Statins to thank for improved survival? I don’t think so

In my regular trawl through on-line newspapers this week I came across this story in the Telegraph (UK). Apparently, death rates in the UK are at a record low. This is, on the surface, a good thing. However, such statistics can belie the fact that while individuals may be living longer, the quality of the life may not be so desirable. One reason for this is that modern medicine has the capacity to keep some very sick people alive, and these people may then endure debilitating symptoms, pain, immobility and growing dependence.

When I was a junior doctor I worked for a lovely cardiologist who first made me aware of the downside of ‘keeping people alive’. He told his assembled team on a ward round one day that just a few years before we had relatively limited options for individuals coming in with a heart attack. The management was, in his own words ‘give them some painkillers, stick them in a bed, and keep an eye on them.” However, even in those days (20 years ago) we had more sophisticated treatments including clot-busting drugs and more effective resuscitation techniques. As a result, he lamented, we were now keeping more people from dying, but we were also creating more ‘cardiac cripples’ (again, his own words) – essentially people who had very poor heart function who had limited tolerance for activity, and might be breathless on a semi-permanent basis. In terms of length of life, more is not necessarily better.

The other reason I wanted to write about this piece in the Telegraph concerns its focus on statins. The contention from some ‘experts’ is these cholesterol-reducing drugs have contributed in no small way to our improved survival. Really? Let’s have a cold hard look at some facts.

Statins are given either to people who are essentially healthy but somehow deemed to be at high risk of cardiovascular disease. We call this ‘primary prevention’. Sometimes, however, statins are prescribed to people with already-established cardiovascular disease who may, for example, already had a heart attack or a stroke. We call this ‘secondary prevention’. The great majority of people taking statins are in the primary prevention category. But do statins reduce risk of death in these people. The answer is ‘no’. I wrote about this quite recently here.

The plain and simple fact is that for the vast majority of people taking statins, their lives will not be extended by one single day. This would perhaps lead us to reconsider the ‘expert’ view that statins are some sort of magic elixir.

In the Telegraph piece we have some figures quoted that caught my eye: “It is estimated that about five million people in Britain are on statins, which are credited with saving 7,000 lives a year.” I’m not sure where these figures came from, but let’s run with them for a moment anyway.

If 5 million people are taking statins, and this saves 7,000 lives a year, then over the course of a year ONE life is save for every 714 (seven hundred and fourteen) people taking statins. Even if we extrapolate forward in time (assuming similar benefit over time) this equates to needing to treat 143 people over five years to prevent just one death.

But of course, the longer you treat for, the greater the risk of adverse effects too. I recently wrote about some research published earlier this year in the British Medical Journal which showed statin use can cause serious adverse effects in significant numbers of people who take them. See here for more about this.

I’d like to round off with a real-life story. It concerns my elderly father who has known heart disease. Some years ago he was prescribed statins. A couple of weeks ago he and my mum came for lunch and my father (an avid reader) picked up a copy of Dr Malcolm Kendrick’s The Great Cholesterol Con that was in a pile of books on a table. Later on, my father was telling my mother and I that he had every one of a list of statin side-effects listed in this book. He also told me that it was taking him twice as long to walk to the local shops than it used to.

He asked my advice about this, and I advised him to stop the statins. “That’s good,” he said “because I’ve already done that.” It turns out that a few weeks before he’d intuitively felt that the statins may not be agreeing with him, so he’d started taking them only very occasionally. I suggested an all out ban. But in addition, I suggested we dose my father up with some CoEnzyme Q10. This nutrient is depleted by statins, and low levels of it can cause, among other things, muscle pain and weakness.

My parents were round again yesterday and my father spontaneously reported that he was feeling so much stronger, and that the time it took him to get to the shops had more than halved. Of course this could be an overblown placebo response. I don’t care if it is (and neither does he).

The point is that the likelihood is that my father had become a ‘cardiac cripple’ – created as a result of taking a drug which supposedly was good for his heart.

