Statins for healthy people? Hang on a minute…

I’ve had a few emails today alerting me to reports of a study concerning the use of statins in healthy individuals. The study in question is a meta-analysis (grouping together of similar studies) of statin trials [1]. Part of this meta-analysis involved assessing the impact of statin therapy in individuals deemed to be at relatively low risk of cardiovascular events such as heart attacks and strokes. One of the stand-out findings of this study is that statins led to a statistically significant reduction in risk of ‘major vascular events’. This was even true for individuals at less than 10 per cent risk of vascular events over a 5-year period. This has led to the suggestion that statins used might be widened to even people at low risk of cardiovascular problems.

Before we swallow this idea, though, it is perhaps a good idea to see just how effective statins were found to be in this meta-analsysis. First of all, what is meant by ‘major vascular events’? Actually, this is a term that includes many different potential outcomes including fatal and non-fatal heart attacks and strokes and ‘revascularisation’ procedures (such as placing tubes called stents in the coronary arteries). When a lot of different outcomes are grouped together, it makes it much more likely that a ‘statistically significant’ results will emerge.

When the outcomes are narrowed a little, the results are less impressive. For example, when we look at risk of death from any vascular event (a heart attack or stroke), we find that statins did not reduce risk in individuals deemed to be at low risk (<10 per cent over 5 years). This, by the way, was even true for those who had known vascular disease.

The ‘positive’ findings from this study have, as is often the case, been expressed as reductions in relative risk. The risk of vascular events overall was 21 per cent lower for each 1 mmol/l (39 mg/ml) reduction in levels of low density lipoprotein cholesterol (LDL-C). However, when overall risk is low, then a relative risk reduction might not amount to much in real terms.

We’re told by the authors this meta-analysis that treating with statins prevented 11 major vascular events for every 1000 people treated for a period of 5 years. Put another way, 91 people would need to be treated for 5 years to prevent one major vascular event. Or in other words, only about 1 per cent of people treated with statins for 5 years will benefit (and about 99 per cent won’t).

Overall, lowering LDL-C by 1 mmol/l was found to reduce the risk of death by 9 per cent over a 5-year period. Again, this might sound like a positive finding to some, but the actual reduction in risk of death was 0.2 per cent per year. What this means is that at this level of cholesterol reduction, 500 individuals would need to be treated with statins for a year for one person to have his/her life saved.

The authors of this meta-analysis give us some soothing reassurances about the fact that the benefits of statins vastly outweighing the risks of adverse events such as myopapthy (muscle pain and weakness). They quote of the excess incidence of myopathy as 0.5 cases per 1000 people over 5 years. However, the source they quote is based on diagnosing myopathy once the marker for muscle damage (creatine kinase) is at least TEN TIMES the upper limit of normal. Many individuals will have significant pain and weakness with much lower levels of creatine kinase. Statins are also linked with adverse effects on the liver and kidneys, and increase risk of diabetes too.

Despite the very positive interpretation of the data by the study authors and the media, this meta-analysis shows us again what previous evidence has revealed: statins are highly ineffective in terms of improving health and saving lives. And their risks are generally downplayed.

Collectively, the authors of the meta-analysis are referred to as the Cholesterol Treatment Trialists’ (CTT) Collaborators, including researchers from Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University. The conflicts of interest statement which accompanies this paper informs us that: “Some members of the writing committee have received reimbursement of costs to participate in scientific meetings from the pharmaceutical industry.” I suppose this may account, at least in part, for a data interpretation that appears so heavily biased towards statins.

References:

1. Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. The Lancet epub 17th May 2012

35 Responses to Statins for healthy people? Hang on a minute…

  1. Michael Allen 17 May 2012 at 7:37 pm #

    Much as I appreciate the detail, John, I actually didn’t need you to point out that the data interpretation ‘appears so heavily biased towards statins.’ I somehow knew that would be the case as soon as I saw a 10 word summary of the research on BBC teletext, early this morning. But then, as someone once told me, I was born cynical.

  2. Tuck 17 May 2012 at 7:48 pm #

    “…groping together…”

    Hopefully not. ;)

  3. John Crane 17 May 2012 at 10:53 pm #

    Will they never give up !!!!

