Thread by @LDLSkeptic

1) I admire MDs listed here because they recognize benefits of #LCHF diet. They question statin use for primary prevention, but each sees value of statins for 2nd CVD prev. My friendly challenge to them is in this tweet series.
@DrAseemMalhotra @bschermd @DoctorTro @FatEmperor

2) Let's start with the claim that 2nd prev benefits are substantial. The 4S study is often cited, but a 25 year old study with data analyzed by a "Merck employee" has little credibility. There's little after 2004 when standards go tougher; so lets go with the Brit HPS, from 2002

3) The so-called substantial 2nd prev benefits, when one looks at % of ppl w/o an adverse effect in my graph, is small - around 1-3%. The largest effect is the composite of all coronary events, at ~3% better than placebo. Notice that the relative risk is inflated to a 27% ⬇️

4) How was this effect reported by Rory Collins to BMJ?
Statins reduce coronary events by 1/3 ! !
Notice that 3% became a 33% ⬇️ in secondary prevention. Statins save 50,000 lives! But with Collins' own #'s = an NNT of 200. Of 200 statin-treated ppl at ⬆️risk, only 1 life saved

5) What of adverse effects? The best study assessing T2D with statins is Cederberg, et al, which revealed a near doubling (5.8 to 11.2%) in development of new onset T2D. These people, therefore, are now at high statin-induced lifetime risk of CVD, as well as other T2D risks.

6) The careful study by Cederberg et al (govt funded) revealed a dose- and time-specific development of T2D. This is a potent adverse effect which is under-reported in pharma-supported RCTs, since A1C and fasting glucose is not measured in most (perhaps all other) RCTs.

7) The T2D effect appears to be more potent in women. A meta-analysis of T2D across statin trials shows a linear relation between % of women in the study and % of ppl with T2D

8) The max % of T2D is in the WHI, which was 100% women. Here the statin associated increase in T2D is seen in all subgroups of BMI and those taking statins for primary and secondary CVD prevention. Thus, adverse statin effects on glucose regulation cut across entire pop of women

9) Adverse effects go beyond T2D. In this paper statin treatment mimicked dementia in an elderly population, which was shown to reverse with statin removal and return with statin rechallenge. How many people are misdiagnosed with AD because of statin treatment?

10) Just one more (of many) adverse effects: Breast cancer. Most statin trials are terminated in <5 years, which is insufficient time to see cancer develop. This retrospective trial shows >2X increased breast cancer over 10 years with statin treatment.

11) MDs say ⬆️risk patients, such as those with ⬆️CAC, should be on a statin, and yet, numerous studies have shown that statins ⬆️CAC. Somehow when a measure (CAC) is seen as 100% predictive of future events, the ⬆️in CAC with statins is seen as protective - 🙄
@FatEmperor

12) Primary risk factors for CVD link through hypercoagulation, with a multi-risk benefit for those on a #LCHF diet. As there has never been a statin RCT for ppl on a #LCHF diet, there is no evidence-basis to justify prescribing a statin to a person on #LCHF

13) Here are DOIs of our papers on the topic.
10.1371/journal.pone.0205138
10.1016/j.mehy.2018.09.019
10.1080/17512433.2018.1519391
10.1586/17512433.2015.1102009
10.1136/bmjopen-2015-010401
10.1586/17512433.2015.1012494
I'll cover this at: lowcarbusa.org/low-carb-event…