Here in the UK this week Professor Rory Collins has enjoyed a bit of a media blitz telling all who will listen that statins should really be considered for anyone over the age of 50, irrespective of their risk of cardiovascular disease and state of health. Here and here you can see how his ideas were reported in the Daily Mail and the Telegraph (two UK national newspapers).
One of the points Professor Collins often seems keen to get across is the ‘small risk’ from statins. However, Professor Collins often puts his focus on muscle damage, which in studies is sometimes only diagnosed if blood markers for damage are several times the upper limit of normal (sneaky, I know, but true). Also, many individuals prone to problems might have been screened out of the actual study before it even begins by employing a ‘run-in’ period where individuals are given the drugs to see how they react. If they react badly, they don’t get to make it into the study which leaves the more resilient individuals to give us a skewed idea of the hazards of medication. Also, we should be aware that statins can do more than damage muscles. They can weaken them, cause pain in them, and damage the liver and kidneys too. Cataract and diabetes are two other side effects.
I was thinking about the pros and cons of statins this week while being consulted by an elderly man with who came with a main diagnosis of Parkinson’s disease, and a past history of more than one ‘mini-strokes’ (known as transient ischaemic attacks). One of the medications he takes is the statin simvastatin. His daughter wondered whether this might be somehow compromising her father’s health, including his muscle and mental functioning. The only legitimate answer to her question is ‘yes’. But as I went on to explain, it is in my view highly unlikely that any problems here are likely to be entertained by her father’s regular doctor.
The problem is that most doctors will see sitting in front of them an elderly man with Parkinson’s disease and a history of mini-strokes, and imagine any compromise in his functioning will be related to these things, not a statin drug which was started several years ago. It might be, however, that the statin drug is genuinely compromising his functioning, and it’s certainly legitimate for this possibility to at least be entertained.
Purely by chance I came across a piece of research this week regarding the potential impact of statins on brain functioning. It’s not uncommon for people to report that taking statins led to them suffering memory or concentration issues. If statins affect the brain, then one might expect them to be particularly problematic in individuals who have compromised brain functioning to begin with, such as those with Alzheimer’s disease.
A group of US-based researchers decided to test this idea in a group of elderly individuals suffering from Alzheimer’s disease . All of the individuals in this study were taking statins at the start of the study. The research involved taking these individuals off statins for 6 weeks, and then putting individuals back on their statin medication for another 6 weeks. During the study, individuals had their mental functioning assessed including with a tool known as the ‘mini mental state examination’ (MMSE). This test is designed to assess brain functions such as memory, the production and understanding of language, problem-solving and decision-making – what researchers and doctors often refer to as ‘cognition’.
This research revealed that withdrawal of statins led to a statistically significant improvement in cognition in the study subjects. Re-starting statin therapy led to cognition worsening again. The implication here is that for individuals with dementia, statin treatment might further compromise brain function and, along with it, quality of life and dependence of carers.
One gratifying thing is that there is hugely growing awareness of the very real downsides and potential for harm of statins. If you care to, you can look at the comments after the two articles I link to and read a steady stream of statin sceptics who often give first-hand tales of apparently being harmed by these drugs. And also encouraging is the fact that there are even murmurings from doctors who believe giving statins to everyone based on their age is just not good medicine (I’m in this camp too, of course).
One of the problems with Professor Collins is that he seems incapable of providing a truly balanced view of statins. He is particularly selective about his quoting of the supposed risks, I think. Plus, it seems he can’t quite bring himself to come clean about facts like statins don’t save lives in people with no prior history of cardiovascular disease (e.g. a previous heart attack or stroke) and the vast majority of people who take statins over several years will not benefit from them.
I reckon Professor Collins has a lot of his credibility invested in us believing his ‘hype’ about statins. He appears to have major blind spots about these drugs, and perhaps these two things are related. One other problem, I think, is that Professor Collins is not a clinician, and simply won’t have the experience of seeing the potential damage statins can cause in the real World. He’s a data man, and a very selective quoter of it, to boot.
1. Padala KP, et al. The Effect of HMG: CoA Reductase Inhibitors on Cognition in Patients With Alzheimer’s Dementia: A Prospective Withdrawal and Rechallenge Pilot Study. Am J Geriatr Pharmacother. 2012 Aug 22. [Epub ahead of print]