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Then we are at an uncrossable philosophical chasm.

I don’t consider 2% ARR huge — especially when the risks of side-effects have been down-played. We can argue about this all we want, but it’s no longer a matter of fact, but of opinion and values.

[haldujai]

You seem to be misunderstanding how evidence works, it is not about “what you consider” and is entirely based on fact. We also don’t talk ARR in isolation when we decide on interventions, it’s NNT vs NNH and considering the specific risk being reduced and the specific harm.

I’ll use your 2% ARR for death although there are better numbers in different patient populations.

In other words: Statins will save 1 life for every 50 patients treated and prevent 1 in ~20-40 non-fatal cardiac events, a medically significant result period. The NNH is > 100, and the harm is a self-limiting myopathy (and a possible risk of accelerated diabetes-onset in observational studies, that is still outweighed by the reduction in all-cause mortality and MACE).

The evidence is unequivocal that the benefits far outweigh the harms.

Separately, you have a personal choice to take/not take any treatment, and you may personally feel treating 50 people to save 1 life is not worth it for you, because you subjectively feel the numbers don’t fit your personal risk/benefit model. This is where you are saying 2% ARR is insignificant to you but this says nothing about the evidence or rationale behind the treatment.

> risks of side-effects have been down-played.

Except every study looking at side-effects has shown they were overstated in the initial trial.

“The most severe complication of SI is discontinuation of effective cholesterol-lowering treatment in patients who, by virtue of their CVD risk and cholesterol level, might otherwise benefit.”

https://www.sciencedirect.com/science/article/abs/pii/S00219...

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This conversation is going in circles.

Linked study equivocating on the overstatement of statin side-effects has the first author as a pharmaceutical consultant (you do not see this as a problem, I do).

2% ARR is meager in relation to lifestyle changes that can account for 3x-15x the in ARR compared to statins (you do not see this as a problem, I do).

Those are the facts. How you interpret them is subjective.

All of the money and manpower thrown into statins, could have been thrown into smoking cessation programs or preventing onset of type 2 diabetes. This is an opinion.

Saving 1 life for every 50 patients, at the cost of untold resources, instead of saving 6-30 for every 50 is myopic. This is an opinion.

Medical significance is an opinion. The determination of significance is a subjective interpretation. This is not a "this idea concurs with my sentiments, so I will say it is so. Period." This is math. Statistical interpretation is an opinion. The difference in statin efficacy vs. lifestyle changes is a quantifiable fact. The difference is 3-15x. To take a statistical finding without incorporating it into the larger context is poor practice, bordering on deception (the former is a fact, the latter is an opinion).

Here are 50 people aged 50 y.o. from the general population:

OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO

Here is the same group of people after 25 years (14 have died due to CVD-related mortality):

XXXXX_XXXXX | XXXXO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO

Here is the same group of people after 25 years, but they were on statins:

XXXXX_XXXXX | XXXOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO

Here is the same group of people after 25 years, but instead of statins, the smokers ceased smoking:

XXXXX_XXXXX | OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO | OOOOO_OOOOO

Here is the same group of people after 25 years, but instead of a treatment, all of them developed diabetes:

XXXXX_XXXXX | XXXXX_XXXXX | XXXXX_XXXXX | XXXOO_OOOOO | OOOOO_OOOOO

[haldujai]

> at the cost of untold resources

Not going to argue the methodology but it seems like a starting point is $22,000-37000/QALY[0-1].

> instead of

This is a false dichotomy, guidelines all start with lifestyle modifications.

[0]https://jamanetwork.com/journals/jamacardiology/fullarticle/...

[1]https://jamanetwork.com/journals/jama/article-abstract/23964...