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Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices?

      The cardiovascular risk reduction associated with different statins for the prevention of cardiovascular disease and the cardiovascular risk increase associated with excess dietary intake of fat have been quantified. However, these relative risks have never been directly juxtaposed to determine whether an increase in relative risk by 1 activity could be neutralized by an opposing change in relative risk from a second activity. The investigators compared the increase in relative risk for cardiovascular disease associated with the total fat and trans fat content of fast foods against the relative risk decrease provided by daily statin consumption from a meta-analysis of statins in primary prevention of coronary artery disease (7 randomized controlled trials including 42,848 patients). The risk reduction associated with the daily consumption of most statins, with the exception of pravastatin, is more powerful than the risk increase caused by the daily extra fat intake associated with a 7-oz hamburger (Quarter Pounder®) with cheese and a small milkshake. In conclusion, statin therapy can neutralize the cardiovascular risk caused by harmful diet choices. In other spheres of human activity, individuals choosing risky pursuits (motorcycling, smoking, driving) are advised or compelled to use measures to minimize the risk (safety equipment, filters, seatbelts). Likewise, some individuals eat unhealthily. Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments. Although no substitute for systematic lifestyle improvements, including healthy diet, regular exercise, weight loss, and smoking cessation, complimentary statin packets would add, at little cost, 1 positive choice to a panoply of negative ones.
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      References

        • World Health Organization
        Part 2: causes of death and part 4: burden of disease DALYs.
        in: Global Burden of Disease: 2004 Update. World Health Organization, Geneva, Switzerland2008: 8-26
        • Nemetz P.
        • Roger V.
        • Ransom J.
        • Bailey K.
        • Edwards W.
        • Leibson C.
        Recent trends in the prevalence of coronary disease.
        Arch Int Med. 2008; 168: 264-270
        • Rose G.
        Sick individuals and sick populations.
        Int J Epidemiol. 1985; 14: 32-38
        • Schlosser E.
        Fast Food Nation.
        Houghton Mifflin, Boston, Massachusetts2001
        • Prentice A.M.
        • Jebb S.A.
        Fast foods, energy density and obesity: a possible mechanistic link.
        Obes Rev. 2007; 4: 187-194
        • Barratt A.
        • Wyer P.C.
        • Hatala R.
        • McGinn T.
        • Dans A.L.
        • Keitz S.
        • Moyer V.
        • Guyatt G.
        Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat.
        CMAJ. 2004; 171: 353-358
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Dans T.
        • Avezum A.
        • Lanas F.
        • McQueen M.
        • Budai A.
        • Pais P.
        • Varigos J.
        • Lisheng L.
        • INTERHEART Study Investigators
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study).
        Lancet. 2004; 364: 937-952
        • LaRosa J.C.
        • Grundy S.M.
        • Waters D.D.
        • Shear C.
        • Barter P.
        • Fruchart J.C.
        • Gotto A.M.
        • Greten H.
        • Kastelein J.J.P.
        • Shepherd J.
        • Wenger N.K.
        • Treating to New Targets (TNT) Investigators
        Intensive lipid lowering with atorvastatin in patients with stable coronary disease.
        N Engl J Med. 2005; 352: 1425-1435
        • Ascherio A.
        • Rimm E.B.
        • Spiegelman D.
        • Stampfer M.
        Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States.
        BMJ. 1996; 313: 84-90
        • Easty D.L.
        The relationship of diet to serum cholesterol levels in young men in Antarctica.
        Br J Nutr. 1970; 24: 307-312
        • Mente A.
        • Koning L.
        • Shannon H.
        • Anand S.
        A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease.
        Arch Intern Med. 2009; 169: 659-669
      1. (Accessed July 9, 2010)
        • Thavendiranathan P.
        • Baggi A.
        • Brookhart A.
        • Choudhry N.
        Primary prevention of cardiovascular diseases with statin therapy.
        Arch Int Med. 2006; 166: 2307-2313
        • Colhoun H.M.
        • Betteridge D.J.
        • Durrington P.N.
        • Hitman G.A.
        • Neil H.A.
        • Livingstone S.J.
        • Thomason M.J.
        • Mackness M.I.
        • Charlton Menys V.
        • Fuller J.H.
        • CARDS Investigators
        Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial.
        Lancet. 2004; 364: 685-696
        • Wilson P.W.F.
        • D'Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Prospective Studies Collaboration
        Blood cholesterol and vascular mortality by age, sex and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55000 vascular deaths.
        Lancet. 2007; 370: 1829-1839
        • Neaton J.D.
        • Wentworth D.
        • Multiple Risk Factor Intervention Trial Research Group
        Serum cholesterol, blood pressure, cigarette smoking and death from coronary heart disease: overall findings and differences by age for 316099 white men.
