Three Studies, One Interview: The Art of Leaving Out
How Professor Kausik Ray of Imperial College London Made the Evidence Sound Stronger Than It Was in His ESC Congress 2026 Interview
Qaisar J. Qayyum, MDChief Editor, Noor Journal of Complementary and Contemporary Medicine, Oklahoma, USA
Email: drqhealthyliving@gmail.com
Abstract
Expert commentary can clarify research, or it can make the evidence sound stronger by highlighting one result, leaving another out, or moving from what a study demonstrated to what it might mean in the future.
This commentary examines Professor Kausik Ray’s ESC Congress 2026 interview on STAREE, AMUNDSEN and REACT [1]. It evaluates the presentation, not every aspect of the three studies.
STAREE asked two equally important main questions. The interview presents the favorable answer and leaves out the other. Atorvastatin reduced a combined measure of cardiovascular events, but did not establish that participants lived longer without dementia or lasting physical disability. Ray highlights a “30% relative risk reduction” and calls the result “immediately translatable into clinical practice.” Notably, he gives neither the actual event rates, 8.3% with placebo and 6.0% with atorvastatin over a median of 5.9 years [2,3], nor the unsuccessful co-primary outcome.
AMUNDSEN produced a large improvement in LDL cholesterol, a laboratory marker, but did not establish fewer deaths or unplanned cardiovascular hospitalizations at one year. The interview acknowledges this clinical result, then redirects attention toward benefits expected with longer treatment. Ray also claims that the result “categorically proves” that benefit from PCSK9 inhibition is “entirely driven by the LDL change and nothing else beyond that” [1]. An uncertain clinical result cannot prove that a treatment works through one biological mechanism alone.
REACT documented the prevalence and extent of silent atherosclerosis in 16,808 adults, but it did not show that screening improves health. Plaque developing before symptoms was already known, and Ray acknowledges earlier autopsy evidence [1,7]. Yet the interview moves from detecting plaque toward the promise of better prevention. The baseline study did not compare imaging-guided prevention with usual care, and the planned randomized phase will mainly measure plaque progression, another surrogate outcome [8]. Finding plaque is not the same as proving that screening for it prevents heart attacks, strokes, disability or death.
The concern is not that the data were fabricated. It is the selective emphasis, omission and extrapolation that must be exposed. The listener receives a persuasive account from a highly credentialed expert, but not all the information needed to judge it.
That is how the illusion of stronger evidence is created.
How Framing Makes Evidence Sound Stronger Than It Is
The interview introduces Professor Ray as Professor of Public Health and Consultant Cardiologist at Imperial College London and Immediate Past President of the European Atherosclerosis Society [1]. These credentials are relevant, but professional authority can make an incomplete account appear complete.
Scientific terms can also create impressions through their ordinary meanings. In everyday language, “significant” means important, substantial or meaningful. In medical research, “statistically significant” means only that a result crossed a chosen statistical threshold. It does not show how large the benefit was, whether it mattered clinically, or whether it outweighed side effects and treatment burden [4].
This difference matters. A reader may hear “statistically significant benefit” and naturally understand “important benefit.” But a small effect can cross the statistical threshold in a large study, while a potentially important effect may remain statistically uncertain in a smaller one. Statistical significance is not a certificate of clinical importance.
Other forms of presentation work in a similar way. A “30% reduction” sounds large, although a relative percentage does not reveal how many people actually benefited. Finding disease early sounds useful, although detection alone does not prove that screening improves health.
Studies show that patients and clinicians view the same treatment more favorably when its benefit is presented as a relative percentage rather than as the actual difference between groups [9–11]. “A 30% reduction” and “23 fewer events per 1,000 people” can describe the same result, but they do not create the same impression. The number may be correct while the message received by the listener is exaggerated.
The medical literature uses the term spin for reporting or interpretation that makes research appear more favorable than its complete results justify [12]. Spin may involve highlighting a favorable result while pushing an unfavorable result into the background, omitting information that could change the reader’s judgment, or presenting a future possibility as though the study had already demonstrated it.
Spin does not require fabricated data or proof of an intention to mislead. Every statement may be technically correct, while the selection, wording and arrangement of those statements create a conclusion that the complete evidence does not support.
The criticism therefore follows three direct questions:
What did the study actually establish?
What impression did the interview create?
What information capable of changing that impression was left out?
STAREE: One Favorable Result Becomes the Whole Story
STAREE compared atorvastatin 40 mg with placebo in 9,971 relatively healthy, community-dwelling adults aged 70 years or older. Median follow-up was 5.9 years [2]. The trial had two co-primary outcomes: a combined cardiovascular outcome and survival free of dementia or persistent physical disability.
The interview reports a “30% relative risk reduction” in major cardiovascular events and calls it “immediately translatable into clinical practice” [1]. It gives neither the absolute event rates nor the other co-primary result.
