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He told me that based on the recent SATURN trial, his medical network (the largest in the country) has decided to recommend Lipitor in high doses to patients with known CAD. The trial results show that both Lipitor and Crestor showed a regression of arterial plaques. I asked for some reading material and he gave me the link below. Very interesting and good to know!
I have a few issues with SATURN, it was relatively small (1,100 participants) and had a cohort percentage of 29% which can be a bit high. In any case, this is a major revelation.
http://www.medpagetoday.com/MeetingCoverage/AHA/29718View Thread


This paper breaks down the reasons for the decrease and found that 40% of the deaths prevented was due to advancement in medical treatment which was preventing deaths. Also, 54% was based on the reduction of risk factors and 6% was unknown.
So with 40% coming from the advancements in treatment, what made up the rest. 30% was due to a reduction in Hypertension, 28% was directly attributed to a reduction in serum cholesterol and 15% in the reduction of smoking. These three areas make up 73% of the deaths prevented from heart disease by cintrolling risk factors. The actual number of deaths prevented by controlling cholesterol was 95K second only to 105K from a reduction in Hypertension.
This is very interesting and I recommend reading it if you have a chance. Don't forget to look at the tables, it is very interesting.
http://www.nejm.org/doi/full/10.1056/NEJMsa053935#t=articleDiscussionView Thread


Based on the data presented, you have to look at the sum total of the reasons for the decline. Perhaps the number of deaths eliminated in the early 80's were from the advances in cardiovascular surgery. That leveled off and then the effects of statins kicked in to keep the decline intact. Also, you need to look at the numbers year over year, and not just as part of a 110 year graph which will show an exponential smoothing effect.
Here's another representation from the UK.

Note the increase in the reduction due to smokers. This makes sense as the UK has more smokers per 1,000 population than the US.
Below is the findings from the NIH, very similar;
We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses.
RESULTS:From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively).View Thread

If you look at the way deaths were reported since the beginning of the 20th century, there has been no consistent measurement due to the way deaths were reported. For instance, between 1900 and 1920 the data only included a few states and some other areas but no one knows what percentage of the population was being represented so the rates mean nothing. From 1930 through the 1950s there was no standard for reporting causes of death but all states were starting to be represented, however most feel the increase in the death rate was more a result of more deaths being reported that were not reported before. More standardization took place in the 60s but it wasn't until the 70s that we know the numbers to be truly representative of the entire population and all being reported as the same code.
What many postulate is that the graph is not actually a bell curve. There is more and more belief that what we really should have is a flat line until we start seeing the dramatic drop in the 80's Personally I don't think that's the case. In my mind it makes sense that there would be some rate of decline which would be driven by the increase in the life expectancy.
Back to the link, their research is solid and I can follow the math and believe that the numbers are more likely to be correct than not. Mostly because we're talking about the period between 1980 and 2000 for which we know we have good data. It is my opinion that we really can only depend on the most recent data.
My personal belief on the matter.View Thread



The crude death rate, the total number of deaths per year per 1000 people.
http://en.wikipedia.org/wiki/Mortality_rate
I'm not missing anything, just trying to show a little broader understanding.View Thread

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