        Arch Int Med. 1992; 152: 56-64
        • De Backer G.
        • Ambrosioni E.
        • Borch-Johnsen K.
        • Brotons C.
        • Cifkova R.
        • Dallongeville J.
        • Ebrahim S.
        • Faergeman O.
        • Graham I.
        • Mancia G.
        • Manger Cats V.
        • Orth-Gomer K.
        • Perk J.
        • Pyorala K.
        • Rodicio J.L.
        • Sans S.
        • Sansoy V.
        • Sechtem U.
        • Silber S.
        • Thomsen T.
        • Wood D.
        • Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice
        Executive summary: European guidelines on cardiovascular disease prevention in clinical practice.
        Eur Heart J. 2003; 24: 1601-1610
        • Greenland P.
        • Smith S.C.
        • Grundy S.M.
        Improving coronary heart disease risk assessment in asymptomatic people.
        Circulation. 2001; 104: 1863-1867
        • Asia Pacific Cohort Studies Collaboration
        Joint effects of systolic blood pressure and serum cholesterol on cardiovascular disease in the Asia Pacific region.
        Circulation. 2005; 112: 3384-3390
        • Hozawa A.
        • Folsom A.R.
        • Sharrett A.R.
        • Chambless L.E.
        The Atherosclerosis Risk in Communities Study (ARIC): absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors.
        Arch Intern Med. 2007; 167: 573-579
        • Leosdottir M.
        • Nilsson P.M.
        • Nilsson J.A.
        • Mansson H.
        • Berglund G.
        Dietary fat intake and early mortality patterns: data from the Malmo Diet and Cancer Study.
        J Intern Med. 2005; 258: 153-165
        • Hooper L.
        • Summerbell C.D.
        • Higgins J.P.T.
        • Thompson R.L.
        • Capps N.E.
        • Davey Smith G.
        • Riemersma R.A.
        • Ebrahim S.
        Dietary fat intake and prevention of cardiovascular disease: systematic review.
        BMJ. 2001; 322: 757-763
        • Law M.
        • Wald N.
        • Rudnicka A.
        Quantifying effect of statins on low density lipoprotein cholesterol, ischemic heart disease, and stroke: systematic review and meta-analysis.
        BMJ. 2003; 326: 1423-1429
        • Nichols A.
        • Ravenscroft C.
        • Lamphiear D.E.
        • Ostrander Jr, L.D.
        Daily nutritional intake and serum lipid levels.
        Am J Clin Nutr. 1976; 29: 1384-1392
        • Clarke R.
        • Frost C.
        • Collins R.
        • Appleby P.
        • Peto R.
        Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies.
        BMJ. 1997; 413: 112-117
        • Law M.R.
        • Wald N.J.
        • Thompson S.G.
        By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?.
        BMJ. 1994; 308: 367-372
        • Mills E.J.
        • Rachlis B.
        • Wu P.
        • Devereaux P.J.
        • Arora P.
        • Perri D.
        Primary prevention of cardiovascular mortality and events with statin treatments.
        J Am Coll Cardiol. 2008; 52: 1769-1781
        • Pletcher M.J.
        • Lazar L.
        • Bibbins-Domingo K.
        • Moran A.
        • Rodondo N.
        • Coxson P.
        • Lightwood J.
        • Williams L.
        • Goldman L.
        Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering.
        Ann Int Med. 2009; 150: 243-254
        • Jacobson T.
        Statin safety: lessons from new drug applications for marketed statins.
        Am J Cardiol. 2006; 97: S44-S51
        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • Blackwell L.
        • Buck G.
        • Pollicino C.
        • Kirby A.
        • Sourjina T.
        • Peto R.
        • Collins R.
        • Simes R.
        • Cholesterol Treatment Trialists' (CTT) Collaborators
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
        • Newman C.
        • Tsai J.
        • Szarek M.
        • Luo D.
        • Gibson E.
        Comparative safety of atorvastatin 80mg versus 10mg derived from analysis of 49 completed trials in 14,236 patients.
        Am J Cardiol. 2006; 97: 61-67
        • Rasumssen J.N.
        • Chong A.
        • Alter D.A.
        Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction.
        JAMA. 2007; 297: 177-186
        • Ridker P.M.
        • Danielson E.
        • Fonseca F.A.
        • Genest J.
        • Gotto Jr, A.M.
        • Kastelein J.J.
        • Koenig W.
        • Libby P.
        • Lorenzatti A.J.
        • MacFadyen J.G.
        • Nordestgaard B.G.
        • Shepherd J.
        • Willerson J.T.
        • Glynn R.J.
        • JUPITER Study Group
        Rosuvastatin to prevent vascular events in men and women with elevated CRP.
        N Engl J Med. 2008; 359: 2195-2207