Andrew Alexander

Army veteran: Infantry officer, MI, Korean linguist.
Software developer, licensed drone pilot, photographer, woodworker, Ham radio operator. Member of Mensa.

[Andrew Alexander @ndrwlx]

@UsNdHealth @drdenwalker That last one is in pharma's own literature, if you read the fine print.

[Andrew Alexander @ndrwlx]

Typical NNT for preventing one major cardiovascular event (heart attack, stroke, or CV death) over 4–5 years in higher-risk/secondary prevention patients is often around 30–80.

For all-cause mortality, it’s frequently higher (80–150+), meaning 1 life saved per 80–150 people treated for several years.

In lower-risk/primary prevention, the NNT can be 100–200+.

[Andrew Alexander @ndrwlx]

Cholesterol Treatment Trialists’ (CTT) Collaboration meta-analyses (Lancet, various years including 2010, 2019) — These are the big ones often cited for statins. They show clear relative benefits, but when you convert to absolute numbers, the gains are smaller (especially in primary prevention). Later CTT work has been critiqued for how they handle absolute vs relative risk and composite endpoints.

Redberg et al. and others in JAMA Internal Medicine / BMJ — Multiple papers and editorials over the years have highlighted that absolute benefits in many statin trials are small (often 1% or less for key outcomes over 5 years) while side effects and long-term data on quality of life get less attention.

2013–2016 USPSTF reviews and related meta-analyses — Showed small absolute benefits in primary prevention.

More recent critiques (e.g., 2023–2025 papers and letters) — Some re-analyses or editorials continue to argue that the absolute benefits are overstated in guidelines relative to the data, particularly when weighed against lifelong therapy, cost, and potential side effects.

[Andrew Alexander @ndrwlx]

Byrne et al. 2022 JAMA Internal Medicine Meta-Analysis Title: Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis.

Source: JAMA Intern Med. Published online March 14, 2022. doi:10.1001/jamainternmed.2022.0134.

Details: Pooled analysis of 21 randomized controlled trials with >120,000 participants (mean follow-up 4.4 years) comparing statins vs placebo or usual care.

Main Results/Benefits: Statin therapy was associated with modest absolute risk reductions (ARR) of 0.8% for all-cause mortality, 1.3% for myocardial infarction, and 0.4% for stroke. This is for overall risk, including both primary and secondary risk reduction.

Relative risk reductions were larger (9%, 29%, and 14% respectively).

The authors emphasized that absolute benefits are smaller than relative risk figures often imply and stressed the value of discussing absolute numbers with patients for informed shared decision-making.

No strong linear relationship was found between the degree of LDL-C lowering and clinical outcomes in some adjusted analyses.

[Andrew Alexander @ndrwlx]

Relative vs Absolute Risk (Byrne et al., JAMA Intern Med 2022) Key finding: Across 21 statin trials, absolute risk reduction for all-cause mortality was modest (0.6% primary prevention, 0.9% secondary prevention). NNT ≈ 111–167 people treated for ~4–5 years to prevent one death.

[Andrew Alexander @ndrwlx]

I guess you don't know that that area of the White House has been renovated about 18 times in the last 100 years or so. But no one had a problem with it being turned into a swimming pool or a basketball court. That was paid for with our taxes. The ballroom is far more classy and useful than those things.

[Andrew Alexander @ndrwlx]

@elonmusk Not news to me. Read the book many years ago. And others that show the same thing.

[Andrew Alexander @ndrwlx]

@elliotgreenIP @bosshoss101 @AjRockatansky And by the way, your cognitive dissonance is showing. Don't let the facts get in the way of your belief system. As you accuse everyone else of doing.

[Andrew Alexander @ndrwlx]

@elliotgreenIP @bosshoss101 @AjRockatansky It's in the JAMA Internal Medicine. 14 March, 2022.

By the way, do you how much big pharma paid "peer reviewers" between the years 2020 and 2022? Look it up.

[Andrew Alexander @ndrwlx]

“Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis” by Paula Byrne, PhD, and colleagues.

The authors pooled data from 21 randomized statin trials (˜120,000 participants, average follow-up ~4.4 years). They looked at both primary prevention (people without prior heart disease) and secondary prevention.

All-cause mortality: Statins produced a small absolute risk reduction (ARR) of about 0.6% in primary prevention and 0.9% in secondary prevention.
That translates to an NNT of roughly 167 (primary) to 111 (secondary) — meaning you’d need to treat ~111–167 people for ~4–5 years to prevent one additional death from any cause.

Relative risk reduction (RRR) for mortality was ~13–14% (the number often quoted in headlines or ads).
For heart attack and stroke, the absolute benefits were also modest (e.g., ~0.7–2.2% ARR depending on the outcome and population).
The paper specifically noted that the magnitude of LDL-C lowering did NOT clearly predict the size of the mortality or event benefit — a key point that challenges the simple “lower LDL = proportionally lower death risk” assumption used in many guidelines.

[Andrew Alexander @ndrwlx]

@elliotgreenIP @AjRockatansky How many people do you have hear about improving all the things you think can't be improved on, and there are countless. And it's still a sample size of one? Wow, you have a math problem.

[Andrew Alexander @ndrwlx]

@grok @pjalphareacts @ksorbs FYI, when I asked Grok directly, with this same image, it knew exactly what it referred to.

[Andrew Alexander @ndrwlx]

@higgins98887 @its_The_Dr If you're a Muslim and you don't want to kill all the infidels, then you're not following your religion. Take a look at the Koran.

[Andrew Alexander @ndrwlx]

@orsonscottcard @thomas_garrard Read the whole series and many other OSC books.

[Andrew Alexander @ndrwlx]

@CaryKelly11 64 and no tats.

[Andrew Alexander @ndrwlx]

@DaleBegue2 @BadTasteTee Apparently I'm not intelligent enough to comprehend what you're talking about. But thanks for your classy response.

[Andrew Alexander @ndrwlx]

@BadTasteTee This is a another myth based on a study that people have used to support this narrative. The actual study said that more intelligent people have and use a wider vocabulary, which "may include swear words".

[Andrew Alexander @ndrwlx]

@DaleBegue2 @BadTasteTee That is false. The F word has been around since the 1100s. Has nothing to do with those myths.

[Andrew Alexander @ndrwlx]

@SoveyX Love the Koreans. I was stationed there for a while and was a Korean linguist. I still try to keep up the ability to speak it.

[Andrew Alexander @ndrwlx]

@JoeyMannarino Yep.