What the “30% Reduction” Means for Actual Patients
The “30% reduction” sounds large, but it is a relative figure. Over nearly six years, cardiovascular events occurred in about 83 of every 1,000 people receiving placebo and 60 of every 1,000 taking atorvastatin [2,3]. That means about 23 fewer people per 1,000 experienced the combined cardiovascular outcome. Approximately 44 people would need to be treated over the study period to prevent one such event.
The benefit was real but modest in absolute terms. The 30% headline makes it sound much larger than it was. The absolute difference was 2.3 percentage points, not 30 percentage points: about 23 fewer people per 1,000 experienced the combined outcome over nearly six years. It does not mean that 30 of every 100 patients benefited, nor does it mean that deaths fell by 30%.
The relative figure attracts attention. The absolute figure reveals the scale. The interview supplies the first and leaves out the second.
One Main Result Gets the Headline; the Other Disappears
STAREE did not establish that atorvastatin helped participants live longer without dementia or persistent physical disability [2]. This was one of the trial’s two main measures of success and a major concern for older adults. Success on one main outcome cannot stand in for success on both.
Notably, the favorable result came from a revised outcome. STAREE originally counted cardiovascular death, nonfatal heart attack and stroke. After a blinded review found fewer events than expected, coronary revascularization was added [13]. The original outcome showed no statistically significant benefit, while the broader outcome produced the reported 30% reduction [2].
The blinded review does not suggest manipulation, but the later protocol amendment changed what counted as a primary cardiovascular event. By adding a clinician-directed procedure, it turned an unsuccessful original outcome into the favorable result behind the “30% reduction” headline. It certainly does not mean that deaths, heart attacks and strokes each fell by 30%.
The official report also noted more muscle-, liver- and diabetes-related adverse events with atorvastatin, although serious adverse events were equally frequent in both groups [3]. The interview nevertheless concludes that there is “no disincentive” to treatment [1]. Equal rates of serious events do not mean equal rates of all side effects.
STAREE showed a modest cardiovascular benefit on the combined outcome. The spin lies in making it sound larger by leaving out its absolute size, its unsuccessful co-primary result and the burden of treatment.
AMUNDSEN: The Blood Test Improved; Clinical Benefit Remained Unproved
AMUNDSEN studied more than 2,100 heart attack patients undergoing coronary intervention [5,6]. Both groups received intensive cholesterol-lowering treatment, while the intervention group also received evolocumab immediately before the procedure.
Evolocumab produced a large laboratory effect: 82% reached the LDL cholesterol target, compared with 40% receiving standard care [5]. But at one year, death or unplanned cardiovascular hospitalization occurred in 14.6% with evolocumab and 15.4% with standard care [5]. The blood test improved substantially. The hoped-for clinical benefit was not established. A favorable per-protocol analysis was described as hypothesis-generating and cannot replace the main randomized comparison [6].
The interview acknowledges that AMUNDSEN did not establish a clinical benefit at one year, then redirects attention toward what longer treatment might achieve [1]. Earlier trials make later benefit plausible [14], but they cannot turn a future expectation into an AMUNDSEN result. The trial’s unsuccessful clinical outcome is pushed aside, while hoped-for future success becomes the message.
Ray then makes a claim that the trial cannot support, stating that the result “categorically proves” that benefit from PCSK9 lowering is “entirely driven by the LDL change and nothing else beyond that” [1]. The force of this statement comes from categorical wording and the authority of the speaker, not from evidence capable of proving it. AMUNDSEN was not designed to test every possible biological mechanism, and its uncertain clinical result cannot do so. Failure to demonstrate an additional early benefit may weaken the case for another mechanism. It cannot eliminate every other biological explanation.
A result too uncertain to establish clinical benefit cannot be repurposed as categorical proof of its only possible cause.
REACT: Finding Plaque Is Presented as Proof of Better Prevention
REACT imaged 16,808 adults aged 18 to 70 years in Denmark and Spain who had no known atherosclerotic cardiovascular disease. Silent plaque was found in 57.1% [7]. The study provided detailed information about where plaque occurs, how extensive it is and how its prevalence changes across adult life.
But REACT did not discover that atherosclerosis begins before symptoms. Ray himself acknowledges that autopsy studies had already established this [1]. REACT’s advance was the scale and detail of imaging in living people, not the discovery of silent disease
Here, the interview delivers a subtle but powerful message through what it implies rather than what it says. Ray does not explicitly recommend universal screening or statins for everyone with visible plaque. He does not need to. By moving directly from finding plaque to changing behavior, preventing disease and preserving health, he leads listeners toward a conclusion the study never tested [1].