Not only is it unscientific and highly misleading to pin our enhanced survival on statins, it ignores the fact that these drugs have the potential to mess up peoples’ lives.

27 Responses to Statins to thank for improved survival? I don’t think so

  1. EDWARD ROOTH 29 October 2010 at 3:08 pm #

    At the risk of sounding extreme, I have long felt that statins have the potential to be the early 21st century’s equivalent of thalidomide.

  2. John Briffa 29 October 2010 at 3:36 pm #

    Edward

    At least with thalidomide, when it became clear from the evidence there was something seriously wrong, something was done about it…

  3. Andy Taylor 29 October 2010 at 5:03 pm #

    I started taking statins about 4 months ago. After a couple of weeks I began having trouble with muscle pains, swelling in the feet, shortness of breath, coughs and a general feeling of being unwell.

    I visited my Doctor and he suggested increasing the dose a bit. After another week of very unpleasant side effects I decided to stop the tablets altogether.

    After a further two weeks I was feeling much better and was due to have a blood test.

    I read a couple of books about diets while taking the statins including ‘Waist Disposal’. I decided at the time to follow the advice given in the book and lost 3.5kg of weight over the next few months.

    When the results of my blood test came back it showed that my cholestrol level had fallen. I was put on statins for a level of 5.9. My level when measured after stopping statins and following the advice in the book was 5.3.

    My doctor wanted to increase the statins again because he wanted me to have a value of 5.2 or less. I told him I was happy without the statins. I was going to look after my diet and health using the advice given in your book. My Doctor wasn’t very helpful and a told me if I wanted to take risks with my heart that was my problem. I did remind that my cholestrol had fallen wothout the statins but he wasn’t interested.

    I personally think that statins are very dangerous drugs which cause more problems than they help. I think there should be a national review on the safety of these drugs.

  4. enid haw 29 October 2010 at 5:36 pm #

    Ten years or so ago, I was prescribed statins as my count was 12.00. At the same time I read your ‘e’ mail giving good reasons for not taking them. I now have a frieze of statin prescriptions on my notice board! I read everything about statins and made my own adjustments which brought it down to an acceptable level (mine) of 6.5. Thank you for your information that came at a timely moment in my life. Goodness knows what state I would be in today if I had followed my GP’s advice. In gratitude

  5. James Ferguson 29 October 2010 at 5:51 pm #

    Are there any circumstances in which statins are useful? Both my father and sister have been put on statins due to a “protein that attaches cholesterol to the arteries” quote from my sister. My sister said the protein was lipid A, though I have been unable to find much information about this on the web. I have been told I also need to do the teats but have so far refused. I follow a predominantly Paleo diet and keep myself in good shape, and feel no need to undergo these tests, especially if I am told to take statins. Although I have tried on countless occasions to tell them statins are not the best route to follow they tend to listen more to their GP. Am at a dead-end with both of them. My sister also told me she has to take another pill whic increases the effectiveness of the statins by 20%, SHE IS 32. Sorry for the long response but I feel like I am banging my head against a brick wall. Your input will be greatly appreciated. I will forward this article onto them with the hope they might open their mind up to different avenues. Many thanks James.

  6. Pete Grist 29 October 2010 at 6:22 pm #

    I’m sure you are right, and I wouldn’t take statins, but as a long term fan of Ben Goldacre, I wouldn’t base anything on an article in the Telegraph!

  7. Jayne Deering 29 October 2010 at 7:23 pm #

    Five years ago, despite being fit and healthy, I was persuaded to go on a new wonder drug Crestor, to reduce my cholesterol – within three months I developed what has finally been diagnosed as systemic sclerosis. No coincidence there….

  8. Michael Allen 29 October 2010 at 7:40 pm #

    About forty years ago, a friend of mine worked in the Edinburgh Univ medical school. A Professor there used to say that the problem was not so much adding years to life, it was adding life to years.

