CAN YOU TRUST TODAY'S "SCIENTIFIC" GUIDELINES FOR THE TREATMENT OF CARDIOVASCULAR DISEASE?
The title of today's post raises a pertinent question; can the current medical guidelines for treating cardiovascular disease be trusted? Sure they can. If you are big pharma or big medicine you can trust them to be your continual cash cow --- a revenue stream that's definitely more raging river than gentle brook.
I've written extensively about MEDICAL GUIDELINES in general, but a brand new study on cardiovascular guidelines was published in today's issue of JAMA Network (Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018) concerning two organizations that I have, upon several occasions, said were as corrupt as any within the academic medical community --- the American Heart Association (AHA) and American College of Cardiology (ACC).
After looking at over 6,300 recommendations by the world's three most prestigious cardiovascular societies --- two from America and one from Europe (at an average of 125 recommendations per guideline) --- these authors, from Duke, Stanford, and the University of Bern in Switzerland, concluded that on average, less than 10% have rigorous evidence behind them. This is even worse than what Duke's David Eddy told us nearly three decades ago in his landmark study published in a 1991 issue of the British Journal of Medicine --- Where is the Wisdom? The Poverty in Medical Evidence (he said less than 15% of all treatments / recommendations are backed by solid evidence). As far as today's study from JAMA Network is concerned, take a peek at these, cough cough ahem, conclusions.
"Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs (randomized controlled trials) or a single, large RCT. This pattern does not appear to have meaningfully improved from 2008 to 2018."
The real question is why? Why are the American recommendations from the ACC and AHA, when added together, only supported by real evidence 8.5% of the time (the European recommendations were a whopping 14%)? Look no further than the recent avalanche of fake news concerning the new fish oil "drug," VASCEPA, that the AHA and ACC have been fawning over for two years. Or you could look at some cardiovascular guidelines that came out just yesterday.
The US Preventative Services Task Force issued an official "recommendation" (their equivalent of a Papal Bull) titled Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication.
"The USPSTF used a CVD microsimulation model to estimate cardiovascular event rates based on baseline risk factors and aspirin use. It used the AHA/ACC risk calculator to stratify findings of benefits and harms by 10-year CVD risk. The USPSTF also calculated estimates of CRC incidence and harms of bleeding to determine the net balance of benefits and harms across individuals with varying baseline CVD risk.... Nearly 40% of U.S. adults older than 50 years use aspirin for the primary or secondary prevention of CVD."
Aspirin use is no small thing. As time has progressed it's become increasingly clear that just like NSAIDS, aspirin is not nearly as safe as people have been led to believe (HERE). According to a 2014 study from Clinical Medicine and Research (The Role of Aspirin in the Prevention of Cardiovascular Disease), not only is aspirin "the most widely used drug in medicine, with nearly 20% of adults in the United States reported taking aspirin daily or every other day, increasing to nearly 50% in those aged 65 and older," but these recommendations have been in place since the 1980's. What should also be noted is that the authors re-crunched the data from history's nine largest aspirin trials, coming to some interesting conclusions of their own.
"In the last 30 years, nine major trials have examined the benefit of aspirin for primary CVD prevention.... When cardiovascular and all-cause mortality was assessed, no statistically significant effect on all-cause mortality was observed."
Folks; that means that not only did the proverbial "aspirin-a-day" mantra prove ineffective at preventing death in those with cardiovascular disease, it did noting to slow down death rates from everything else either, including the myriad of diseases caused by INFLAMMATION. Despite this, just last September the ACC (New Data on Aspirin Use in the Era of More Widespread Statin Use) was still recommending aspirin for most adults, age 40 to 70. Sort of makes you wonder when the new recommendations are going to come out on STATIN DRUGS? No, I'm not holding my breath.
As I've shown you in my posts on EVIDENCE-BASED MEDICINE, there is really only one reason these sorts of recommendations are produced and followed for decades, despite significant evidence to the contrary. Money. With the people writing guidelines often having their fingers in a wide array of financial and pharmaceutical pies, it's no surprise that we can trust neither the recommendations from private entities like those of the ACC or AHA nor the recommendations from governmental watchdog agencies such as the FDA (HERE). What should people be doing instead?
Instead of continuing to live an inflammation-producing / inflammation-saturated life and then trying to mop up the effects of excess SYSTEMIC INFLAMMATION with an array of drugs, why not simply turn off the faucet that's perpetually flooding your body with inflammation in the first place? Fortunately for you I am giving you a way to start the process (HERE), completely free, as in no charge to you. While not a panacea or cure-all, the simple fact is that if you can reduce your body's systemic inflammatory load, good things tend to happen, body and soul! If you appreciate what goes into creating these posts, be sure and spread the wealth by liking, sharing, or following on FACEBOOK, since it's still an effective way of reaching those you love and value most.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).