JAMA Internal Medicine, Jaundiced Headlines and Cardiovascular Health
Wow! What is the agenda of the Editors of JAMA Internal Medicine? Why the use of opinionated subtitles like “Gluttony in the Time of Statins”? Or “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements”? Do the managers of this medical journal believe that such headings advance scientific discourse? Do they believe these interpretations help inform consumers to adopt healthier behaviors? Or is the goal simply to get their journal name in the media? In other words, to build brand awareness?
Sugiyama and colleagues examined trends in 24h dietary intake records (calories and fat) of a nationally representative cross-section of US adults. They compared temporal trends between statin users, prescribed by physicians to reduce serum cholesterol concentrations, and non-users. Statin users had statistically lower caloric intake than non-statin users until 2003-2004. From 2005-2006, average daily caloric intake was similar. In 2009-2010, the average caloric intake of statin users was numerically greater (for the first time) but not statistically different from non-users (Fig 1). A similar trend was found for fat intake. In both cases, the mean intake values between users and non-users were not statistically different in 2005-2006, 2007-2008, and 2009-2010. Within the discussion, the authors wrote:
“Owing to the self-reported nature of the information on diet in the present study, and the repeated cross-sectional design, the observed increase in caloric and fat intake should be interpreted carefully. First, because the information on nutrients was collected through dietary recall interview, the result was subject to social desirability bias (tendency to provide answers that convey a favorable image of the interviewee24); in the extreme, if statin users became less likely to hesitate to reveal their true intake, our observations might not reflect true change in diet.”
In other words, the JAMA Internal Medicine subtitle does not jive with the discussion. Just like a December editorial on multivitamin and mineral supplements was not generalizable to the American population.
The Hippocratic oath requires health practitioners to act in the best interest of their patients. Shouldn’t this extend to the sharing of guidance? Guidance based on evidence rather than opinions. The new American College of Cardiology and American Heart Association guidelines are projected to have doctors prescribing statins to 12.8 million more people, a total of >50 million. Eighty percent will be adults without cardiovascular disease. Statin use is associated with a 13% increased risk of newly diagnosed diabetes mellitus. The majority of statin users (62%) who stop using statins do so because of muscle pain and/or weakness. Two meta analyses have shown no mortality benefit with statin use. When doctors prescribe statins to reduce cardiovascular risk factors, patients should be advised of the risks of prescription drugs, even statin drugs. Patients should be taught about the importance of healthy diet and activity behaviors.
Maybe the medical profession doesn’t believe nutrition affects health outcome. Maybe medical doctors are becoming cynical that their patients will change lifelong habits. Maybe.
Regardless, for the benefit of everyone – scientists and consumers, I wish JAMA Internal Medicine would editorialize less and stick to reporting the conclusions of their contributors.
Sugiyama T, Tsugawa Y, Tseng C-H, Kobayashi Y, Shapiro MF. Different time trends of caloric and fat intake between statin users and nonusers among US adults. 2014 JAMA Intern Med doi: 10.1001/jamainternmed.2014.1927
Guallar E, Stranges S, Mulrow C, Appel LJ, Miller III ER. Enough is enough: Stop wasting money on vitamin and mineral supplements. 2013 Ann Intern Med doi:10.7326/0003-4819-159-12-201312170-00011
Redberg RF, Katz MH. Reassessing benefits and risks of statins. 2012 NEJM doi: 10.1056/NEJMc1207079
Goldfine AB. Statins: Is it really time to reassess benefits and risks? 2012 NEJM doi:10.1056/NEJMp1203020