Re: Fortune Magazine Story on NSAIDS, Statins, Aging

Hi Steve,
            This latest gushingly exuberant, one sided report of life
extending drugs which taken together have been shown by the latest
clinical trials and mega studies to give only a two month life
extension to normal people has made me wonder why the medical
establishment is so giddy over their best life extension efforts.
Steve has said a statin drug is the best life extending drug ever
developed. As this article exemplifies aspirin is thought to also be a
wonder drug. It gives a 6% increase in life expectancy in a megacohort
of normal people and cardiac patients. while Lovastatin shows a 4%
decrease in life expectancy in people with normal cholesterol, but hi
cardiac risk. For normal people at low to moderate risk of CHD
extrapolation of the results suggests an even more negative effect of
the statins, but more powerful very long term epidemiologic studies
indicate a probable benefit of aspirin in cancer and Alzheimer's. Yet
the medical establishment trumpets the life extending attributes of
these, their best efforts(?) as loudly as a goose who thinks it has
finally managed to lay a golden egg. Why?
           I think they are feeling left out. Natural medicine has
been hitting one home run after another in the last ten yrs. Daily nut
consumption and fish oil alone have been shown in a score of studies
to give a three to five year life extension benefit. (possibly as much
as five years if taken together, and their sole benefits are well
additive) Surely it hurts to see the enemy whom you have so strongly
criticized over the years strutting in a fine parade down Main St.
while you are still in the alley trying to jump start your pitiful
little floats. Many of us owe our lives to the medical establishment
for their fine work on vaccinations, public sanitation, yearly health
exams, and disease specific efforts. But now healthy adults have left
them behind in the effort to remain alive and healthy, and have done
so with very little leadership. Imagine what we could do if we joined
forces. Yes, I know it's a very remote possibility for the next decade
or so.
         Below I attach some references for my claims. Which unlike
those in the fortune article are very representative of the related
science and quite recent.

Thomas

Arch Intern Med. 2003 Sep 22;163(17):2006-10.  Related Articles, Links
An update on aspirin in the primary prevention of cardiovascular
disease.
Eidelman RS, Hebert PR, Weisman SM, Hennekens CH.
Division of Cardiovascular Research, Mount Sinai Medical Center--Miami
Heart Institute, Miami Beach, Fla., USA.
         BACKGROUND: In 1988, the aspirin component of the Physicians'
Health Study, a randomized, double-blind, placebo-controlled trial of
22 071 apparently healthy men was terminated early, due principally to
a statistically extreme (P<.00001) 44% reduction in the risk of a
first myocardial infarction (MI). The Cardio-Renal Drugs Advisory
Committee recommended that the US Food and Drug Administration approve
professional labeling of aspirin to prevent first MI. The agency did
not act on this recommendation because the only other trial, the
British Doctors' Trial of 5139 men, showed no significant benefits.
Since that time, 3 additional randomized trials (which included men
and women) of aspirin in the primary prevention of MI have been
published. METHODS: A computerized search of the English literature
from 1988 to the present revealed 5 published trials: the Physicians'
Health Study (22 071 participants), the British Doctors' Trial (5139),
the Thrombosis Prevention Trial (5085), the Hypertension Optimal
Treatment Study (18 790), and the Primary Prevention Project (4495).
RESULTS: Among the 55 580 randomized participants (11 466 women),
aspirin was associated with a statistically significant 32% reduction
in the risk of a first MI and a significant 15% reduction in the risk
of all important vascular events,

**but had no significant effects on nonfatal stroke or vascular
death.**

 CONCLUSIONS: The current totality of evidence provides strong support
for the initial finding from the Physicians' Health Study that aspirin
reduces the risk of a first MI. For apparently healthy individuals
whose 10-year risk of a first coronary event is 10% or greater,
according to the US Preventive Services Task Force and the American
Heart Association, the benefits of long-term aspirin therapy are
likely to outweigh any risks.PMID: 14504112
THIS IS FROM HEART, MAR, 2001  This mega study no doubt includes some
of those below.
Accepted 14 September 2000
OBJECTIVETo determine the cardiovascular and coronary risk thresholds
at which aspirin for primary prevention of coronary heart disease is
safe and worthwhile.
DESIGNMeta-analysis of four randomised controlled trials of aspirin
for primary prevention. The benefit and harm from aspirin treatment
were examined to determine: (1) the cardiovascular and coronary risk
threshold at which benefit in prevention of myocardial infarction
exceeds harm from significant bleeding; and (2) the absolute benefit
expressed as number needed to treat (NNT) for aspirin net of cerebral
haemorrhage and other bleeding complications at different levels of
coronary risk.
MAIN OUTCOME MEASURESBenefit from aspirin, expressed as reduction in
cardiovascular events, myocardial infarctions, strokes, and total
mortality; harm caused by aspirin in relation to significant bleeds
and major haemorrhages.
RESULTSAspirin for primary prevention significantly reduced all
cardiovascular events by 15% (95% confidence interval (CI) 6% to 22%)
and myocardial infarctions by 30% (95% CI 21% to 38%), and

