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cover ■「ニセ医学」に騙されないために

 ホメオパシー、デトックス、千島学説、血液型ダイエット、ワクチン有害論、酵素栄養学、オーリングテストなどなど、「ニセ医学」についての本を書きました。あらかじめニセ医学の手口を知ることで被害防止を。

0017-10-31 LDLコレステロールと心疾患の因果関係

[]LDLコレステロールと心疾患の因果関係、およびスタチンの有用性は十分に確立されている LDLコレステロールと心疾患の因果関係、およびスタチンの有用性は十分に確立されているを含むブックマーク

The causal relationship between low-density lipoprotein cholesterol (LDL-C) and coronary atherosclerosis is well established. Multiple randomized trials have demonstrated that lowering LDL-C by treatment with a statin significantly reduces the risk of major coronary events (1).

https://www.ncbi.nlm.nih.gov/pubmed/23083789

(1)で参照されているのはhttps://www.ncbi.nlm.nih.gov/pubmed/21067804




Cholesterol is carried in the bloodstream on different types of particles, called lipoproteins. The majority is carried on low-density lipoprotein (LDL) particles and is sometimes referred to as “bad” cholesterol, because high levels of LDL particles can lead to heart disease and stroke.

For people who are at increased risk of having a heart attack or stroke, statins may be recommended even when cholesterol levels might not seem too high. “Statins have a well-established track record for reducing the risk for heart attacks and strokes,” Smith says. “Whether or not a statin is appropriate for a specific patient should involve a conversation between the patient and his or her healthcare provider.”

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm

FDA。



Prof. Peter Weissberg, Medical Director at the British Heart Foundation, said:

High cholesterol is a major risk factor for heart disease and reducing your cholesterol level is an effective way of reducing your risk of a future heart attack or stroke.

“This analysis supports previous findings that it’s the lowering of ‘bad cholesterol’ – or LDL cholesterol – that really matters when it comes to preventing heart attacks, and not the means by which it is achieved. Statins are a safe and effective way of lowering cholesterol, and this study helps to dispel the notion that statins work in ways that are unrelated to lowering cholesterol.

“The vast majority of patients in this analysis were taking statins and several of the non-statin approaches included in the study, such as bowel surgery, are not viable options for patients today. Patients on statins should be reassured that by lowering their cholesterol levels they are helping to protect themselves from future heart attacks and strokes.”

http://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-heart-disease-risk-reduction-of-statins-and-other-cholesterol-lowering-methods/

スタチン以外のLDLコレステロール低下療法も心血管イベントを抑制するというJAMAの系統的レビューおよびメタ解析( https://www.ncbi.nlm.nih.gov/pubmed/27673306 )を受けて。



Lifelong exposure to raised concentrations of LDL cholesterol increases cardiovascular event rates, and the use of statin therapy as an adjunct to diet, exercise, and smoking cessation has proven highly effective in reducing the population burden associated with hyperlipidaemia. Yet, despite consistent biological, genetic, and epidemiological data, and evidence from randomised trials, there is controversy among national guidelines and clinical practice with regard to LDL cholesterol, its measurement, the usefulness of population-based screening, the net benefit-to-risk ratio for different LDL-lowering drugs, the benefit of treatment targets, and whether aggressive lowering of LDL is safe.

2014年のLancet。議論はあるがLDLコレステロールと心疾患の因果関係やスタチンの有用性についてではない。



Up to 8,000 lives could be saved every three years by offering statins to anyone with a 10 per cent risk of developing cardiovascular disease (CVD) within a decade, says NICE.

The effectiveness of these medicines is now well proven and their cost has fallen. The weight of evidence clearly shows statins are safe and clinically and cost effective for use in people with a 10% risk of CVD over 10 years.”

https://www.nice.org.uk/News/Article/wider-use-of-statins-could-cut-deaths-from-heart-disease

NICE(イギリスの国立医療技術評価機構: National Institute for Health and Care Excellence)。コストに厳しいイギリスも。



Reducing high blood cholesterol, a risk factor for cardiovascular disease (CVD) events in people with and without a past history of CVD is an important goal of pharmacotherapy. Statins are the first-choice agents. Previous reviews of the effects of statins have highlighted their benefits in people with CVD. The case for primary prevention was uncertain when the last version of this review was published (2011) and in light of new data an update of this review is required.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004816.pub5/full

コクラン。コクランのメタ解析すら「利益相反にともなう影響大」として否定できるのなら、どのようなニセ医学的な主張もし放題。



Statins — Statins are among the most powerful drugs for lowering LDL cholesterol and are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death. Statins include lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin (table 1). These medications decrease the body's production of cholesterol and can reduce LDL levels by as much as 20 to 60 percent. In addition, statins can lower triglycerides and slightly raise HDL cholesterol levels. Statins may prevent heart attacks and strokes in more ways than just lowering cholesterol levels. For instance, statins seem to help keep buildups in blood vessels (known as plaques) from rupturing. Plaque rupture is an important event that can lead to a heart attack.

https://www.uptodate.com/contents/high-cholesterol-treatment-options-beyond-the-basics

UpToDate。



Why have I been offered statins?

Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).

CVD is a general term that describes a disease of the heart or blood vessels. It's the most common cause of death in the UK. The main types of CVD are:

coronary heart disease – when the blood supply to the heart becomes restricted

angina – sharp chest pain, caused by coronary heart disease

heart attacks – when the supply of blood to the heart is suddenly blocked

stroke – when the supply of blood to the brain becomes blocked

Your doctor may recommend taking statins if either:

you've been diagnosed with a form of CVD

your personal and family medical history suggests you're likely to develop CVD at some point over the next 10 years and lifestyle measures (see below) haven't reduced this risk

https://www.nhs.uk/conditions/Cholesterol-lowering-medicines-statins/Pages/Introduction.aspx

NHS(イギリスの国営医療サービス事業)。


Statins are a mainstay in both primary and secondary prevention of cardiovascular disease (CVD) and have consistently been shown to decrease cardiovascular morbidity and mortality.1-3 High-dose statin therapy for secondary prevention is a Class IA recommendation by the American College of Cardiology (ACC)/American Heart Association (AHA)4, but despite their proven benefit, there continue to be disparities in prescription patterns as well as adherence to statins in patients with known CVD. For this reason, there is particular interest in identifying gaps in care to better inform means by which to improve statin prescription and adherence.

http://www.acc.org/latest-in-cardiology/articles/2014/12/22/12/53/quality-of-care-and-adherence-to-statin-therapy-in-secondary-prevention-based-on-the-2013-acc-aha-cholesterol-management-guidelines-expert-analysis

ACC。


In 2013, the American College of Cardiology and American Heart Association (ACC/AHA) published the new Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (1) along with a companion Guideline on the Assessment of Cardiovascular Risk in asymptomatic individuals (2). Using a rigorous process of independent evidence review and synthesis based largely on results from randomized clinical trials (RCTs), the 2013 ACC/AHA cholesterol guideline panel found that the vast majority of evidence indicating efficacy and safety of low-density lipoprotein cholesterol (LDL-C) lowering for risk reduction came from trials of statin drugs.

http://www.onlinejacc.org/content/68/1/92#tab1

2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk。"Fire and Forget"から"Treat to Target"への回帰、および、スタチン以外のLDL-C低下療法の併用の考慮。

トラックバック - http://d.hatena.ne.jp/NATROM/00171031