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Heart Scans Only Useful in Specific Situations When Statins Are Prescribed

By MedImaging International staff writers
Posted on 01 Apr 2014

Image: A computed tomography (CT) scan of a healthy heart shows the coronary artery running down the front. A scan showing calcium buildup in the artery could trigger treatment (Photo courtesy of Vassilios Raptopoulo).

New research has revealed that with the existence of inexpensive statin therapy, which lowers cholesterol and is readily available, it is not necessary to perform a heart computed tomography (CT) imaging scan to measure how much plaque has accumulated in a patient’s coronary arteries, when patients have been taking statins.

Researchers from the University of California San Francisco (UCSF; USA) designed a statistical model to forecast whether it was practical to do the scan, using data from the Multi-Ethnic Study of Atherosclerosis (MESA) and other sources. They modeled the effects of statin therapy in 10,000 55-year-old women with high cholesterol and a 10-year risk of coronary heart disease of 7.5%. The model predicted that prescribing statins to all of them would prevent 32 heart attacks, cause 70 instances of statin-induced muscle disease, and add 1,108 years to their cumulative life expectancy.

Then, the investigators looked at how a coronary artery calcium (CAC) test could be used to target statin therapy only in those women the test showed were at heightened risk of coronary heart disease. They found that this strategy would save money on statin costs and expose fewer women to side effects from statins but would not prevent as many heart attacks. Moreover, the test itself exposes the women to a small risk of radiation-induced cancer and costs about USD 200 to USD 400 per scan.

The researchers concluded that as long as the price of a statin remained low— USD 0.13 a pill—and did not reduce quality of life for patients, it was not cost-effective to perform a CAC test. But if the price of the pill were more costly—USD 1 or more—or if taking them reduced patients’ quality of life, then it did make sense to use the CAC test.

The result is somewhat surprising, given all the evidence that has accumulated over the last decade that the test strongly predicts heart attacks, said the lead author, Mark Pletcher, MD, MPH, an associate professor of epidemiology and biostatistics, and medicine, at UCSF. The study was published online March 11, 2014, in the journal Circulation: Cardiovascular Quality Outcomes.

Traditional prediction models, such as the Framingham-based risk equations, work imperfectly, and clinicians have long tried to find better ways to figure out which patients would benefit most from taking statins, which can cause side effects, such as decreased cognitive function, muscle aches, and cataracts.

“The prevailing wisdom is that if you have a test that predicts heart attacks, you should use it,” Dr. Pletcher said. “But even a test that is strongly predictive of future events, like a coronary artery calcium scan, does not itself improve outcomes. If it is used to keep some people off of statins that would otherwise take them, then fewer people will get protection from using statins, and more people will have heart attacks.”

The study integrated data from MESA and many other sources to create a cost-effectiveness model. The researchers tested whether changing the other model inputs made a difference, and it turned out that the only critical factors were the cost of statins and the degree to which they decreased quality of life for patients.

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63 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

64 (102.04315185547): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

65 (592.94700622559): SELECT fid FROM jos_deeppockets WHERE id=294751527 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294751527 AND published='1' LIMIT 1

66 (48.160552978516): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

67 (41.007995605469): select jos_twitters.link from jos_twitters where cat=10

68 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

69 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

70 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

71 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294751527 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294751527 AND published='1' LIMIT 1

72 (30.040740966797): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

73 (312.08992004395): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (242.94853210449): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (40.054321289062): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

76 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (94.890594482422): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (48.160552978516): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (56.982040405273): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

93 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

108 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

109 (88.930130004883): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751527 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (100.13580322266): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751527 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

112 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

113 (54.121017456055): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294751527 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (611.0668182373): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294751527 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (594.8543548584): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (520.94459533691): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

118 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

119 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

120 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

121 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

122 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

123 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

124 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

125 (308.99047851562): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 26433.944702148): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

127 (602.96058654785): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751527 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751527 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (!!!!! 10215.044021606): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

129 (175.95291137695): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (87.976455688477): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

131 (49.114227294922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

132 (82.969665527344): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

133 (48.160552978516): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

134 (483.98971557617): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

135 (61.03515625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

136 (56.982040405273): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

137 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

138 (522.13668823242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (542.87910461426): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (90.122222900391): SELECT name FROM jos_deeppockets WHERE id=211

141 (61.988830566406): SELECT name FROM jos_deeppockets WHERE id=211

142 (668.04885864258): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (656.8431854248): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

144 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

145 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

146 (!!!!! 11397.123336792): TRUNCATE TABLE jos_trademed_module

147 (145.91217041016): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751527 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (128.98445129395): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751527 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (663.99574279785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

152 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

153 (!!!!! 1724.9584197998): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

154 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

155 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

156 (58.889389038086): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751527 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751527 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (47.922134399414): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

158 (42.915344238281): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

159 (56.028366088867): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

161 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751527 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751527 AND published='1' LIMIT 1

162 (58.174133300781): select jos_twitters.link from jos_twitters where cat=10

163 (84.877014160156): select jos_facebook.link from jos_facebook where cat=10

164 (45.061111450195): select jos_google_plus.link from jos_google_plus where cat=10

165 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

166 (395.05958557129): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

167 (!!!!! 1495.1229095459): insert into jos_banners_delta values (14615,'2025-08-19 01:11:21','216.73.216.0','view'),(14202,'2025-08-19 01:11:21','216.73.216.0','view'),(14203,'2025-08-19 01:11:21','216.73.216.0','view')

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