  4. stephanie 18 May 2012 at 5:57 am #

    Totally agree – statin related articles have been popping up all week – so I am thinking there is some co-ordinated marketing push with sympathetic stories. As a clinical researcher many years ago for some of the big pharma companies it was not hard – or controversial – to ‘drop’ research that did not favour the drug – reflecting on some points in your previous blogs. Now having returned to my original degree as a nutritionist, I am witnessing the damage statins and other drugs do to the body’s metabolism let alone brain function. Down here in Australia statins are quickly catching up with the US and UK – unfortunately we already lead the world in ritalin prescriptions (Perth)

  5. Jo 18 May 2012 at 1:24 pm #

    Thanks for this analysis – enlightening as usual. I am sick to death of the media just publishing what are effectively press releases for the pharmaceutical companies without any kind of critique.

  6. TerryJ 18 May 2012 at 3:57 pm #

    Typo (funny one this time!)

    meta-analysis (groping together of similar studies)

  7. Megan 18 May 2012 at 5:03 pm #

    Thank you for commenting on this and making the statistics clearer. I saw this on the news yesterday and early fell out of my seat. My ever patient husband bore the brunt of my anger. I just had to explain to him about the evils of statins and even pointed out that it will be children and pergnant women that they will be drugging next. The thing is that trying to explain to the average person about the possible side effects and lack of actual benefit from taking statins is hard work. They all believe their doctors, because doctors are well meaning and care about their patients. If only they cared enough to to correctly understand the data.
    Thankyou for being the voice of reason here in the UK. I just wish you had a wider audience…

  8. Dr John Briffa 18 May 2012 at 5:09 pm #

    Tuck and TerryJ

    Thanks for spotting – corrected now (though was tempted to leave it, to be honest)

    John

  9. mamaprophet 18 May 2012 at 5:44 pm #

    Megan I so totally agree, it’s very hard work trying to convince my husband and family that the doctors don’t always know best.

  10. Hilary 18 May 2012 at 6:21 pm #

    Many thanks for your comments on this paper. It’s good to have a professional interpretation that one can really trust.

  11. sja45uk 18 May 2012 at 6:30 pm #

    John, is there any validity behind this paper: “Statins use is associated with a reduced incidence of colorectal adenomatous polyps: a case-control study” ( http://gut.bmj.com/content/60/Suppl_1/A5.1.abstract ). Unfortunately, as is often the case, the full paper is only available to subscribers which makes assessment very hard. However, I probably could not do a good job of understanding it even if I had access to the full paper!

  12. Dan Sinclair 18 May 2012 at 6:50 pm #

    Dammit.
    I was working on the assumption that theoretically if we all took statins, an aspirin a day, ate chocolate, drank red wine and chowed down on golden syrup flavoured weetabix smeared in benecol, none of us should ever get heart attacks again.
    Bravo scientific community, bravo

  13. Julian Stanton 18 May 2012 at 7:02 pm #

    Is this going to be another case of mass medication, like flouride in the water supply? The pharmaceutical industry has a surplus of statins and as it wont hurt anyone lets force it on everyone. All will benefit especially the shareprice of various pharmaceutical companies. Or am I just a cynic?

  14. Feona 18 May 2012 at 7:59 pm #

    Here’s another article, published last January, same group, same number of randomized trials (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261846/). This time they were looking to see if giving cancer patients statins would have any effect. While the meta-analysis apparently had no pharma funding, the trials they analyzed most certainly did. Looks very much like wild thrashing about to find anything that can keep up the income stream now that the patents are about to run out.

  15. Jill 18 May 2012 at 11:21 pm #

    This all makes me think the money behind the statins belongs to some very frightened people. They have to sink to the level of deception to sell their product. I was particularly interested to see how very cheap these drugs are – is this because they’re so unpopular? After all, drugs people really want cost an awful lot. No doubt they’ve done their homework and because so many people are looking to natural ways of preventing heart disease, they need to target those who want to pop a pill in the misguided belief they’re safe from disease. Since when was heart disease due to the lack of a pharmaceutical drug?

  16. Lorna 19 May 2012 at 12:13 am #

    As soon as I saw the artiicle on the front page of The Telegraph this week, I said ‘can’t wait till Friday and Dr Briffa’s blog so I can see the truth behind the wonder drugs (again!)’. You don’t disappoint and like others, I thank you for continuing to challenge distorted representations of ‘research’ so lay-people have an intelligent understanding of this ongoing assault on common sense. Keep up the good work -it’s essential!