  9. Jill Bishop 29 October 2010 at 7:45 pm #

    Dear John,

    Please look at Detoxamin for your father. My husband had a heart bypass just before he was 50. He is now 67 and takes neither statins nor aspirin. He is very well. A few years ago he had a full scan of his arteries and they were “better than 60% of the male population of his age”. Chelation therapy works very effectively when taken this way and you will be able to monitor your father’s progress.

    With best wishes,

    Jill

  10. Susan 29 October 2010 at 9:33 pm #

    About a year or more ago there was a BBC radio 4 documentary (one of the medical progs) about statins with people for and against, but some mainstream consultants questioned the value of the numbers that have to take it for any statistical reduction in heart attacks or strokes – i seem to recall they said 1 in 90 but that may be wrong. They also discussed serious side effects which were not at all uncommon. Also if you’re prescribed statins in your 50′s or 60′s you could be on them for decades.

  11. Liz Smith 29 October 2010 at 9:41 pm #

    I have just read on a USA website that chewable cholesterol drugs for children over the age of 10yrs have been approved by the European Commission.Pfizer (Lipitor) are going to apply for a six-month patent. The mind boggles yet again.

    All this on top of the swine flu jabs scaringly being touted for ALL childredn incase the threat of it raising its ugly head this year. I guess they have so many packets of this poison sitting on shelves and no other countries are mad enough to buy it off us. The medical people are getting nearly as clever at the Met weather predictions!

  12. DR.BG 29 October 2010 at 11:01 pm #

    Dr.Briffa you are a THINCer!!!

  13. Jane 29 October 2010 at 11:58 pm #

    I like the sound of your old Cardiologist, I think in healthcare we are the victims of our own success. I was told 15 yrs ago that I had high cholesterol and chose to not take statins. I figured that with no significant family history of death from heart disease I’ll take my chances. I see the average age of patients in hospital increasing but seemingly with a decreased quality of life. I didn’t want to potentially extend my life to end up as one of the many 90+yr olds with multiple medical and social issues. It seems now I was probably right (but for the wrong reason) not to take them.

  14. Philip Achard 30 October 2010 at 12:23 am #

    Thank you for the wake up call. I have been taking Atorvastatin for 10+ years, when I mentioned side affects plus ‘other’ problems, I was told “it doesn’t appear on my list of side affects, you need too keep taking the tablets, for your health’s sake”.Now it seems I have put up with muscle weakness, memory problems and little or no sex drive for nothing

  15. Kate 30 October 2010 at 1:21 am #

    I question the statement in the article that ‘of course, the longer you take them, the more likely the risk of bad side effects.’

    I don’t think is necessarily true for every drug and I’m fairly sure it’s not true for statins. This implies a somewhat fatalistic attitude that you may be taking a statin and not have had a bad side effect but if you continue, don’t worry, you will. This is simply not true.

    The statement is misleading and may be a variation of a statement about the distribution of side-effects in a larger population over a longer period of time compared to a smaller population and/or a shorter period of time. But not reliably predictable of side-effects in the case of a single individual who chooses to take a statin well into old age. People do and when they do, many are side-effect-free and healthier for having taken the drug.

  16. Hal 30 October 2010 at 11:50 am #

    Perhaps the Daily Telegraph would be better for being relaunched as the ‘Obscurer’?

    I notice there is a comment beneath the article at The Telegraph online (27/10/10 01:26PM) posted by ‘malcolmken’ which I would take to be from the author of ‘The Great Cholesterol Con’, Malcolm Kendrick. Other of the comments caught my eye. And only after reading the comments would I reason being called a THINCer might be complemenatry.

    I am largely opposed to pills. When my GP (whom I repect highly) prescribed Statins perhaps three or more years ago I read the in pack literature which advised not to combine Statain taking with eating grapefruit. So I looked into ‘the grapefruit effect’ and summarily made the exclusive choice in favour of grapefruit!

