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BMJ 2009; 338 doi: (Published 06 April 2009) Cite this as: BMJ 2009;338:b1423

People on haemodialysis get no cardiovascular benefit from statins

People on maintenance haemodialysis have a high risk of cardiovascular events and the search is on for a safe way to protect them from this lethal companion to end stage renal disease. Statins now join the long list of interventions that have fallen by the wayside, after rosuvastatin failed to protect patients from heart attacks, strokes, or death from cardiovascular disease in a placebo controlled trial (hazard ratio for rosuvastatin v placebo 0.96, 95% CI 0.84 to 1.11). All participants were over 50. About a quarter had diabetes, and about 40% had pre-existing cardiovascular disease. Rosuvastatin worked no better than a placebo for anyone, although it reduced serum concentrations of low density lipoprotein cholesterol by a mean of 43% from a baseline of 2.6 mmol/l.

The trial was large (n=2776) and just powerful enough to exclude a clinically meaningful effect, says an editorial (p 1455). The most likely explanation for the disappointing results is that statins simply don’t work in these patients—probably because their heart disease has an unusual aetiology that doesn’t respond to cholesterol lowering treatments. People on maintenance haemodialysis tend to have left ventricular hypertrophy and aortic calcification, rather than the atheromatous heart disease encountered in the general population.

US medical associations must cut ties with industry or lose public trust

Many opinion leaders in the US believe that the complex web of interactions between the drugs industry and professional medical associations is undermining scientific integrity, safe health care, and public trust in the profession. A purge is long overdue, and one group of authors recently set out in the clearest possible terms how associations should go about doing this. Their recommendations include working towards a ban on all industry funding, except for revenue from journal advertising and exhibition stands at meetings (which must be placed out of the way, so delegates are not forced to walk past …

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