A Critical Look At The REDUCE-IT Trial

It’s finally here. The results of the REDUCE-IT trial were presented today at the American Heart Association conference and the paper is also up on The New England Journal of Medicine. I’ve been excited to see the results of this trial ever since the announcement in September (which I wrote about here) so let’s get right into it. I’ll just copy and paste what I’d written before in September regarding the inclusion/criteria and statistical analyses so that I can get right into the results. Read More

Analysis Issues In That New Low-Carb/LDL Study

Recently, a randomized trial that investigated the impact of a low-carbohydrate diet on plasma low density lipoprotein cholesterol (LDL-C) in young and healthy adults was published. The study was done in Norway between 2011 and the end of 2012. A total of 30 participants completed the study, where they were either randomized to a low-carbohydrate group (<20 grams/d) or a control group. Basically, the investigators found a difference between the groups, Read More

Misplaced Confidence in Observed Power

Two months ago, a study came out in JAMA which compared the effectiveness of the antidepressant escitalopram to placebo for long-term major adverse cardiac events (MACE). The authors explained in the methods section of their paper how they calculated their sample size and what differences they were looking for between groups. First, they used some previously published data to get an idea for incidence rates, “Because previous studies in this field have shown conflicting results, there was no appropriate reference for power calculation within the designated sample size. Read More

The Rise, Fall, and Rise Again of Fish Oil?

With the exception of this past week, it hasn’t been a very good year for fish oil. In early 2018, a large meta-analysis and systematic review of several randomized trials was published in JAMA. This large pooled analysis (77,000 + participants) assessed the impact of supplementing fish oil on cardiovascular disease events and found that there was no statistically significant effect (p=.10). The relative risks (RR) and coverage of the confidence intervals (CI) also suggested a very small effect (RR: 0. Read More

Is Moderate Carbohydrate Intake the Best?

Recently, a giant paper on carbohydrate consumption and mortality was published in The Lancet. The paper discussed the findings of a prospective cohort study and a meta-analysis of several cohort studies. Studies like this are often the ones that generate the most hype, which is always bizarre to me given that higher quality randomized studies almost never receive any attention. As a result of all the noise (see below), I had to discuss the study in question. Read More

Does Protein Increase the Risk of Heart Failure?

About three weeks ago, a cohort study was published in Circulation that claimed that protein consumption was associated with heart failure. The press reacted as I expected them to. If you read some of these articles, most of them seem to conclude that a high protein diet is probably not good for you and that Americans eat too much protein. Anyway, back to this study. Given the nature and limits of these types of studies (you can read more about that here) I was a bit skeptical, but also open to the idea that there might be a possible relationship between increased protein consumption and an increased rate of heart failure. Read More

It's Looking Bad for Fish Oil and CVD

Fish oil supplements and cardiovascular disease have had a long and controversial history. There was a lot of inconsistency in the research around supplementation and several organizations only added to this confusion. The incomplete reporting by media outlets have also confused the public. Here, I’ll give a brief timeline of the evidence for fish oil and CVD outcomes. 1970s | A group of explorers noticed that people who consumed fish also had lower incidences of heart disease. Read More