BMJ Open杂志的一篇文章写到，对于大于60岁的老年人，高的低密度胆固醇（high LDL cholesterol）和死亡率呈逆相关性。作者说到，他们很多人也怀疑这个结论的真实性，但是结论的一致性是令人惊讶的。所以对于老年人他汀类药物的益处被夸大了。（这不是要砸很多人饭碗嘛）。当然也有很多专家提出这个结论的问题。
说到他汀类药物，想起学术推广中熟练运用数据的技巧，比如某药做了个SPERCL研究（如有雷同纯属巧合），入组研究前1-6个内患者脑卒中或TIA患者5000名，在随访的5年间，某他汀组265例患者发生死亡或非死亡脑卒中，安慰剂组为311例。DA上写到脑卒中发生风险比安慰剂组下降了15% 。数据很好，最终销量也很好。可仔细算算，其中只有46位患者受益，占某他汀组（n=2500）的1.84%，这数据还不如肿瘤药呢。
https://m.firstwordpharma.com/study-suggests-benefits-statin-therapy-older-adults-may-be-exaggerated
原文如下：
Study suggests benefits of statin therapy in older adults may be "exaggerated"
Ref: The Guardian;The Times;Daily Mail;NHS Choices;The Telegraph;BMJ Open
Findings published in the BMJ Open journal from a systematic review of cohort studies indicate that high LDL cholesterol is "inversely associated with mortality" in most people aged 60 years and older. The authors, who remarked that their "analysis provides reason to question the validity of the cholesterol hypothesis," are calling for guidelines on the prevention of cardiovascular disease and atherosclerosis in older adults to be re-evaluated as they said "the benefits from statin treatment have been exaggerated."
Investigators conducted a search of the PubMed database and identified cohort studies in which LDL cholesterol had been investigated as a risk factor for all-cause and/or cardiovascular (CV) mortality in individuals from the general population aged 60 years or more. In all, 19 English-language studies met the criteria for review, and these included 30 cohorts involving a total of 68 094 participants. All-cause mortality was recorded in 28 cohorts and CV mortality in nine cohorts.
Researchers found that there was an inverse association between LDL cholesterol and all-cause mortality in 16 cohorts, representing 92 percent of the studied patients, with statistical significance observed in 14 cohorts, while no link was observed in the remaining 12 cohorts. In the studies assessing a CV mortality link specifically, there was no association seen in seven cohorts, while the other two found that those with LDL cholesterol levels in the lowest quartile had the highest CV mortality.
"What we found in our detailed systematic review was that older people with high LDL levels…lived longer and had less heart disease," remarked co-author Malcolm Kendrick, adding "many of us suspected this may be true but the consistency of the results was astonishing." Kendrick also predicted that the findings would likely stir controversy, but he defended them as "robust" and "thoroughly reviewed."
Still, some experts have pointed to limitations in the study, including the reliance on a single database, not looking at levels of other blood lipids, and the possibility that other health and lifestyle factors might be influencing the link. Further, the study authors acknowledged that their findings do not take into account the statin use by some participants during the observation period, which "may have increased the lifespan for the group with high LDL cholesterol."
Jeremy Pearson, associate medical director at the British Heart Foundation, said some of the study's results were not surprising "because, as we get older, many more factors determine our overall health, making the impact of high cholesterol levels less easy to detect." Nevertheless, he added that "the evidence from large clinical trials demonstrates very clearly that lowering LDL cholesterol reduces our risk of death overall and from heart attacks and strokes, regardless of age."