  17. Mat 19 May 2012 at 12:19 am #

    With regards to the sympathetic articles appearing ; the statin manufacturers aren’t going to let a £23billion revenue stream dry up…

    Expect a massive fight from them.

    I also expect them to fight dirty as well!

    Keep up the awesome work Dr John!

  18. Simon Pimenta 19 May 2012 at 12:57 am #

    Great article. It is worrying that this sort of research is reported enthusiastically by the media, without looking at the detail. Thanks for your great article Dr Briffa. As ever, the voice of reason and common sense.

  19. Paul Anderson 19 May 2012 at 1:00 am #

    I recall the BBC reporting the end of World poverty a while back – and the other channels as well. I remember thinking that was a little premature, at the time. They reported it with a straight face. Next thing they’ll say is they are abolishing the monarchy. I feel that statins are a ticking bomb – not just their potential effect on every cell in the body, but in combination with other drugs, a low fat (polyunsaturated heavy) diet an avoiding sunshine.

    Best blog around. In danger of giving doctors a good name.

    Paul.

  20. Liz Smith 19 May 2012 at 1:53 am #

    Dogs in USA are currently given Prozac (you know how excitable puppies can get) so I wonder how long it will be before vets are advising owners with fat dogs, to be sold Statins? I’m sure some bright spark will write about it in one of the heavies and it will be the fashion. It does not matter to the manufacturer who is buying as long as they are sold.

  21. JustMEinT 19 May 2012 at 8:25 am #

    I just Knew we could depend on you Dr. B to tell it – as it really is. Anytime I see an article hyping the supposed value of this class of drugs I cringe. Basically because I know there are so many folks out there who just worship their doctors and would never go against what has been prescribed. Does not seem to matter how many articles written by credentialed people – state the dangers of these drugs, some people will still take them because their doctors and the media say they will die without them! I pray for patience, but sadly there are times I find I have an inadequate supply!

    Clare in Tassie

  22. audrey wickham 19 May 2012 at 12:19 pm #

    After a scan of my head it was found half of the right side of my brain had shrunk – you know the bits that look like bananas. I was advised Statins both by the Consultant and my G.P. I was amazed when I told just a couple of friends about this – their immediate response was don’t take them. I broadened my news on email and found that ALLl my correspondents told me not to take them. My GP is pissed off with me and only just about giving me the time of day and when I went further on Google and found that a stomach operation I had about ten years ago – from my pubic hair to my belly button could have upset my B12 centre – the consultant stopped consulting. The most recent test of my B12 showed it to be normal but that is now. However, having put myself under the microscope I now realise that the initial stroke was about 40 years ago with little ones coming about every two years.

    I take your point about bread – gave up potatoes as a staple years ago and have never been addicted to rice or pasta so look forward to a bread free future and less of me.

  23. hilda glickman 19 May 2012 at 4:59 pm #

    Hi, This is just another example of the reason why the man in the street and children need to be better educated in science. Very few even highly educated people can read a research paper and understand it. We should all want the see the evidence when something like this comes out. children learn in science how ablast furnace works – very useful but not much about health and nutrition.

  24. Sue Gooch 19 May 2012 at 10:05 pm #

    “I wonder how long it will be before vets are advising owners with fat dogs, to be sold Statins?”

    The same amount of time it took to advise from feeding them glucosamine & Chondroitin for the joints? I fed my poor dog with these for several years because of his arthritic limp. It didn’t make the slightest difference and now it seems that anyone taking these are fooling themselves, they have no measurable effect whatsoever!

  25. Marie 20 May 2012 at 1:38 am #

    Patient story from Sweden (1)

    I have never taken statins – nor would I.
    Several people close to me were prescribed statins and that made me look for information on the Internet and in books. I started in 2004 and is still going on.

    M o t h e r

    had a small heart attack about 10 years ago.
    Immediately she was prescribed Zocor (=simvastatin).
    In 2004 she told me that she was suffering from weakness and cramps in her legs. She also had sleeping problems (received sleeping pills year after year).

    She had phoned her doctor asking if her symptoms could be side effects from her blood pressure medication, but he said no and the conversation had ended.

    One day, I visited the library and noticed a health magazine – a special cholesterol issue.
    I started reading and discovered Uffe Ravnskov and the cholesterol sceptic network – thincs.org. I read his first book and gave it to my mother.

    I also discovered several sites with patient stories from the U.S.
    Many of them were similar to my mothers.