**non-significantly reduced all deaths by 6%**

 (95% CI 4% to 15%). Aspirin non-significantly increased strokes by 6%
(95% CI 24% to 9%) and significantly increased bleeding complications
by 69% (95% CI 38% to 107%). The risk of major bleeding balanced the
reduction in cardiovascular events when cardiovascular event risk was
0.22%/year. The upper 95% CI for this estimate suggests that harm from
aspirin is unlikely to outweigh benefit provided the cardiovascular
event risk is 0.8%/year, equivalent to a coronary risk of 0.6%/year.
At coronary event risk 1.5%/year, the five year NNT was 44 to prevent
a myocardial infarction, and 77 to prevent a myocardial infarction net
of any important bleeding complication. At coronary event risk 1%/year
the NNT was 67 to prevent a myocardial infarction, and 182 to prevent
a myocardial infarction net of important bleeding.
CONCLUSIONSAspirin treatment for primary prevention is safe and
worthwhile at coronary event risk = " src="/math/12pt/normal/ges.gif"
1.5%/year; safe but of limited value at coronary risk 1%/year; and
unsafe at coronary event risk 0.5%/year. Advice on aspirin for primary
prevention requires formal accurate estimation of absolute coronary
event risk.

Here are two search strings which can be run at Medline and give the
true picture of the current thought on the relationship between NSAIDs
and Alzheimer's

alzheimer's AND NSAIDs AND Human AND (cohort study[mh] OR case control
study[mh]) NOT (asthma OR child* OR occupation* OR breast OR behavior*
OR infant OR prenatal OR Am J Obstet Gynecol OR infect* OR cervical OR
adolescent OR smok* OR HIV OR AIDS OR J Bone Joint Surg Br OR
management OR pregnancy OR pre-eclamps* OR surgery OR ear OR
pediatric* OR nurs* OR syndrome or critical care OR rehabilatat* OR
intensive care OR social OR Arch Otolaryngol Head Neck Surg. OR public
OR mental health OR J Am Acad Dermatol OR Obstet Gynecol. OR Am J Surg
Pathol OR reaction)

alzheimer's AND NSAIDs AND (clinical trial[pt] )

HPS: Statin Landmark Study
Evaluating 20,536 patients at 69 British medical centers over the
course of 5 years, HPS is the largest, most comprehensive randomized
trial conducted to date to evaluate the long-term effects of statin
drugs on vascular and nonvascular mortality and major morbidity. The
study examined specific high-risk patient groups that were not
considered traditional candidates for statin therapy, including those
at high risk with normal to low levels of low-density lipoprotein
cholesterol (LDL), patients with diabetes, women, persons older than
age 70, and patients with noncoronary vascular disease. Researchers
reported that a daily dose of 40 mg of simvastatin (Zocor, Merck)
significantly reduced all-cause mortality (12.9% vs 14.7%, P < .0001).
In addition, the drug was associated with a 24% reduction in the
incidence of "major vascular events" (ie, nonfatal myocardial
infarction [MI] and coronary death, stroke, and revascularization;
19.8% vs 25.2%; P < .0001) (Table 1). PMID: 12867249  Vascular
mortality was 7.6 vs 9.1% Stroke, non fatal MI and other vascular
events were not much better. This huge, recent, (2001) study closes
the door on statins for prevention in those without high LDL. A 13%
reduction in mortality.
@Heart disease

          Here is the only study done on a statin and people with
normal cholesterol.
     This is from the full text of PMID: 12817199   5.71 mmol
cholesterol level is moderately hi, not normal or at least not out of
the hi risk level. . 5.17 mmol/L=200 mg/dL
The focus returned to primary prevention, and AFCAPS/TexCAPS was a
placebo-controlled, randomized trial to investigate the effects of
lovastatin therapy on an average-risk healthy population with normal
total cholesterol levels (mean 5.71 +/- 0.54 mmol/L).[18] After an
average follow-up of 5.2 years in a total of 5608 men and 997 women,
the first major coronary event, defined as myocardial infarction,
unstable angina, or sudden death, was highly significantly reduced (RR
0.63, 95% CI 0.50-0.79). A similar marked improvement was seen in risk
of myocardial infarction, unstable angina, and coronary
revascularization.

** Although no adverse effect of therapy was seen in comparison with
the placebo group, there was no difference in the total mortality of
the 2 groups.[19] In fact, there were 80 deaths in the lovastatin
group and 77 in the placebo group **

(RR 1.04, 95% CI 0.76-1.42). What was equally striking was that of the
total deaths (157) in both the treatment and placebo groups, more than
two thirds (115) were from noncardiovascular causes. This emphasizes
the point that in a group of people not at high risk of coronary
deaths, therapy to lower cholesterol cannot do very much to lower
mortality as the patients are more likely to succumb to
noncardiovascular causes. Previous experiences with nonstatin
hypocholesterolemic drugs have revealed similar findings of a
reduction in cardiac end points without total mortality reduction in
primary prevention trials. AFCAPS/TexCAPS thus emphasizes the point
that in primary prevention, targeting patients at higher risk will
bring a bigger impact at lower cost.[20,21] Furthermore, the safety
and efficacy of lovastatin is most welcomed given its lower cost
compared with the other patented statins