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May 10, 2007
Meteor and asteroid
Don't you love the names of these studies? Decades ago, it was the rare trial that had a memorable name. Now they all have these great acronyms. METEOR -- Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin -- looked at a surrogate end-point (the thickness of one layer in the carotid artery) for risk from subclinical (no symptoms) atherosclerosis. They measured the progression of this thickness over two years with a statin and placebo. They found statistically significant reduction in the rate of progression with the statin.
Great but useless. Ever since we learned to measure things medical, like specific gravity (of urine) and temperature, we have made measurement more important than life. Even the JAMA editorial recognizes the minimal value of surrogate end points (looking at some measurement other than the clinically important one). As Dr. Lauer points out, numerous agents which improved surrogate endpoints "were even found to cause harm when tested for their ability to prevent clinical events."
Statins may improve even certain clinical events (heart attack or stroke) under the right controlled conditions. But the evidence does not exist for a meaningful reduction in all cause mortality. In other words, they might prevent a heart attack but you still die in the same time of something else. But METEOR showed that the progression was not reversed by the statin. So maybe if all the low risk people are started on it soon enough, it would help. That is 50% of 50 year old men and 40 % of 50 year old women. Treat half the population to slow down an unproven connection in a handful. Is this clinical, social or cultural iatrogenesis? They are blurring now.
| By Robert Maddox | 10:02 PM
Comments
Posted by: Dr. Alice at May 11, 2007 12:39 PM