Please everyone, Stop and Think about the NEJM paper on plastics and heart disease
This will be a short post. I have read the NEJM paper on plastics and the risk of future heart events. It is a clever and interesting analysis. It has led to substantial attention on social media.
But there are serious limitations of this correlational study. Sadly, the accompanying editorial did not focus on these limitations. Nor did many of the analyses online.
Tomorrow on the This Week in Cardiology podcast, I will discuss the details. The podcast comes out on the usual channels. The transcript can be found at theHeart.org | Medscape Cardiology site.
Thanks to all the new subscribers.
Is this an editorial error? CEA for asymptomatic patients? Raises concerns for shenanigans right there, and to include “all cause mortality “ as an endpoint of a purported CV study adds to the concern. I did not read the full publication yet, perhaps there are some redeeming qualities, although at first blush it appears to be activism masquerading as science.
It’s not surprising that this type of study would generate oodles of fodder for media. Schlock sells.
I do wonder about CEA for asymptomatic folks. I’m from the NASCET era and haven’t kept up with that aspect in 20 years, but that sounds a bit curious.
Nonetheless, when M/NP’s have been found in drinking water, beer (!!), wine (!!!), toothpaste(!!!!), salt, and seafood (not surprising) among many other things humans eat/use, it should not be shocking that there would be some bio-accumulative effect. It is interesting that they end up in atheroma, but I wonder where else those bits go. And I wonder what nearly half the cohort were doing to NOT have any show up in their plaques (Vs those that did). And there is still a big black box regarding what predisposes a modern human doing regular human things (ie not actively eating plastic) to have these things end up in your atheroma, as well as the biologic plausibility and mechanism by which these bits actually predispose to CV outcome events downstream.
And the solution seems like something that would require a sea-change of global reckoning. Kinda a climate change level type problem. All of that said, getting a better grasp of what is going on here seems like a general good.
Looking forward to Dr. Mandrola’s take from an appraisal standpoint. As observational studies go, this seems not terrible.