The implied chain is powerful: find plaque earlier, treat earlier, live healthier. REACT established only that plaque could be found. It did not establish that screening leads to better treatment decisions or better health. That is the art of spin: never state the unproved claim; shape the message so the listener reaches it alone.
REACT established that plaque can be found. It did not establish that looking for it leaves patients better off.
One statement in the interview requires direct correction. Ray says SCORE2 has “very low specificity” because a low score does not exclude plaque [1]. But REACT reported that a high SCORE2 category had 99.8% specificity and only 1.9% sensitivity [7]. A low score fails to rule out plaque because the test has very low sensitivity, not low specificity. The interview reverses the two statistical terms.
The planned randomized phase will compare imaging-guided care with standard care, but its main outcome is plaque progression, another surrogate [8,15]. A positive result could therefore mean only that plaque progressed more slowly, not that patients lived longer or remained healthier. Before the strategy can claim clinical benefit, it must show fewer heart attacks, strokes, cases of disability or deaths, and prove that these gains outweigh unnecessary treatment and other harms.
Even current European guidance draws a clear line: imaging may refine risk assessment in selected patients, but coronary imaging or calcium scoring is not recommended as a broad cardiovascular screening test [16].
A better scan does not prove that patients live longer, remain healthier or avoid major clinical events
Extensive Industry Ties Require Close Scrutiny
Professor Ray’s 2025 disclosure lists 23 companies under consulting or lecture honoraria, five under institutional research support, and three in which he held stock options [17]. These relationships are not identical, but together they reveal an extensive industry network.
The interview prominently presents Ray’s Imperial College London position and former leadership of the European Atherosclerosis Society [1], yet leaves these financial ties undisclosed. His authority is placed before the listener; his financial context is left out.
The overlap is clearest with AMUNDSEN. Ray discussed evolocumab, an Amgen drug, in a trial supported by Amgen and the ACTION Study Group [6]. His disclosures list honoraria and institutional research support from Amgen [17], and he wrote the accompanying editorial [1,18]. None of these connections was disclosed in the interview.
These ties do not prove motive or invalidate the evidence. But when industry sponsorship, financial relationships, editorial involvement and favorable spin appear together, the independence of the interpretation demands close scrutiny. Even without those ties, the omissions, shifts in emphasis and unsupported mechanistic certainty remain.
Consulting or lecture honoraria | Institutional research support | Stock options |
Abbott Laboratories | Amgen | New Amsterdam Pharma |
Amgen | Daiichi Sankyo | Scribe |
AstraZeneca | Sanofi | Pemi 31 |
Bayer Healthcare Pharmaceuticals | Regeneron | |
Boehringer Ingelheim | Ultragenix* | |
Cargene | ||
CRISPR | ||
Daiichi Sankyo | ||
Eli Lilly Company | ||
Emendobio | ||
Esperion | ||
Kowa | ||
New Amsterdam Pharma | ||
Novartis Corporation | ||
Nodthera | ||
GSK | ||
Novo Nordisk | ||
Pfizer | ||
Regeneron | ||
Sanofi | ||
Scribe | ||
Silence Therapeutics | ||
Vaxxinity |
Source: Professor Ray’s disclosure in the cited 2025 publication [17]. Each column is a separate list; alignment across rows does not imply a relationship between companies. “Ultragenix” appears to be a misspelling of Ultragenyx in the source.
Conclusion
The pattern is consistent across all three studies. STAREE’s modest absolute cardiovascular benefit becomes a “30% reduction” headline, while its unsuccessful co-primary outcome disappears. AMUNDSEN’s unproved early clinical benefit is replaced by the promise of later success, while an uncertain result is turned into categorical proof of an exclusive mechanism. REACT’s detection of silent plaque becomes an implied promise that screening will improve health before any clinical benefit has been demonstrated.
These studies produced useful evidence. The spin lies in making each study appear to establish more than it did.
The problem is not whether the quoted numbers are accurate. It is how selected results are used to create a clinical message that the complete evidence does not support.
Disclosure. The author develops a herbal formula and owns Dr. Q Formula/Insulinn LLC. This commercial interest should be considered when assessing the author’s selection and interpretation of evidence, just as the financial relationships discussed above should be considered when assessing the expert commentary.
Editorial assistance
Artificial intelligence assisted with source retrieval, calculations and language editing. Sources include research papers, methodological publications, a statistical analysis plan, an interview transcript and official reports. In the event of any inadvertent errors, the responsibility lies with the AI/authors, and corrections will be made promptly upon identification.
Acknowledgment
I would like to express my sincere gratitude to [Reviewer name] for her thoughtful review and invaluable feedback, and [Reviewer name] for his valuable feedback. Their expertise and guidance have played a pivotal role in refining and enhancing this article.
Scope
This commentary evaluates the presentation of cardiovascular research. It does not advocate replacing evidence-based conventional care or evaluate complementary treatments.
References
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