If you want to look about the use of Statins (Cholesterol lowering medications) to prevent heart attack and stroke, you don't need to look beyond the series of excellent meta-analysis conducted by the "Cholesterol Treatment Trialists' Collaboration"

A thread ....

#Medtwitter
This GIF sums up everything nicely. It tells us three things

1. Statins work
2. More LDL reduction - lower the risk of heart attack, stroke etc
3. More statins/ more powerful statins- more LDL reduction Image
Q1. Do statins reduce the risk of heart attack and stroke ?

"Statin therapy significantly reduces the incidence of major vascular events and vascular mortality in a wide range of people."
"Reduction of LDL cholesterol using statin therapy reduces all-cause mortality by about one tenth for each 1 mmol/L (39 mg/dl) reduction in LDL cholesterol, principally reflecting a significant reduction in vascular mortality."

Ref: cttcollaboration.org/efficacy-web-p…
Q2. Does more intensive LDL reduction with more dose of statin or with more powerful statins have incremental benefit ?

"Further reductions in LDL cholesterol produce definite further reductions in the incidence of major vascular events"
"Compared with less intensive statin regimens, more intensive regimens produced a highly significant 15% further reduction in major vascular events associated with a mean 0・51 mmol/L further LDL cholesterol reduction"

Ref: cttcollaboration.org/efficacy-web-p…
Q3. Do statins work in patients with diabetes ?

"Statin therapy is effective among patients with diabetes mellitus and should be considered for all diabetic individuals who are at sufficiently high risk of vascular events"
"There was a significant 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in people with diabetes, which was again similar to the effect observed in those without diabetes"

Ref: cttcollaboration.org/efficacy-web-p…
Q4. Do statins work in patients with low baseline risk of cardiovascular event (heart attack and stroke) ?

"The benefits of statins apply both to those at high risk and those at low risk of vascular disease"
"In individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction of about 11 fewer major vascular events per 1000 treated over 5 years."

Ref: cttcollaboration.org/efficacy-web-p…
Q5. Do statins work in women?

"In women and men at an equivalent risk of cardiovascular disease, statin therapy is of similar effectiveness for the prevention of major vascular events"
"the proportional reductions in major coronary events, coronary revascularization, and stroke did not differ significantly by sex."

Ref: cttcollaboration.org/efficacy-web-p…
So in brief cholesterol-lowering medications work.

Now if a WhatsApp message or someone on Twitter tells you to stop your cholesterol medications, you are better empowered to counter the same
If you still wish to discontinue your cholesterol medications after reading a series of meta-analysis done with data from more than 20 clinical trials involving more 175,000 trial participants and counting, you better get yourself good insurance because you are going to need it

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More from @omlakhani

24 Jun
If Toto Wolff gives a contract to Russell instead of Bottas for 2022, and then Hamilton retires, what happens next?
a) Ocon is already locked with Alpine till 2024

b) Lando is locked with McLaren

c) Leclerc and Sainz are unlikely to move out of Ferrari

d) If Max wins his maiden title with Red Bull, he is unlikely to leave the seat
They can retain Bottas, but after the humiliation will he stay ? Perhaps he would, but what if he decides to move on. Williams may potentially be more competitive next year
Read 7 tweets
24 Jun
Q1. Do statins reduce the risk of heart attack and stroke ?

"Statin therapy significantly reduces the incidence of major vascular events and vascular mortality in a wide range of people."
"Reduction of LDL cholesterol using statin therapy reduces all-cause mortality by about one tenth for each 1 mmol/L (39 mg/dl) reduction in LDL cholesterol, principally reflecting a significant reduction in vascular mortality."

Ref: cttcollaboration.org/efficacy-web-p…
Q2. Does more intensive LDL reduction with more dose of statin or with more powerful statins have incremental benefit ?

"Further reductions in LDL cholesterol produce definite further reductions in the incidence of major vascular events"
Read 13 tweets
24 May
Let us answer all the questions asked by this Dhongi Baba. I will try and answer 1 or 2 questions every day for the benefit of the general public. Please share so that the falsehood of this person is exposed on a daily basis.

Please retweet with the hashtag #RemoveRamdev....
Answer 1:

First, there is nothing like "Allopathy". Allopathy is a term used by the

Wikipedia says

"The terms were coined in 1810 by the inventor of homeopathy, Samuel Hahnemann. It was originally used by 19th-century homeopaths as a derogatory term for heroic medicine"
Q. What is "Heroic medicine" ?

"Heroic medicine was based on the belief that disease is caused by imbalance among the four "humours" (blood, phlegm, yellow bile, and black bile) and sought to treat disease symptoms by correcting that imbalance"

Ref: @Wikipedia
Read 16 tweets
23 May
Dear @verified

Please remove the verified status of one Mr Ram Kisan Yadav with the Twitter handle @yogrishiramdev . The person has violated the regulations of @Twitter and @TwitterIndia on several occasions. A suspension may also follow.

#SuspendRamdevfromTwitter
These are the policies that this person has violated on several occasions

help.twitter.com/en/managing-yo… Image
Recently the said person launched a video abusing doctors and health care professionals. This triggered the @IMAIndiaOrg and other organization to file official complaints against the person

timesofindia.indiatimes.com/city/ludhiana/… @TOIIndiaNews
Read 12 tweets
22 Apr
Q. What are steroids ?

Steroids are organic compounds with four rings in a very specific molecular configuration.

They are extensively found in plants and animals
Steroids have two main functions in a living thing:

a) They are part of the cell membrane
b) they act as hormones or signaling molecules in living things
Read 25 tweets
10 Mar
#Medtwitter #ClinicalPearl

This thread will tell you how Quackery works...
Step 1: Quacks understand the market needs. If patients find oncology treatment painful and expensive, they will 'create' a product for cancer. Quacks understand entrepreneurship
Step 2: Once the "area of need" is identified, quack delivers a product that is relatively cost-effective (and largely ineffective). It could be a mixture of "herbs", "natural product", some fancy-sounding "diet"
Read 19 tweets

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