They say that lobbying is a good thing. Because politicians can’t understand everything they’re supposed to pass laws on. But what if MPs have to understand 59 footnotes? That’s what happened in a recent statement by the German Society of Cardiology (DGK) about the so-called “Healthy Heart Act”. Interested readers, including those in parliament, rub their eyes in amazement and ask themselves: Who is supposed to understand all this? No problem! That’s why we exist, dear MPs. We help you through the thicket of study.
Spoiler: We ourselves have been shocked at how selective sourcing can be used to try to support claims with alleged evidence that is not even evidence or, in the most egregious case, even disproves the claim. Or to put it another way: just search enough on Pubmed to find alleged evidence that the Earth is flat. Or even easier: just add random footnotes (Public Science 2023; 32(7): 835-844). (Duration: 53:25 minutes)
Summary
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In the current episode of the EvidenzUpdate podcast, Denis Nößler and Martin talk about the “Healthy Heart Act” (GHG) and the statement by the German Society of Cardiology (DGK) about it. Scherer describes the GHG as an “absolute waste of time”. The law is going in the completely wrong direction and is causing more harm than good. “The biggest problem with the draft law is that the symptoms of our struggling healthcare system would be exacerbated by the planned law.”
Scherer takes a critical view of the evidence base in the current DGK statement. The sources used are not systematic but rather selective. According to Scherer, the cited ESC guidelines are also not based on a systematic literature search and have significant conflicts of interest. He sees another problem in the requirement for LDL target values in the cited ESC guidelines.
Scherer also criticizes the lack of systematic reviews and important studies in the DGK statement, such as the recent US Preventive Services Task Force (USPSTF) assessment of lipid screening in children.
In his appeal to the members of the German Bundestag, Scherer urges them to carefully examine the statements and look closely at the scientific basis. If the GHG bill becomes law, “in my opinion the fun will stop”. It should be about making well-founded, evidence-based decisions that actually improve medical care.
Sources
- Scherer M, Nößler D. Evidence update podcast: “The Healthy Heart Act is harmful, unconstitutional, poorly made and crazy!”. AerzteZeitung.de. 2024. www.aerztezeitung.de (accessed August 6, 2024).
- Federal Medical Association. Statement by the German Medical Association on the draft law to strengthen heart health (Healthy Heart Act – GHG). 2024. www.bundesaerztekammer.de (accessed August 6, 2024).
- On the wrist. Think Tank Cardiovascular e.V. Parliamentary Breakfast Transcript 2024 June 14, 2024. 2024. herzkreis-impuls.de (accessed August 6, 2024).
- Prevention: SPD politician Baradari views Lauterbach’s healthy heart law with skepticism. AerzteZeitung.de. 2024. www.aerztezeitung.de (accessed August 6, 2024).
- Herzmedizin.de. The National Heart Alliance welcomes the Healthy Heart Act. 2024. herzmedizin.de (accessed August 6, 2024).
- Yang G, Mason AM, Wood AM, et al. Dose-response associations of lipid characteristics with coronary artery disease and mortality. JAMA Open Network 2024;7:e2352572–2. do:10.1001/jamannetworkopen.2023.52572
- Borén J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020;41. do:10.1093/eurheartj/ehz962
- AkdÄ. New European “guideline” for lipid lowering: As low as possible? Prescribing in practice 2020;47:21–5. www.akdae.de (accessed August 6, 2024).
- Federal Medical Association (BÄK), National Association of Statutory Health Insurance Physicians (KBV), Association of Scientific Medical Societies (AWMF). National Care Guideline for Chronic CHD, Version 6.0. Published online first: 2022. doi:10.6101/AZQ/000491
- Paulina Elena Stürzebecher, Adrienn Tünnemann-Tarr, Katja Tuppatsch, et al. Treatment and control of LDL cholesterol in patients with high and very high cardiovascular risk in Germany and in a European comparison – data from the SANTORINI registry. DMW – German Medical Weekly 2023;148:55-64. do:10.1055/a-2009-5077
- Scherer M, Chenot JF, Nößler D. Podcast “EvidenzUpdate”: LDL cholesterol and target values – what is the new normal? AerzteZeitung.de. 2021. www.aerztezeitung.de (accessed August 6, 2024).