    Incidentally, I’m scepitical, though perhaps less so by degree, of supplements. The recent news on glucosamine and chondroitin and the remaining duplicity in the surrounding knowledge economy may go some way to justify such a little healthy scepticism. Have not some of the supplement manufacturers now become subsidiary to big pharma? Just like pills, I am sure there are some valuable supplements, but in all probability there will also be some bogus ones. The primary incentive for the manufacturers is to find, create, or preserve, markets. Increasingly, so it may seem, they do so without justifiable benefit to consumers or patients, and in some cases with evident great harm.

    What follows is an opinion that will be a big leap for many who read it but increasingly, I feel, humans including key opinion leaders and an informed public will have to be prepared to question and openly debate if the peculiar attributes of the largely monopolistic and predomininating medium of exchange, fiat money, stands as an impediment to meeting the accumulating challenges of the 21st Century ranging from, and not limited to, climate, energy, and the relationship of pharma to patient.

  17. Feona 30 October 2010 at 1:43 pm #

    I was advised to take Lipitor for high cholesterol some years ago by my then consultant. I took just one and had one of the worst nights of my life, so took no more. The consultant was doing reasearch into statin use at that time, and was funded by Pfizer. Interestingly, since the research and the funding stopped, he no longer recommends statins to people with raised cholesterol, but will not tell a mere patient why he has changed his approach. I think we can guess, can’t we?

  18. Cybertiger 30 October 2010 at 4:36 pm #

    There was a time you could expect impartial advice from your GP about treatment.

    No longer. The rot set in with Margaret Thatcher’s reforms of 1991 – with vaccination and smear targets – and became further entrenched with Labour’s Quality & Outcomes Framework (QOF) of 2004.

    http://www.qof.ic.nhs.uk/search/

    I believe that a ‘cholesterol level’ is virtually meaningless and lowering the blood level with a statin is of dubious value to anyone. Except, of course, to the GP who has been given a financial incentive to arrange useless tests and prescribe drugs that can cause a lot of harm and precious little good.

    http://www.bmj.com/content/336/7637/174.5.full

  19. Cybertiger 30 October 2010 at 5:05 pm #

    Points win prizes.

    Kenneth Clarke was Chancellor in 1991 and he was right about GPs and their wallets. And Big Pharma understood what made GPs tick. For the last six years GPs have been scrabbling for QOF points and very big prizes.

    http://www.qof.ic.nhs.uk/faqs/

    There are 10 Coronary Heart Disease Indicators (87 points) and there are two that relate to cholesterol levels and the lowering of cholesterol.

    1. “The percentage of patients with coronary heart disease whose notes have a record of total cholesterol in the previous 15 months.”

    2. “The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the previous 15 months) is 5 mmol/l or less.”

    GPs don’t care about patients but they do care about prizes – and so does Big Pharma.

  20. Cybertiger 30 October 2010 at 6:55 pm #

    A Podiatrist writing to BMJ online has noticed a relationship between women taking statins and a diagnosis of PMR.

    http://www.bmj.com/content/340/bmj.c620.full/reply#bmj_el_243745

    Why haven”t GPs or Rheumatologists noticed such a relationship?

  21. John Briffa 30 October 2010 at 7:08 pm #

    Kate

    I question the statement in the article that ‘of course, the longer you take them, the more likely the risk of bad side effects.’
    I don’t think is necessarily true for every drug and I’m fairly sure it’s not true for statins. This implies a somewhat fatalistic attitude that you may be taking a statin and not have had a bad side effect but if you continue, don’t worry, you will. This is simply not true.

    I didn’t imply any such thing. But, please answer this question:

    If someone takes a statin for a year, are the generally more or less likely to experience side effects than if they take the statin for a day?

    The statement is misleading and may be a variation of a statement about the distribution of side-effects in a larger population over a longer period of time compared to a smaller population and/or a shorter period of time. But not reliably predictable of side-effects in the case of a single individual who chooses to take a statin well into old age. People do and when they do, many are side-effect-free and healthier for having taken the drug.

