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Sek Kathiresan MD @skathire
, 6 tweets, 2 min read Read on Twitter
Unbelievable. 😱

The famous ‘Mediterranean diet’ is awesome study seems to have had serious randomization issues affecting >20% enrolled participants

Retracted and republished!
nejm.org/doi/full/10.10…
Why would anyone trust the new effect size based on abstract below!
Is there any precedent for retraction and republication?
Problem sleuthed by Carlisle, Torbay Hospital UK.

ncbi.nlm.nih.gov/m/pubmed/28580…

To detect fraud, analyzed 1000s articles to see if distribution baseline characteristics consistent with randomization

11 articles inconsistent with randomization & in @NEJM

Check out editors note 👇
Sad day for credibility of major medical journals and nutritional science.
Terrific piece by @ginakolata explaining what happened in the retracted Med diet study.

Makes me even more suspect of the re-analyzed effect size.

Mediterranean Diet Study Was Flawed. But Was It Wrong? nyti.ms/2MnNckp
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More from @skathire see all

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REDUCE-IT trial: when added to statins in its w/ CVD (or T2D+1RF), Rx with 4g purified EPA (Vascepa) (compared to mineral oil placebo) lowered risk CVD events 👇🏽

Vascepa worked but full results expose that we don’t know why

A few thoughts
nejm.org/doi/pdf/10.105…
Difference between 2 groups (Vascepa and mineral oil placebo) in plasma TG was ~40mg/dl and non-HDL-C was ~15.5 mg/dl

But, lipid difference does not explain the 25% RRR

A 15.5 mg/dl delta in non-HDL-C would be expected to alter CVD by only about 10%

👇🏽
nejm.org/doi/full/10.10…
Could it be the antithrombotic or the antiarrhythmic effects

lots of in vitro evidence for these effects
but also some human evidence from this trial

higher bleeding rate in those Rx with Vascepa
lower rate of CV death

jamanetwork.com/journals/jama/…
Read 12 tweets
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@matthewherper @sciencescanner Great ? @matthewherper

Look for a small thread later today on this.
@matthewherper @sciencescanner A short thread on triglycerides (TG), triglyceride-rich lipoproteins (TRL), coronary artery disease, and medicines development
@matthewherper @sciencescanner Lipoproteins: macromolecules that carry lipids in center
We approximate [lipoproteins] by measuring lipids they carry
TG levels approximate [TRLs] (a collection of several particles)
But, TRLs also carry cholesterol
For every 5 mg/dl triglycerides in TRL, ~1 mg/dl cholesterol
Read 12 tweets
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How likely are you to have a heart attack over next 5y?
Risk prediction model developed in 400K in contemporary New Zealand
Cool study
Thread
thelancet.com/journals/lance…
Risk prediction for first CV event is a hard problem.
Without any testing, if you just told everyone that they will *not* have a heart attack over the next 5y, you would be correct >95% of time!
At present, first CV event rates low over 5y period – median 2.3% women, 3.2% men
In US, ACC/AHA Pooled Cohorts Equations (PCE) is recommended

PCE predicted risk used to guide BP and chol Rx

But, in many studies now, PCE predicted risk consistently shown to over-estimate actual observed risk

Same over-estimation by PCE seen in this NZ study (middle panel)
Read 8 tweets

Related threads

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A couple notes on the soy sauce colon cleanse video I posted here:
1. I mentioned Jilly Juice briefly in context of how much sodium the patient consumed. J Juice didn't exist, to my knowledge, in 2012 when CG presented. Still, false detox claims aren't new
2. Stroke in hypernatremia happens, and it's not explained well online. It's a hemorrhagic stroke, meaning it bleeds out into the brain. Another type of stroke is ischemic stroke, where a clot blocks blood vessel in the brain. Hemorrhage happens because of shearing from shrinkage
2. It is discussed in this case report from 2013 of a similar case ncbi.nlm.nih.gov/pubmed/23735849 which brings me to the next point.
Read 16 tweets
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Thanks for @emcrit for pointing their followers to our recent @NEJM publication on antipsychotics for @ICU_delirium: nejm.org/doi/full/10.10…
I appreciate their thoughtful and thorough commentary, especially the description of when to consider using an antipsychotic. But a number of points should be clarified. emcrit.org/pulmcrit/antip…
"89% of these patients had hypoactive delirium" - True at randomization but the percent with hypoactive delirium fluctuated during the trial; 209 (37%) experienced 1 or more days of hyperactive (agitated) delirium.
Read 9 tweets
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NEJM letter from Johns Hopkins neurologist/father of 1st known case of govt. admitting liability 4 autism after vaccines. (Dr. Poling sets straight false info distributed by Children's Hospital's Dr. Paul Offit.) 1/2 nejm.org/doi/full/10.10…
2/2 (PS Govt. sealed vaccine-autism case & payment so other parents wouldn't find out.) The NEJM letter from Johns Hopkins neurologist (Dr. Poling) references my reporting for CBS News on conflicts of interest of Dr. Offit and others.
(And then Children's Hospital's Dr. Offit provided false info to the Orange County Register after my report discussing his conflict of interests but they corrected him.) ocregister.com/2011/04/18/cor…
Read 3 tweets
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Study finds more deaths from Hurricane Maria in Puerto Rico than from September 11 or Hurricane Katrina. Nearly as many as the two put together.
Here's the full text of the Harvard study that found an estimated 4,645 deaths in Puerto Rico as a result of Hurricane Maria. Some notes to follow... nejm.org/doi/full/10.10…
The Hurricane Maria study is a statistical analysis of household mortality rates. As the authors note, their figure of 4,645 deaths "is likely to be an underestimate because of survivor bias."
Read 15 tweets
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OK, folks. Let’s all sit down for a quick chat about this article the “Annals of Medicine” coughed up a few weeks ago about RCT’s: tandfonline.com/doi/full/10.10…
This will be my longest TWEETORIAL yet, but that’s because we have a LOT to talk about here
Several others have discussed this recently on Twitter and I welcome their thoughts as well (@statsepi, @stephensenn, @briandavidearp, @Prof_Livengood, @learnfromerror)
Read 76 tweets
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The next study in my sequence of studies used by S-T & K is the Boston Diet Heart Study. Published in 1985, the study looked at observations on men living in Ireland, men born in Ireland living in Boston and Irish men born and living in Boston. Echoes of Ni-Hon-San, right?
Except that unlike Ni-Hon-San, there were no differences between the groups at all. The study was based on a single dietary recall that was then scored using the Hegsted and Keys scores. The study was unremarkable, showing exactly what you would expect.
Those with the highest cholesterol and saturated fat in the diet had the highest rate of heart disease and those with the lowest had the lowest rates. Plant matter, both fiber, starch and plant protein were all protective. nejm.org/doi/full/10.10…
Read 5 tweets

Trending hashtags

#CardioTwitter #respect #AcademicPeds #ACCFIT #Regrets #Matrix #PEEP #assault #PICSyndrome #Hypertension #IA #abuse #microfluidic #medtwitter #researchers #ECMO #FOAMed #ARRIVE #VEST #SoMe #theNASEM #MeTooSTEM #ICUrehab #EPeeps #cardiotwitter

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