Sunday, October 13, 2013

Wonder drugs cut toll of strokes by 40%: How the use of statins has helped thousands control their blood pressure (?)

The report below is thoroughly dishonest  -- presumably written by an apostle of the statin religion or perhaps a featherheaded dupe who believes everything she hears.  There is no way the effects of the various medications can be separated out in the data available below.  The benefit could be entirely due to the various blood pressure drugs, not statins. 

The fact that "Hypercholesterolemia increased significantly during the study period" suggests that the statins did not even control cholesterol, let alone blood pressure or stroke!  Journal abstract added below -- JR

By Jenny Hope

Strokes have fallen by 40 per cent in just 16 years thanks to the growing use of statins.

The prescribing of blood pressure drugs have also helped cause rates to plummet among older people - those most vulnerable to their devastating effects.

Huge advances have been made in the treatment of patients with high cholesterol and high blood pressure.
Professor Graham MacGregor, chairman of charity Blood Pressure UK, said stroke rates were plummeting 'throughout the UK' as a result of better treatments

Professor Graham MacGregor, chairman of charity Blood Pressure UK, said stroke rates were plummeting 'throughout the UK' as a result of better treatments

Six million Britons take drugs to lower their blood pressure, usually for life. In addition, more than eight million take statins to reduce cholesterol levels - meaning these are now the most widely prescribed drugs in Britain.

Many older people have also heeded campaigns to have medical checks, and to make lifestyle changes such as cutting back on salt.

As a result, the incidence of strokes has dropped from 247 per 100,000 in 1995 to 149.5 in 2010, according to researchers at King’s College London.

Professor Graham MacGregor, chairman of charity Blood Pressure UK, said stroke rates were plummeting ‘throughout the UK’ as a result of better treatments.

‘We’ve got better blood pressure drugs now and they are used more effectively,’ he said. ‘In the past GPs would prescribe one drug.

‘But we now know they work more effectively in combination, and they are often more acceptable to patients, with fewer side effects, so they take them and don’t leave them in the medicines cupboard.

‘Statins cut the risk of stroke by 30 to 40 per cent so they have also played a part, but we need to do more.’ He said the study demonstrated a huge proportion of strokes were preventable.

‘Every patient who ends up on a stroke ward is a sorry indictment of our failure to help prevent it,’ he said.
Huge advances have been made in the treatment of patients with high cholesterol and high blood pressure

Huge advances have been made in the treatment of patients with high cholesterol and high blood pressure

Dr Yanzhong Wang, lecturer in medical statistics at King’s College London and lead author of the research, said ‘This study on the trends in stroke is the most comprehensive in the UK. It shows a 40 per cent overall reduction of stroke over 16 years, which is good news.’

Strokes affect around 152,000 Britons each year, often triggered by high blood pressure or high cholesterol levels.

Patients with hypertension – the medical term for high blood pressure  – are routinely advised to change their lifestyle and eat less salt, lose weight, drink less alcohol, eat more fruit and vegetables and exercise more.

The study, published in the medical journal Stroke analysed records on 4,245 patients living in South London who had their first-ever stroke between 1995 and 2010. But the findings are likely to apply to the rest of the country, say researchers.

The rate fell in men, women, white groups and those aged more than 45. But it did not drop among those aged 15 to 44 years and black groups. ‘The reasons for this are not entirely clear but it could be because of a rise in diabetes and obesity in these groups,’ Dr Wang said.

‘If this trend is not reversed we could face a major public health concern because long-term disability, as a result of stroke, will put a strain on health and social care services.’

Researchers are calling for greater efforts to identify younger people at risk, including those with diabetes.

Co-author Professor Tony Rudd said: ‘It is essential we begin to understand the reasons for the differences in incidence and how we can address them. Without this we are only going to see widening health inequalities amongst the UK population.’

Trends in Risk Factor Prevalence and Management Before First Stroke : Data From the South London Stroke Register 1995–2011

Iain J. Marshall et al.


Background and Purpose—Vascular risk factors are suboptimally managed internationally. This study investigated time trends in risk factors diagnosed before stroke and their treatment, and factors associated with appropriate medication use.

Methods—A total of 4416 patients with a first stroke were registered in the population-based South London Stroke Register from 1995 to 2011. Previously diagnosed risk factors and usual medications were collected from patients’ primary care and hospital records. Trends and associations were assessed using multivariate logistic regression.

Results—Seventy-two percent of patients were diagnosed previously with 1 or more risk factors; 30% had diagnosed risk factors that were untreated. Hypercholesterolemia increased significantly during the study period; myocardial infarction and transient ischemic attack prevalences decreased. Antiplatelet prescription increased in atrial fibrillation (AF), myocardial infarction, and transient ischemic attack (AF, 37%–51%, P<0.001; myocardial infarction, 48%–69%, P<0.001; transient ischemic attack, 49%–61%, P=0.015). Anticoagulant prescription for AF showed a nonsignificant increase (12%–23%; P=0.059). Fewer older patients with AF were prescribed anticoagulants (age, >85 versus <65 years; adjusted relative risk, 0.19; 95% confidence interval, 0.08–0.41). Black ethnicity (adjusted relative risk, 1.17; 95% confidence interval, 1.10–1.23) and female sex (adjusted relative risk, 1.09; 95% confidence interval, 1.03–1.15) were associated with increased antihypertensive drug prescription; other medications did not vary by ethnicity or sex.

Conclusions—Antiplatelet and cholesterol-lowering treatment prescribing have improved significantly over time; however, only a minority with AF received anticoagulants, and this did not improve significantly. Overall, 30% of strokes occurred in patients with previously diagnosed but untreated risk factors.


The ironies of Australia's public health policy regarding "obesity"

Jeremy Sammut

This week the CIS' WasteWatch blog focused on a new taxpayer-funded growth industry - the ever increasing number of reports into Australia's obesity 'epidemic'.

This is a very lucrative business for public health academics, especially now that the National Preventive Health Agency is able to fund research into the stubborn problems of over-eating and sedentary lifestyles.

However, the proliferation of obesity-related reports reflects the hard truth of public health policy - we have next to no idea about what actually works in terms of getting people off the couch and out of the takeaway shops.

The evidence regarding the effectiveness of the billions of dollars that Australian governments already spend on the promotion of healthy lifestyles is very weak.

This was the central finding of the UK Wanless review of public health policy, which found, in particular, that 'there is little evidence about what works among disadvantaged groups to tackle some of the key determinants of health inequalities.'

The lack of evidence reflects the fact that in a free society, governments rightly have limited authority over unhealthy lifestyle behaviours and lack the ability to micro-manage daily dietary and exercise habits.

Achieving lifestyle change is also extremely difficult as it ultimately depends on personal qualities - will, self-discipline, and impulse control - that public health policies struggle to instil in people who do not already possess them.

Not for nothing, therefore, have anti-obesity campaigns been accurately described as a 'policy looking for an evidence base.'

Obesity invites endless investigation and report after report after report.

Herein lies a greater irony. Those who endlessly warn the community about the perils of eating too much junk food have much in common with so-called 'vice industries' they love to attack.

Like those who trade in fatty foods and sugary and alcoholic drinks, the public health lobby is equally dependent on the flaws and weaknesses inherent in human nature to justify its call on public resources.

Rather than continuing to pour money into public health research that implausibly seeks to straighten the crooked timber of humanity, policy makers would be better off recognising the limits of government activity in relation to obesity.


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