Doctor asks serious questions about the widespread use of statins

A few times on this site I have written about the writings of Dr Des Spence – columnist in the British Medical Journal and practising doctor based in Scotland, UK. Regularly, Dr Spence uses his column to expresses doubt about the ‘wisdom’ of conventional medical practice, and quite frequently takes a swipe at what he regards as ‘bad medicine’. Quite recently, for instance, Dr Spence lamented the pharmaceuticalised management of diabetes, which I wrote about here.

Recently, Dr Spence’s chosen subject of the week was cholesterol-reducing statin drugs [1]. To put this context, my experience tells me that the majority of general practitioners here in the UK have considerable appetite for these drugs, and generally don’t hesitate to whip out the prescription pad when the advice to ‘eat a low-fat diet and take exercise’ fails to ‘control’ cholesterol levels sufficiently. Recent times have seen some suggest that statins should be more widely prescribed, including to the middle-aged. Dr Spence, though, questions whether his is good medicine.

Dr Spence draws our attention to the fact that our management of cardiovascular disease is based on risk factors such as cholesterol, blood pressure and blood sugar levels, but also points out that there is a view that that there is no ‘normal’ level of cholesterol in the bloodstream.

There has been a gradual downward drift of what is regarded as an acceptable cholesterol level and some attempt to popularise the idea that, when it comes to cholesterol, the ‘lower is better’. But we know, for example, that pretty much everything may be bad in excess, but the body may suffer if levels are too low too. This goes for blood sugar, blood pressure, body temperature, sodium levels and a myriad other things.

Now, one might argue that cholesterol is just a poison, of course, like arsenic and cyanide. But then why would it be a constituent in every cell in the body, and a critical component of other things including key hormones and vitamin D? It should perhaps be borne in mind that low levels of cholesterol are associated with enhanced risk of death, including from cancer.

The thrust of Dr Spence’s issue with statins concerns their effectiveness in low risk individuals. He states (and he’s right, I think), that the effects of statins need to quantified. What he’s alluding to here is the fact that while statins are often said to reduce the risk of, say, heart attack by about a third, this only becomes meaningful when someone’s risk of having such an event is high.

A good way to gauge effectiveness is through a measurement known as the ‘number needed to treat’. So, for example, we might ask how many people would need to be treated with statins for a year to prevent a cardiovascular event such a heart attack or stroke. Dr Spence informs us that the figure for low risk individuals over the age of 60 is 460. And the number need to treat to prevent one cardiovascular death comes out at somewhere between 1,250 and 5,000. Trust me when I tell you that when these sort of figures are presented to individuals, and the possible side effects explained too, most people decide they won’t bother.

Dr Spence ends on a low note:

But scepticism is futile. Guidelines will be issued to expand statin use, and these orders dutifully followed. Patients trust doctors and will go along with this advice, eroding societies’ wellbeing and fanning health anxiety. Soon the natural extension of this logic will see a clammer for statins in ever younger age groups and for more aggressive treatment. Is “statins for all” bad medicine? Time will tell.

Our appetite for statins as a profession hinges on the ‘magical’ relative risk reductions that are quoted loudly and often. The fact most people are highly unlikely to benefit from these drugs and have significant risk of being harmed by them is conveniently forgotten.

References:

1. Spence D, et al. Bad medicine: statins BMJ 2013;346:f3566

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10 Responses to Doctor asks serious questions about the widespread use of statins

  1. Jules 21 June 2013 at 9:13 am #

    I think it might be a relatively easy decision to make if you fall into the category of ‘low risk, but let’s just start you on a statin to be safe’; I don’t think I would have any hesitation of saying no thanks after all I’ve read.

    However, there seems to be so little guidance for people with a, supposedly, higher risk; and what exactly is higher risk. If the same people who suggest we take the statin in the first place also tell us who is at higher risk, should we believe them?

    I fall into the ‘apparently’ higher risk category and currently have some simvastatin 40mg sitting in my kitchen unopened. Most literature is based on the over-prescribing of statins to the ‘low risk, middle-aged with a marginally raised cholesterol’. At the moment, my ‘risk’ seems to be solely based on a cholesterol reading and a parent who had an MI in their 60s. I am not surprised that I was handed the prescription, but would have liked to have a reasonable discussion regarding my real / perceived risk. I am fairly sure I am doing the right thing by not taking these tablets……..

  2. LeonRover 21 June 2013 at 9:55 am #

    Thank you for referring to Dr Spence’s paper.

    I was surprised at the data on some statin NNTs; I had only been aware of a value of 250.

    ( I wonder if Dr ‘Lipid’ Dayspring will take note ?)

    I also appreciate the NNT details you recently noted WRT hypertension medication NNTs.

  3. Chloe 21 June 2013 at 10:41 am #

    Thanks again for this Dr B!

    What do you think of matcha powder? I’d love to hear your take on it as it seems to be the thing to drink at the moment for antioxidant power and weight loss.

