Washington Post discovers distinction between "risk factor" and "risk"
In a story Saturday on "Heart Choices ," the Washington Post discusses the recent ENHANCE study showing, as they put it, the newer, more expensive anti-cholesterol drug Vytorin "is not known to be dangerous; it's just no better than the cheaper alternative." But the story goes on to draw a broader -- and much more important -- lesson:
lower LDL cholesterol itself is not the final goal; the goal is to lower the risk of heart disease and stroke. Only with the new study has it become known that Vytorin and Zetia are probably not superior to statins in improving health. Although another study looking directly as their effects on heart disease and stroke is underway, it looks as if consumers may hav been throwing away their money.
This distinction between "risk factors" such as LDL cholesterol and "risk" of heart attack and strokes (not an extrapolation from the risk factor findings, but an examination of the actual health outcomes), is one too often ignored and central to understanding the current controversy over whether or not to encourage general reduction of dietary salt. Salt reduction may affect the "risk factor" of blood pressure in many individuals; it also affects other disease "risk factors" such as insulin resistance, plasma renin activity and sympathetic nervous system activity. What it seems NOT to affect is the "risk" or rate of cardiovascular disease, CV events like heart attacks and strokes or, ultimately, mortality.
The Post says "FDA could take some steps to prevent similar waste." We agree. Stop advocating salt reduction in the absence of any evidence that it reduces heart attacks or strokes.
