A brief aside in to statins and FH and all cause mortality

I must admit that I have not read this paper, just the abstract. My excuse is, once again, that I have no access to any ondansetron.

Statins in Familial Hypercholesterolemia: Consequences for Coronary Artery Disease and All-Cause Mortality

As always the results of statin therapy are, to say the least, dramatic.

"In patients with heterozygous FH, moderate- to high-intensity statin therapy lowered the risk for CAD and mortality by 44%".

Wow. But why the need for a composite end point?

If we leave aside soft end points which include coronary re-vascularisation (never influenced by serum lipid levels. No laughing at the back there!) and concentrate on the hard end point of all cause mortality we end up with, for non statinated people:

9 deaths per 4,892 person-years, which I make 1.8 deaths per 1000 person-years.

On a statin we have 17 deaths per 11,674 person-years, 1.5 per 1000 person-years.

That looks like a reduction in mortality of 0.3 people per 1000 person-years.

Or, being more whole numberish, 1 person saved by treating for 3,300 person-years on a statin.

Does that convert to treating 100 people for 33 years to avoid one premature fatality? We're all going to die one day so no one avoids death permanently, even by taking a statin. Unbelievable as that sounds.

If you have heterozygous FH your chances of dying tomorrow are rather low but not quite zero. If you take a statin it will reduce this chance by a vanishingly small amount.

Taking the difference between "rather-low-but-not-quite-zero" and "a-vanishingly-small-amount less than rather-low-but-not-quite-zero", dividing this difference by "rather-low-but-not-quite-zero" and multiplying by 100 we get a massive 17% reduction in all cause mortality. Which means diddly squat, but sounds good if you are a statinator. Admittedly not as good as 44% for the composite end point but hey... Neither means anything.

The main benefit of a statin appears to be that the number it gives you on a lab report might just influence a cardiologist to leave your coronary arteries alone.

Peter