  4. Stephen Rhodes 21 June 2013 at 6:35 pm #

    This link is to an interesting paper I saw on the drmalcomkendrick.org which summarises a lot of research into dietary fats and discusses how inflammation can result from a combination of bad dietary practice and unlucky genetics.

    Since the only beneficial effects of statins are the unintended ‘anti-inflammatory’ side effect it is probably a better approach to prevent the inflammation rather than cure it.

  5. Stephen Rhodes 21 June 2013 at 6:36 pm #

    Oops!

    The link:- http://advances.nutrition.org/content/4/3/294.long

  6. Robert Park 21 June 2013 at 7:09 pm #

    After being a vegetarian for 17 years I was taken down by a heart attack. Subsequently, I had an emergency quadruple by-pass and upon coming out of IC was asked what I would like for breakfast; my reply was, “If I am about to die (which then was a possibility) then I am going to die happy so make it streaky bacon and eggs”. That was 23 years ago. With one exception I maintain excellent health. Over the past six years the GP said (on two occasions only) that my cholesterol was a tad high and she was about to put me on statins but was unable to see my heels for the dust! There is a neighbour of mine who has been on statins for 12 years and he wanders around like a zombie; totally out-of-touch with all around him.

    Since about c2000 I have developed a drag on my left foot and 4.5 years ago my back went out and when the problem was overcome I was left with a left foot limp. The GP’s comment was, “You have had a minor stroke.” I was sent to the physiotherapist who was unable to do anything other than to provide a contraption to help lift the foot but immediately my leg became dependent on it so it was abandoned.

    Dr Terry Wahls (see TED on the Net) managed to overcome multiple sclerosis through diet and on reading of her experience she too developed a similar limp and was given the standard MS treatment which appears to have accelerated the condition. I did not accept treatment and while I still have the limp (a form of sclerosis possibly) my condition has not deteriorated. I am partially disabled but sufficiently mobile to effectively manage and enjoy life.

    I am 82 years of age but not old! What angers me is that the medical profession is aware of substances which are readily available which clears plague from arteries but I was not informed about this option. The medical profession is also aware of natural substances that quickly rids influenza (medical research) yet it pushes the drugs of the pharmaceutical companies.

    Like Dr Terry Wahls I too have managed to wean myself off prescription drugs through diet. I do not want a GP to tell me that I am unwell but whenever I feel unwell I will consult them.

  7. Mark Struthers 21 June 2013 at 7:52 pm #

    Des Spence’s article can be read in full at,

    http://bad4umedicine.blogspot.co.uk/2013/06/bad-medicine-statins.html

    Please note that in the article Des also expresses some very ‘conventional’ views on vaccination – in particular that they are “medicines miracle”.

    Some views on the less than miraculous nature of vaccines – and statins – have been expressed in the rapid responses to Des Spence’s article,

    http://www.bmj.com/content/346/bmj.f3566?tab=responses

  8. SueG 22 June 2013 at 2:23 pm #

    I have had 2 “health” checks in the last year. In that time I have also largely given up carbs. My cholesterol has risen from 5.7 to 6.7! I eat all the things that are now considered healthy, raw milk, raw butter, green leafy veg. red meat, white meat and fish. Nearly everything I eat is freshly made and whole and organic where possible. We eat only twice a day, try to fast 3 days a week and I don’t eat very much because too big a meal gives me palpitations also.

    Apparently I also have a fatty liver although I seldom drink because it causes palpitations. I also have Chronic kidney disease which I was reassured was nothing serious and likely just age related (I am 62). I seldom eat bread, only rye if I do, I don’t eat potatoes, pasta and rice once in a blue moon. Just where am I going wrong?

    I take magnesium 10000ius Vit.D3, Krill oil, turmeric, milk thistle, COQ10 and probiotic capsules. I have even been trying Oxbile in an effort to shift my weight as I no longer have a gall bladder. I’m beginning to think I’m stuck with this extra 3.5 st forever!

    Any suggestions welcome, bear in mind I am not about to take up running and given all the information re. the futility of exercise with regard to weight loss I won’t be running myself ragged in the gym any time soon.

  9. Vanessa 27 June 2013 at 12:05 pm #

    “Soon the natural extension of this logic will see a clammer for statins in ever younger age groups and for more aggressive treatment. Is “statins for all” bad medicine? Time will tell”.

    By ‘clammer’ does he mean ‘clamour’ or am I misunderstanding something???

  10. Searcher 1 July 2013 at 8:14 pm #

    SueG

    Have a look at Dr Mercola’s site and search “cholesterol”. According to him the two important markers are
    “HDL/Total Cholesterol Ratio: Should ideally be above 24 percent. If below 10 percent, you have a significantly elevated risk for heart disease.
    Triglyceride/HDL Ratio: Should be below 2.”
    He is not concerned about total cholesterol (within reason)

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