    I offered to come along on her next doctor´s visit – or write a letter – but she refused.
    She was afraid of offending him. After all, he was such a kind man and he was also taking Zocor (after stroke). Therefore, it must be good.

    In spite of this, I sent him two friendly letters. The last one included many patient stories.
    I told him that I cared about my mother and did not want her to be on more medications than necessary. I wondered if she could taper out and stop Zocor.
    After some weeks, I got a reply. It was neither a yes, nor a no.
    In reply to my second letter he referred to the national guide lines, which recommended even lower cholesterol levels.

    I translated many patient stories for my mother and she had also read Uffe Ravnskov`s first book. I left it at that. I figured that she had received enough information to decide herself.
    After a year, I asked – are you still on Zocor – and she replied – no, I stopped long ago.
    She had phoned the doctor`s office and the nurse had phoned back and said that it was okay if she stopped.

    My mother will soon be 92 years and is still going strong. She takes daily walks and finds life interesting.

    What`s the use of taking statins to lower your cholesterol if you start to develop one problem after the other and become more or less handicapped?

  26. Marie 20 May 2012 at 1:46 am #

    Patient story from Sweden (2)

    X was my close friend for over 20 years.
    He died at the age of 74, prematurely aged, after several years of suffering.
    He was on simvastatin, and other medications, for years, but neither he – nor I – realised that his “new” symptoms could be side effects of Simvastatin.

    When I did, he was too sick to take the battle and the medical staff did not like my “interference”. I knew what I was talking about because by then I had read one book after the other – most of them from the U.S. I had also read hundreds of patient stories.

    I wouldn´t have a clue of the methods of the pharmaceutical industry, side effects of different medications etc. if it wasn´t for people close to me and their suffering. It made me angry.

    X had terrible, shooting pains in his hips, legs, feet, hands etc (diagnosed as reumatism.
    Imuran + prednisolone were added for years on end)

    He was week, could drop things without notice.
    He felt dizzy now and then (was told it was due to tension in his neck)
    He had problems to swallow.
    He lost most of his hair.
    He got tinnitus.
    He lost his taste.
    He had headaches (just like my father, he was told it was due to tension in his neck)
    He was medicated for diabetes-2 which he didn`t have before
    He aged quickly
    He was told that he had trombocytopeni
    He got hives
    He became irritated
    His memory – which had been fantastic – started to deteriorate and I kept wondering why.
    I bought a PC and encouraged him to learn the basics, but was surprised how hard it was and the lessons usually ended in frustration.
    His legs became very thin and so did his arms (he used to be very muscular)

    The list is not complete.

    This story lasted for several years and he did not get the side effects at once. They appeared little by little and was diagnosed as other diseases and his list of medications became longer and longer.

    Please, if you – or your loved ones – are on statins and other medications – start to “educate” yourself. It`s absolutely necessary wherever you live.

  27. Marie 20 May 2012 at 2:10 am #

    List of Books – from Sweden (3)

    Here are some of the books I have read over the years.
    It`s a mixture, not just about statins.
    I have just started a new, interesting book – Pharmageddon by David Healy.
    Google the names of the writers and titles and you will find more information.

    Statins and LCHF:

    Books by Uffe Ravnskov (several have been translated into English and other languages).
    The Great Cholesterol Con (Anthony Colpo)
    Book with the same title ( Malcolm Kendrick)
    Lipitor – thief of memory (Duane Graveline)
    The Statin Damage Crisis (Duane Graveline)
    Eat Fat – Lose Fat (Mary Eunig + Sally Fallon)
    $29 billion resasons to lie about cholesterol (Justin Smith)
    Good Calories, Bad Calories (Gary Taubes)
    The Truth about Cholesterol-Lowering Drugs (Shane Ellison)

    Different kinds of books:

    Overdosed America (John Abramson)
    Our Daily Meds (Melody Petersen)
    Malignant Medical Myths (Joel M. Kauffman)
    Death by prescription (Ray D. Strand)
    The Truth About The Drug Companies (Marcia Angell)
    Powerful medicines – the benefits, risks and costs of prescription drugs (Jerry Avorn)
    Overtreated (Shannon BrownLee)
    White Coat Black Hat (Carl Elliott)
    Top screwups doctors make and how to avoid them (Joe och Teresa Graedon)
    How doctors think (Jerome Groopman)
    Your Medical Mind (Jerome Groopman + Pamela Hartzband)
    What if medicine disappeared? (Gerald E. Markle mfl)
    Selling Sickness (Ray Moynihan + Alan Cassels)
    How patients should think (Ray Moynihan + Melissa Sweet)
    The Devil`s poison (Dean Murphy – about fluoride)
    The Myth of Osteoporosis (Gillian Sanson)
    Overdiagnosed (Gilbert H. Welch, Lisa M. Schwartz, Steven Woloshin)
    Bitter Pills (Stephen Fried, about quinolone antibiotics – Cipro, Levaquin etc.)

