{"id":7948,"date":"2020-01-20T11:30:27","date_gmt":"2020-01-20T11:30:27","guid":{"rendered":"https:\/\/www.zoeharcombe.com\/?p=7948"},"modified":"2020-01-19T10:30:36","modified_gmt":"2020-01-19T10:30:36","slug":"ldl-cholesterol-targets-following-ischemic-stroke","status":"publish","type":"post","link":"https:\/\/www.zoeharcombe.com\/2020\/01\/ldl-cholesterol-targets-following-ischemic-stroke\/","title":{"rendered":"LDL-Cholesterol targets following ischemic stroke"},"content":{"rendered":"
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Executive summary<\/strong><\/p>\n

* A study was published in the NEMJ in January 2020. It reported on a clinical trial where 2,860 patients \u2013 who had had an ischemic stroke \u2013 were assigned to two different LDL-cholesterol targets.<\/p>\n

* The paper reported that the patients assigned to the lower LDL-cholesterol target group had a lower event rate during the approximately 3.5 years of follow up.<\/p>\n

* There were at least a dozen issues with the study:<\/p>\n

1) The trial was industry funded;<\/p>\n

2) The authors had extensive conflicts of interest;<\/p>\n

3) The trial was registered after it started, not before;<\/p>\n

4) The trial was stopped early;<\/p>\n

5) The trial measured the intended effects, but not side effects;<\/p>\n

6) The LDL-cholesterol targets were not achieved;<\/p>\n

7) If the LDL-cholesterol targets were not achieved and benefits occurred, they were the result of something else;<\/p>\n

8) The primary end points (the key events to be measured) were changed late in the trial with no reason given;<\/p>\n

9) The method of allowing for dropouts favoured the lower LDL-cholesterol target group;<\/p>\n

10) Few results were significant or generalisable;<\/p>\n

11) The data are due to be shared (only?) with the Cholesterol Treatment Trialists;<\/p>\n

12) Issues are present related to conflict and competence \u2013 and conspiracy?<\/p>\n

* This post goes through each of these issues with the conclusion that the peer review process has failed again.<\/p>\n

Introduction<\/strong><\/p>\n

Last week\u2019s note was about a non-industry-funded study, which examined thousands of people who had had a heart attack or acute heart failure and the relationship between their LDL-cholesterol levels and subsequent mortality. It found consistent relationships between having higher LDL-cholesterol and a lower risk of dying. These findings were supported by examination of all other studies available on the topic (i.e. systematic review).<\/p>\n

This week\u2019s note looks at an industry-funded study, which undertook a randomised trial involving 2,860 people who had had an ischemic stroke. It found that those in the lower LDL-cholesterol target group had fewer cardiovascular events than those in the higher LDL-cholesterol target group.<\/p>\n

These two papers \u2013 albeit one following heart disease and the other following one type of stroke \u2013 appear to contradict each other. What\u2019s going on?<\/p>\n <\/div>\n

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