- Johannesen CDL, Langsted A, Mortensen MB, et al. Association between low-density lipoprotein and all-cause and cause-specific mortality in Denmark: a prospective cohort study. BMJ 2020;371:m4266. do:10.1136/bmj.m4266
- Scherer M, Chenot JF, Nößler D. Podcast “EvidenzUpdate”: Statin therapy – “These recommendations are unreasonable!” AerzteZeitung.de. 2022. www.aerztezeitung.de (accessed August 6, 2024).
- Mangione CM, Barry MJ, Nicholson WK, et al. Statin use for primary prevention of cardiovascular disease in adults. JAMA 2022;328:746. do:10.1001/jama.2022.13044
- Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. New England Journal of Medicine 2017;376:1713–22. do:10.1056/nejmoa1615664
- Giugliano RP, Pedersen TR, Park JG, et al. Clinical efficacy and safety of achieving very low LDL cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial. The Lancet 2017;390:1962-71. do:10.1016/s0140-6736(17)32290-0
- Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. New England Journal of Medicine 2018;379:2097-107. do:10.1056/nejmoa1801174
- Szarek M, White HD, Schwartz GG, et al. Alirocumab reduces total nonfatal cardiovascular and fatal events. Journal of the American College of Cardiology 2019;73:387–96. do:10.1016/j.jacc.2018.10.039
- Canhão CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. New England Journal of Medicine 2015;372:2387–97. do:10.1056/nejmoa1410489
- Murphy SA, Cannon CP, Blazing MA, et al. Reduction in total cardiovascular events with post-acute coronary syndrome from ezetimibe/simvastatin. Journal of the American College of Cardiology 2016;67:353–61. do:10.1016/j.jacc.2015.10.077
- O’Donoghue ML, Giugliano RP, Wiviott SD, et al. Long-term evolocumab in patients with established atherosclerotic cardiovascular disease. Circulation 2022;146:1109–19. do:10.1161/circulaçãoaha.122.061620
- Starr B, Gaye S. Hadfield, Hutten BA, et al. Development of sensitive and age- and sex-specific low-density lipoprotein cholesterol cutoffs for diagnosis of first-degree relatives with familial hypercholesterolemia in cascade testing. Clinical chemistry and laboratory medicine 2008;46. do:10.1515/cclm.2008.135
- Floresta DS, Floresta NJ. Integration of parent-child screening and cascade testing for familial hypercholesterolemia. Medical Screening Journal 2018;26:71–5. do:10.1177/0969141318796856
- Luirink IK, Wiegman A, Kusters DM, et al. Twenty-year follow-up of statins in children with familial hypercholesterolemia. New England Journal of Medicine 2019;381:1547–56. do:10.1056/nejmoa1816454
- Bijl D, Hama R. Statins for childhood-onset familial hypercholesterolemia. New England Journal of Medicine 2020;382:487–9. do:10.1056/nejmc1915311
- Barry MJ, Nicholson WK, Silverstein M, et al. Screening for lipid disorders in children and adolescents. JAMA 2023;330:253–3. do:10.1001/jama.2023.11330
- Lindholt JS, Søgaard R. Population screening and intervention for vascular disease in Danish men (VIVA): a randomized controlled trial. The Lancet 2017;390:2256–65. do:10.1016/s0140-6736(17)32250-x
- Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-year results of the Danish cardiovascular screening trial (DANCAVAS). New England Journal of Medicine 2022;387:1385–94. do:10.1056/nejmoa2208681
- McCracken C, Zahra Raisi-Estabragh, Liliána Szabó, et al. Participation in the NHS Health Check is associated with reduced risk of multiorgan disease: a matched cohort study in the UK Biobank. BMC Medicine 2024;22. do:10.1186/s12916-023-03187-w
- IQWiG. Target group-specific approach for insured persons during general health examinations. QUICK REPORT. Published online first: 7 May 2024. doi:10.60584/P23-01
- Jasilionis D, van Raalte AA, Klüsener S, et al. The disappointing German life expectancy. European Journal of Epidemiology 2023;38:839–50. do:10.1007/s10654-023-00995-5
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