    Psychiatry:

    Your Drug May Be Your Problem, Toxic Psychiatry, The Antidepressant Fact Book, Medication Madness mfl (Peter R. Breggin)
    Mad in America + Anatomy of an Epidemic (Robert Whitaker)

    ”””””””

  28. Ian Day 20 May 2012 at 9:25 pm #

    I wasn’t warned against the muscle pains side effects – apart from the small print in the leaflet. I had to sleep with a pillow under my legs to minimise the pain. That was on 10mg.

    It was several months before I read letters in “Balance” relating their adverse experience. I stopped immediately, & the pains disappeared in a week. Then my Dr said it was a known side effect. The pharmacist said they didn’t warn people because we would attribute problems to the drug….

  29. Diane Smith 21 May 2012 at 9:18 pm #

    Thanks for posting this info Dr Briffa. I was horrified when I saw the news report about giving statins to healthy people! The only benefit from this would be in the bank accounts of the drug companys!

  30. Ed Terry 22 May 2012 at 4:03 pm #

    The reported incidence of side effects is much lower than the actual rate. Doctors always automatically dismisss compllaints of muscle weakness/soreness or cognitive impairment as “just getting old”, as if that describes anything.

  31. Bill Walker 25 May 2012 at 10:26 pm #

    I would like to get a look at the paper itself. LDL is often not measured directly and accurately, but is instead calculated based on a single formula for all people. They use the total cholesterol – HDL – TG/5 and call it LDL. If you have low triglycerides (a good thing), your LDL will look higher than if you have larger TG values. Also, there is more than one type of LDL and having larger fluffy LDL (Type A???) is good and this does not show in the lazy way of calculating LDL. They have been lowering levels needed of total cholesterol and now LDL for years to get more people on statins.

  32. Rural gourmet 4 June 2012 at 11:47 pm #

    I recently read the book by Nora Gedgaudas, PRIMAL BODY PRIMAL MIND. Another good contribution to the debate along with WAIST DISPOSAL et al. Also it is “only” ?40 years since the book PURE WHITE AND DEADLY by John Yudkin, which was ahead of its time and was well in line with some of today’s thinking.

    A friend (74) has been diagnosed with salicylate sensitivty. Can this ever be caused by statins? He has ceased taking them, with his doctor’s agreement, but it appears that he should never have been put on them, although he does have a history of CHD and is still nervous about asking about stopping some of his other drug intake. I’ve suggested he further reduces his carb. intake. Thanks for all your work.

  33. JustMEinT 6 June 2012 at 2:07 am #

    RURAL GOURMET
    I too have a salicylate sensitivity which makes preparing what is termed a balanced meal very difficult – as is eating lots of vegetables…… I do not think it is caused from statin drugs. It can be assisted tho – the healing of the gut with FREE FORM L-Glutamine Powder. I take it every morning on an empty stomach and it does seem to be helping me. I would advise your friend to go striclty low salicylate for a minimum of 6 months, and read up on the Rotal Prince Alfred Hospital (Sydney Australia) programme. Howard and Sue dengate are world renowned people in this area… do a Google search for links etc… “Fed Up with Food Additives” is a key search word.

    Clare in Tasmania

Trackbacks/Pingbacks

  1. Just how effective are blood pressure medications? - 14 June 2012

    [...] Some of you may have noticed that I have, more than once, written about just how ineffective cholesterol-reducing drugs (including statins) are for preventing heart attacks and stroke and saving lives. Taken over several years, the data show that the vast majority of people who take them will simply not benefit from them (and have a significant risk of side effects too). You can read a couple of recent posts regarding these facts here and here. [...]

  2. Statins for Healthy People? | Nutritionhelp Blog - 2 July 2014

    […] the media talking about a proposal for the increased use of statins, this post from Dr Briffa is very […]

Leave a Reply