    Seeing as you’ve mentioned taking statins in old age, perhaps you’d like to present the research which demonstrates that statins have benefits in old age, and please quantify the benefits for us too.

  22. Brian Abbott 31 October 2010 at 1:58 am #

    I read some time ago( can’t remember what cardiologist and where I read it) that every male patient who had suffered a heart attack that the cardiologist had treated suffered from abnormally low levels of testosterone. Has anyone else heard about this?

  23. Lorna 31 October 2010 at 2:28 am #

    Two different GPs, two totally different reactions: ‘raised’ cholesterol level – Doctor 1; first reaction was to refer to hyperlipid specialist. Doctor 2 ” nothing to worry about, medical press very slow to catch up with current findings that suggest heart disease is more complex than high cholesterol levels”. These 2 consultations in the same GP practice and less than 3 months apart. How is a patient to know what is right? I didn’t take the statins. I read a lot and got hold of Uve Ravnskov’s enlightening book from Sheffield Uni Medical School Library. Thanks to all who contribute to this essential debate, Lorna

  24. Edward 2 November 2010 at 10:53 pm #

    @James Ferguson
    James,
    She is talking about lipoprotein A – commonly referred to as Lp(a) in medical literature. I believe the Pauling theory (named after Dr. Pauling) can give you some more information.

  25. Chris 10 November 2010 at 9:22 pm #

    Big wheels keep on turning, Dr Briffa.

    The Daily Express of 9th November 2010 bore the front page headline “STATIN IS NEW WONDER DRUG” that “.. ..cuts heart risk for everyone .. .. [and] (e)ven those who already have low levels of of cholesterol can benefit from taking statins, according to latest research. .. ..
    “Now a major study .. .. ” Please enough!

    Read deeper in and Jo Willeys article seems to carry a general advocation originating from Prof. Colin Baigent [1] and from Prof. Jeremy Pearson [2] that benefits of statin prescription are, well, universal. The mantra that “cholesterol is a major risk factor for heart disease” is nicely pasted into the article. The healthy level of LDL is now advocated, according to this article, at 4.4mmol/l and total cholesterol should be less than 5. So the implication is that the bar has been lowered to include more people and higher dosage is advocated to achieve even greater reductions. Six million people in the UK take statins and in the USA the market for them was worth a reported $4.3bn.

    Aside from the controversy surrounding effectiveness of these drugs you’d have to admit that if Baigents’ and Pearsons’ advice was adopted it would constitute a sizeable increase in the market for these drugs. It does have me wondering if the Daily Express readership constitutes a particularly attractive demographic and I’ll be watching to see if advertising for cholesterol lowering margarine follows soon.

    The Daily Express report does not say, but the release behind it must be linked to a study published in THE LANCET also on 9.11.2010. Forgive me, but should not the study be peer reviewed before its findings are impressed upon a vulnerable demographic? despite the fact that I would like to find reason to discredit Messrs Baigent and Pearson, I can’t in the time available, but illuminating upon the funding of the study is some consolation. .. “Merck; The Clinical Trial Service Unit also receives funding from the UK Medical Research Council and the British Heart Foundation.”

    Yet Jo Willeys article concedes that simvastatin has controversial side effects particularly at the higher dose levels advocated but concludes, ” .. a smaller, 20mg dose of one of the newer and more potent statin drugs such as duovastatin could produce the same benefits.” So a study into simvastin is being used to advocate use of a different drug.

    But lets have the last laugh at the Daily Express expense because on p38 of the same edition is an article that features reports of the possible link between poor oral hygiene, oral inflammation, and its’ possible association with incidence of heart disease.

    Few things in life are absolute but count on this, “money makes ze verld go arround, ze verld go arround .. and we each must preserve our seat on the great gravy train.

    1, Prof. Colin Baigent hails from the Clinical trials Unit of Oxford University

    2, Prof. Jeremy Pearson of Kings College London, devotes 60% of his time to the British Heart Foundation in the role of associate medical director.

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