JW>In reply to Tom's comments, we must remember that this is the age of EBM
JW>(probably followed the Age of Aquarius), and the 4S EBM is already here.
Hang on ......... didn't 4S stop at age 70 and wasn't it
80% Male and secondary prevention?
and didn't they exclude pnt with cholest > 8.0 mmol
and WOSCOP was primary prevention, male only and Glasgow
The second Sheffield risk table (1) gave a chart for primary
prevention but stopped at age 70.
(and without risk factors in F age 72 they did not suggest
doing the cholest in the first place.)
Where is the EBM?
We don't know, but extrapolating (see below) the Sheffield
risk table, risk prob about 2%.
Assume 50% relative reduction over 5.4 yrs
(vvv generous and > than both WOSCOP & 4S)
2% vs 1%
NNT = 100 pnt to be treated for about 5 yrs.
One study (2) found that lipids were not a risk factor in the
elderly with women actually being less likely to die if they
had a high cholesterol - they questioned the validity of
extrapolating to the higher age group. It was called the
survival effect, those with high cholest that were going to
drop off the perch had already done so?
Too many hypotheticals for me to recommend if she was my
patient in an age group as yet not tested with statins.
David Jobson
1. Lancet 10 Aug 1996
2. JAMA 1994;272:1335-40
* SLMR 2.1a *
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|