Actuaries are individuals who use mathematics to assess, among other things, the financial impact of risk and uncertainty. Their critical analysis of data is an essential part of evaluating things like how much our we pay for our insurance premiums and what our pension contributions should be. I was recently made aware of a piece which appeared in the August 2011 edition of Actuary – the Magazine for the Actuarial Profession. Written by actuary Garth Lane and entitled Heart of the Matter, it deftly disassembles many of the cherished beliefs held by the medical profession that related to heart disease and its prevention [1].
Mr Lane starts by skewering original research conducted in the 1950s by epidemiologist Ancel Keys which purported to show a relationship between fat consumption and heart disease in a handful of countries. But as Mr Lane points out, this represented a ‘misuse’ of the data. When we look at the wider evidence available at the time, the supposed relationship between fat and heart disease simply disappears.
Subsequently, the focus was thrown on cholesterol-containing foods. But, as Mr Lane points out, in the late 1990s Ancel Keys himself admitted that “There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter unless you happen to be a chicken or a rabbit.”
So, what is the relationship between cholesterol levels and heart disease? Mr Lane points our attention towards a study published in 2009 which measured supposedly unhealthy LDL-cholesterol in almost 137,000 individuals admitted to hospital with a heart attack [2]. 75 per cent of hear attack victims had LDL levels below the recommended threshold of 3.4 mmol/l (130 mg/dl). Yes, that’s right – the majority of people who have a heart attack have cholesterol levels their doctor would be proud of.
Mr Lane goes further when he refers to the fact that in ‘primary prevention’ (people without established cardiovascular disease), statins do not save lives. He also draws our attention to the risk of ‘probably under-reported’ side-effects including liver and muscle damage.
Here’s Mr Lane’s closing paragraph in full: “Statins are not the swallows heralding a summer free of heart disease for everyone. Arguably, if we do not insist on a proper answer to the question of what really causes heart disease then we may unduly medicate millions of people for little benefit at the danger of making a significant number of them seriously ill.”
I wholeheartedly agree with Mr Lane on this, and ask, how come he sees this but the vast majority of doctors don’t? Could part of the reason be that actuaries are trained to take a critical eye data, but we doctors are not (although, we think we are). And could another reason be something to do with money? Some elements of industry, at least in part to swell the coffers, will seemingly contort the evidence to convince doctors that statins are wonder drugs. Actuaries do work that has financial implications too, the difference being that decisions are based on more objective analysis of the facts.
References:
1. Lane G. Heart of the Matter. Actuary. August 2011;28-29
2. Sachdeva A, et al. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009;157(1):111-117.
