If you took a statin and it lowered your cholesterol, my first response would be “So what?” What does that REALLY mean? And does anyone really give a squat about their cholesterol, or is it really that they don’t want to have a heart attack or stroke?
I’ve written before about the folly of using surrogate endmarkers like cholesterol in medicine today. Our entire system is a house of cards built upon this concept. So what is a surrogate end marker?
Basically, we take a population and look at some value. To be consistent in this case we’ll look at cholesterol. Those with lower cholesterol had less risk of heart attacks. Makes sense. It is likely that those who take better care of themselves have lower cholesterol. But it is NOT the lower cholesterol that protects their heart. Their heart is protected because of the choices they have made. These choices lower cholesterol. AND raise HDL. AND lower blood pressure. And maintain ideal body composition. And improve gut health. And lower uric acid… The list is endless.
So how do we manage to find a single item on a long list (cholesterol) and decide that, if we lower that single value artificially through drugs, that it will be good for the patient???? It is a concept that has built the foundation of pharmaceutical intervention and it is a failed model. Society just doesn’t know it yet.
(Just in case you think that my opinion is an isolated one and that using a drug to change a single marker is a great idea, you might want to read Dr. Ray Moynihan’s commentary in BMJ…)
So why do I bring it up? Looking at this particular study, you see no reference at all to risk of heart disease or death in patients. It is all about whether the drugs were effective and lowering cholesterol. There is no doubt these drugs lower cholesterol, but do you want to place the full weight of your life on a surrogate endmarker?
So this study is a perfect example of how we can use a study to promote the use of a drug…We wave the study high in the air, pound our fists on our chest and proclaim how it saves lives. But we didn’t look at lives saved. We looked at whether a single solitary number got better. Pretty weak.