 97.4 million hours were available,
so the treated group lived 1.15% longer (forget about
significant figures; this is not entirely accurate anyway.).

It is all the same thing. Three weeks in the available
(52*5=) 260 weeks is also 1.15%.

Additional "oddness" arises in that life-or-death is a
digital phenomenon, whereas the time involved is continuous
phenomenon. A few people can "win" additional existence.
Most, by far, apparently, do not win anything.

Why do people buy house insurance? Cardiovascular disease is
more common than household fires.

I think the correct metric for efficacy is relative hazard ratio.

The reasoning goes like this. If you have a significant decrease in
the hazard rate for treated group for a certain disease, and you
multiply by the overall societal importance of that disease (and the
cost of the morbidity and mortality), then you will get an idea of the
overall benefit.

The scientific idea is that you are trying to estimate the benefit
of therapy on the underlying disease process. That is the
key parameter, not the specific length of time in a specific trial
which was a human designed contrivance.

Dr Chaos said:

On Wed, 05 Nov 2003 22:00:17 -0600, Al. Lohse <[email hidden]>

Quoted message said:

It happens to be identical to saying the treated group
enjoyed (21*24*2222=) 1,119,888 hours of additional life
over a five year period. 97.4 million hours were available,
so the treated group lived 1.15% longer (forget about
significant figures; this is not entirely accurate anyway.).

It is all the same thing. Three weeks in the available
(52*5=) 260 weeks is also 1.15%.

Additional "oddness" arises in that life-or-death is a
digital phenomenon, whereas the time involved is continuous
phenomenon. A few people can "win" additional existence.
Most, by far, apparently, do not win anything.

Why do people buy house insurance? Cardiovascular disease is
more common than household fires.

I think the correct metric for efficacy is relative hazard ratio.

The reasoning goes like this. If you have a significant decrease in
the hazard rate for treated group for a certain disease, and you
multiply by the overall societal importance of that disease (and the
cost of the morbidity and mortality), then you will get an idea of the
overall benefit.

The scientific idea is that you are trying to estimate the benefit
of therapy on the underlying disease process. That is the

I couldn't agree more!

Quoted message said:

key parameter, not the specific length of time in a specific trial
which was a human designed contrivance.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard