Dear Diana,
I think that you made some very valid points. Personally, I have no
wish to question the taking of statins if people are getting the right
advice. Obviously all individuals have to weigh up their balance of
risk.
One question arising out of previous correspondence is what happens if
one were to become decrepit as a result of a heart event. Stroke is
one of the more common outcomes, often contributing to "sans teeth,
sans eyes, sans taste, sans everything". This possibility is
something we all have to face whether we dance with beautiful partners
or not. Interestingly, however, a stroke is usually associated with a
bleed or clot on either one side of the brain or the other. Since it
appears to be rare that both sides of the brain is affected at the
same time, then one would either be paralysed physically but with
conversation - which could be employed as one is being wheeled about
by one's former dance partners - or one has no conversation but can
still dance!
Of course, such a happy outcome depends on one's ability to make and
retain friends in the first place. Perhaps the best advice that a
practice nurse can give when dealing with future outcome is to refer
to the parable of the bad steward, and suggest in all cases, whatever
the outcome of the tests, that one should make more firm friends fast.
Best wishes,
John Urquhart
On 23 February 2012 15:04, Kornbrot, Diana <[log in to unmask]> wrote:
> Hi
> Nice recommended current risk calculator:
> http://www.patient.co.uk/showdoc/40000133/
> Practice nurse may have something more sophisticated
> There are 2 aspects to consider:
>
> is cholesterol very high, independent of any other risk factors (criterion
> bit hihger than NICE, overall >6 total/hdl>3.5). I take statins, because
> cholesterol is 9.2 without drugs & under 5 with, and furthermore I
> experience no side effect
> is 10 year risk factor > 20%. They don’t tell you r-square!. But note that
> some factors are treated continuously, bp and and cholesterol, others are
> ‘triggers’ - may be triggers even if you insert number, e.g. Is change of
> risk form bmi=30 to bmi-25 form obese to overweight or modelled
> continuously? This partly because of the quality of original Framingham –
> they only asked if either parentdies young of chd, not how young or how mnay
> parents.
> side effects may be exagerated. IF presnet, they are likely to be mainifest
> immediately, and one can then re-consider. If absent, they tend to stay
> absent. For example, I went on a 2 month ‘holiday’ [that’show I know about
> 9.2], I was unable to detect any difference of well-being of any kind
>
>
> At leasdt GPs talk about it sensibley now
> Best
> Diana
>
>
>
> If you relly want to get technical try
> http://onlinelibrary.wiley.com/doi/10.1002/sim.4508/full
>
>
>
> On 23/02/2012 12:35, "[log in to unmask]" <[log in to unmask]> wrote:
>
> Dear Johns,
>
> I have been working in Sierra Leone (see www.villageaid.org
> <http://www.villageaid.org> ) and came back to a letter from my doctor
> saying my cholesterol level was too high and that there is an over 30%
> chance of an adverse event.
>
>
> This has been going on for about five years. My initial response was to
> research statins with google and found that there are side effects which
> seemed large and secondly that there was controversy about the effectiveness
> of statins.
>
> I challenged my excellent doctor on this and he asked about my family
> history and noted that I was not over weight, exercised quite a bit and did
> not drink alcohol very much. When asked about the 30% figure above he
> commented that my chance of an adverse event was probably about 20% anyway.
> We agreed I should not take statins.
>
> If an adverse event is imminent my recommnedation is to go to beautiful
> Sierra Leone and reflect on a happy life whilst sitting on Lumley Beach. The
> city traffic jams may give you a heart attack though.
>
> David Drew
>
>
> In a message dated 14/02/2012 15:16:46 GMT Standard Time,
> [log in to unmask] writes:
>
> Dear Johns, and all
>
> Is it a coincidence that 2 weeks ago I had the equivalent conversation with
> my GP? No, I think it might say something about the age distribution of
> those on the RadStats list.
>
> Anyhow, I was told that my cholesterol level had edged past some trigger
> point, on the basis of which they performed their magic calculation, and
> hey presto it seems I have a 21% chance of an adverse cardiovascular event
> in the next 10 years. I was told that 20% is the threshold level (not the
> 'norm') above which they recommend statins.
>
> My reaction was to decline their kind offer. (I first asked and was assured
> that they would check up on me every year, so I have a chance of revisiting
> that decision as I go through my risky decade.) The basis of my decision
> was a) 21% is not much over 20% b) who decided on the 20% threshold, is it
> like the 5 portions of fruit a day? c) enduring the 2% risk implied by
> waiting for a re-test did not seem too bad a gamble d) an embedded
> preference for non-intervention wherever possible.
>
> I do have a doubt about John Urquhart's description on how the calculation
> is performed: "They seem to be based mainly on a combination of blood sugar
> and cholesterol levels, blood pressure, and weight:height ratio, with a
> possible input based on exercise levels." My GP certainly did not have
> uptodate information on much of this - my height is fairly static, but she
> took no measurement of weight, and any blood sugar and blood pressure data
> they have is months to years old. I wasn't asked about exercise. So - did
> she make those numbers up, or are they not in the formula?
>
> Jonathan Rosenhead
>
>
> ________________________________
>
> From: email list for Radical Statistics on behalf of John Urquhart
> Sent: Tue 2/14/2012 2:31 PM
> To: [log in to unmask]
> Subject: Re: Statinistics
>
>
>
> Dear John Bibby,
>
> By a fascinating coincidence, I'm off to see my doctor tomorrow
> morning, based on a 23% chance in the next 10 years! I have been told
> that 20% is the norm, and there is an implication already that I
> should be on statins. However, as a fellow statistician I am very
> leery of the calculation methods used to arrive at this 23%. They
> seem to be based mainly on a combination of blood sugar and
> cholesterol levels, blood pressure, and weight:height ratio, with a
> possible input based on exercise levels. It does not seem to take
> into account any kind of family or genetic disposition. My anecdotal
> concern about statins is the suggestion that they suppress the Q10 co
> enzyme when a sudden demand is made on the heart, leading to a
> possible myocardial infarction. Supposing I lose two stone in weight,
> does that mean I will then be below the desirable 20%? Suppose I took
> less exercise, does that put me up the scale? What is the effect of
> constantly sitting close to a microwave source which exposes me to
> more than 1000 microwatts per square centimetre (i.e. the wi-fi on my
> computer router)?
>
> I think the one-fits-all indicator now extensively used in GP
> surgeries needs more serious examination. Probably, worrying about
> puts your blood pressure up anyway! A much better approach is to take
> up dancing with beautiful women. That too may increase your blood
> pressure, but - hell - what a way to go!
>
> Best wishes,
>
> John Urquhart
>
> On 13 February 2012 13:09, John Bibby <[log in to unmask]> wrote:
>> Dear All
>>
>> A few weeks ago I sought your advice regarding statins and their
>> statistics.
>> Thank you to the 30+ respondents, whose replies I shall be collaging and
>> distributing FYI in due course.
>>
>> Naturally there was some overlap. The most-repeated comment was "David
>> Spiegelhalter will know the answer to this".
>>
>> And indeed he did!
>>
>> The second-most common reference was to the Framingham Heart Study, which
>> is
>> the source for much of this data - see
>> http://en.wikipedia.org/wiki/Framingham_Heart_Study
>>
>> My question now - dear statisticians - is maybe not truly statistical,
>> but
>> affects the statinistics. It concerns the definition of "cardiovascular
>> event", which is the Framingham output measure. I assume that this
>> includes
>> everything from ministrokes to permanent paraplegia and death - am I
>> right
>> in this? And if so, what is the conditional likelihood of the various
>> points
>> on this spectrum, given that I have such an event?
>>
>> e.g.I am told I have a 30% 10-year risk of a cardiovascular event. This
>> will
>> reduce to 23% if I take statins like a good boy. (Strong steer from
>> doctor
>> to do this.) My decision will or may be different depending upon whether
>> the
>> bulk of these events are ministrokes, or whether the bulk is at the
>> serious
>> end of the spectrum. (I guess it's mainly in the middle - but what is
>> the
>> middle; indeed, what is the metric?)
>>
>> Thanks for any help or advice you can provide. If I do not reply it is
>> more
>> likely due to email overload than to any other adverse event.
>>
>> JOHN BIBBY
>>
>>
>>
> Please access the attached hyperlink for an important electronic
> communications disclaimer: http://lse.ac.uk/emailDisclaimer
>
>
> ****************************************************** Please note that if
> you press the 'Reply' button your message will go only to the sender of this
> message. If you want to reply to the whole list, use your mailer's
> 'Reply-to-All' button to send your message automatically to
> [log in to unmask] Disclaimer: The messages sent to this list are the
> views of the sender and cannot be assumed to be representative of the range
> of views held by subscribers to the Radical Statistics Group. To find out
> more about Radical Statistics and its aims and activities and read current
> and past issues of our newsletter you are invited to visit our web site
> www.radstats.org.uk. *******************************************************
>
>
>
> ________________________________
> Emeritus Professor Diana Kornbrot
> email: [log in to unmask]
> web: http://dianakornbrot.wordpress.com/
> Work
> School of Psychology
> University of Hertfordshire
> College Lane, Hatfield, Hertfordshire AL10 9AB, UK
> voice: +44 (0) 170 728 4626
> fax: +44 (0) 170 728 5073
> Home
> 19 Elmhurst Avenue
> London N2 0LT, UK
> voice: +44 (0) 208 444 2081
> mobile: +44 (0) 740 318 1612
>
>
>
>
>
> ****************************************************** Please note that if
> you press the 'Reply' button your message will go only to the sender of this
> message. If you want to reply to the whole list, use your mailer's
> 'Reply-to-All' button to send your message automatically to
> [log in to unmask] Disclaimer: The messages sent to this list are the
> views of the sender and cannot be assumed to be representative of the range
> of views held by subscribers to the Radical Statistics Group. To find out
> more about Radical Statistics and its aims and activities and read current
> and past issues of our newsletter you are invited to visit our web site
> www.radstats.org.uk. *******************************************************
******************************************************
Please note that if you press the 'Reply' button your
message will go only to the sender of this message.
If you want to reply to the whole list, use your mailer's
'Reply-to-All' button to send your message automatically
to [log in to unmask]
Disclaimer: The messages sent to this list are the views of the sender and cannot be assumed to be representative of the range of views held by subscribers to the Radical Statistics Group. To find out more about Radical Statistics and its aims and activities and read current and past issues of our newsletter you are invited to visit our web site www.radstats.org.uk.
*******************************************************
|
