So, that old chestnut
your mother told you turns out to be rooted in valid, scientific evidence:
eating an apple a day really would keep the doctor away. In fact, according to
the new analysis by British researchers, if individuals ate just one extra apple
a day, approximately 8500 deaths from vascular disease could be prevented in
the UK.
The reduction in
vascular deaths by adding an apple to the diet is on par with the reduction
that would be observed if all UK individuals over 50 years of age were
prescribed statin therapy. In that scenario, 9400 deaths from vascular disease
could be prevented if these adults were started on simvastatin 40 mg.
"Statins and
apples are both iconic," lead researcher Dr Adam Briggs (University of
Oxford, UK) told heartwire . "An apple a day is known throughout the
English-speaking world as a saying for health, and statins are now some of the
most widely prescribed drugs in the world. So, when you now have a debate in
the medical world about increasing the amount of statins prescribed for primary
prevention, we wanted to look at what that would mean for population health and
if there were other ways of doing it."
In the US, as
reported by heartwire , the new American College of Cardiology/ American Heart
Association (ACC/AHA) guidelines for the management of cholesterol suggest
treating primary-prevention patients if they have an LDL-cholesterol level
between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular
disease >7.5%. In the UK, the guidelines are less aggressive and recommend
statin therapy for primary prevention of cardiovascular disease if the 10-year
risk score is >20%.
However, Briggs said
there is debate in UK about expanding the use of statins to all patients 50
years of age or older.
"What we're
trying to say from this analysis is that dietary changes initiated at the
population level can have a really meaningful effect on population
health," he said. "And second, so can increasing drug prescriptions.
Now, we're not trying to say that people should be swapping their statins for
apples; that's not where we're going. However, if they want to add an apple to
that as part of disease prevention, then by all means do so, because you'll be
further along in reducing your risk of fatal heart attacks and strokes."
The new report is
published December 17, 2013 in the Christmas issue of BMJ. In addition to this
"Comparative Proverb Assessment Modelling Study".
Apples
Are Both Nutritious and Delicious
To assess the
potential benefits of putting more patients on statins, the researchers used
data from the Cholesterol Treatment Trialists' meta-analysis that showed
vascular mortality is reduced 12% for every 1.0-mmol/L reduction in LDL
cholesterol. This was applied to the annual reduction in vascular mortality
rates in UK individuals 50 years of age or older who were not currently taking
a statin for primary disease prevention.
For the apple-a-day
assessment, they used a widely published risk-assessment model (PRIME). This
model includes a multitude of dietary variables, in which investigators can
substitute different food choices to assess the effects on population health.
The apple was assumed to weigh 100 g, and calorie intake was assumed to remain
constant. This allowed investigators to assess the effect of substituting in
one apple daily on vascular mortality in the UK population.
For statin therapy,
offering the treatment to an extra 17 million individuals and assuming 70%
compliance would prevent 9400 vascular deaths each year. Assuming 70%
compliance with the apple, even though "apples are of course both delicious
and nutritious," say the researchers, the estimated reduction in vascular
deaths would be 8500. They add that prescribing statins to all those eligible
would lead to 1200 cases of myopathy, 200 cases of rhabdomyolysis, and 12 300
new diagnoses of diabetes mellitus.
Interestingly, the
cost of statin therapy from the drug alone would be £180 million compared with
£260 million for the apples. However, the authors point out that the National
Health Services (NHS) might be able to negotiate apple price freezes
("although defrosted apples may not be so palatable," they add).
To heartwire , Briggs
said he was surprised at how well the apples compared with statin therapy.
However, he stressed the point is not to encourage patients to stop taking
their medication. He points out that the UK has a "five-a-day"
campaign to increase fruit and vegetable consumption, but 69% of the population
do not meet the recommendations.
Having now studied
the science underlying an apple a day for keeping the doctor away, the group
jokingly states they will next "model the effect of inquisitiveness on
feline mortality rates."
Briggs, along with
coauthors Drs Anja Mizdrak and Peter Scarborough (University of Oxford) report
no conflicts of interest. Briggs consumes at least five fruits and vegetables
per day, Mizdrak tries to, and Scarborough is a vegetarian. All their diets
include apples. None of the researchers take statins, and all "purport to
be under 50 years old."
(Source: Medscape Medical News, 8 December 2013)
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