statins; why bother?

[email hidden] (fresh~horses) wrote in part:

Quoted message said:

Atherosclerosis. 2004 Feb;172(2):329-35. Related
Articles, Links

Cardiovascular disease and mortality in statin-treated
patients with familial hypercholesterolemia.

Mohrschladt MF, Westendorp RG, Gevers Leuven JA, Smelt AH.

Department of General Internal Medicine, Leiden University
Medical Center, P.O. Box 9600, 2300 RC Leiden, The
Netherlands.

Patients with familial hypercholesterolemia (FH) are at an
increased risk of premature cardiovascular disease (CVD).
The benefits of statin therapy are not well known since no
placebo controlled studies have been performed in these
patients. The aim of this study was to determine the CVD
event and mortality risk in statin-treated patients with
FH. A total of 345 FH patients were followed prospectively
for 8 years. Mortality from CVD was compared to that of the
general population. The absolute risk of CVD in patients
without a previous history of CVD was 3% per year for men
and 1.6% for women. Mortality from CVD in patients without
a previous history was 1.4-fold (95% CI = .6-3.3) increased
and ischaemic heart disease (IHD) mortality was
2.6-fold (95% CI = 1.1-6.3) higher compared to the general
population. This mortality risk was highest in patients
aged 40-59 years. Female FH patients had no increased CVD
or IHD mortality risk. Over a period of 8 years the event
risk of patients with a history of CVD was almost 30% per
year under age 40 years and 15% in patients aged 60 years
and over. When compared to the general population,
mortality from other causes than CVD was lower for
patients with FH, the relative risks not reaching
statistical significance. The relative risk of mortality
from all causes was 1.5 (P < 0.05) for men and 1.0 for
women. In conclusion, male patients with FH, treated from
middle-age with statins remain at an increased risk of
developing CVD.

PMID: 15019543 [PubMed - in process]

Seems like a really odd study. Why would you compare a group
of FH patients on statins with "the general population?" It
seems like they should be compared with a matched group of
FH patients not on statins or on some other treatment to see
which works better.

I guess this shows that FH patients still don't look quite
like the general population, even when they are statins. But
that result doesn't bear on any treatment decision.
--
Jim Chinnis Warrenton, Virginia, USA