Doctors question the use of statins in the elderly

In previous posts I’ve expressed a distinct lack of enthusiasm for cholesterol-reducing statin drugs. These medicaments are very much in vogue as a result of their much-touted ability to reduce the risk of ‘cardiovascular’ conditions such as heart disease and stroke. However, a better measure of the effectiveness of a ‘preventive’ treatment such as statin drugs is ‘overall mortality’ (basically, funeral rates). Research shows that in individuals with no prior history of cardiovascular disease (who represent the great majority of those taking statins), funeral rates are NOT reduced by taking statins.

This fact reared its ugly head again in an ‘analysis’ piece in today’s British Medical Journal [1]. Three General Practitioners, one based in New Zealand and two others from the UK have questioned the use of statin drugs in the elderly. The paper is based on the findings of what is known as the PROSPER study, which assessed the effects of the statin pravastatin in a group of more than 500 individuals aged 70-82 years.

In this population, heart attacks and death due to heart attack was reduced. However, risk of being diagnosed with cancer was 25 per cent higher in those taking the drug. Crucially, overall mortality rates were not reduced by taking the pravastatin. The authors of this paper suggest that the taking of statins by the elderly is likely to give with one hand and take with the other: cardiovascular risk goes down while risk of cancer goes up. The authors state: By providing treatments designed to prevent particular diseases, we may be selecting for another cause of death unknowingly, and certainly without the patient’s informed consent. This is fundamentally unethical and undermines the principle of respect for autonomy. They go on to add that: Prevention has side effects other than the hazards of the treatment”in particular, the shadow cast over a currently healthy life by the threat of disease, which might be magnified in elderly people for whom mortality looms closer.

These all seem like very good points to me. Furthermore, they make another good point in their observation that the problem here is not that we have inadequate data, but how that data is interpreted and communicated to doctors and their patients.

One reason for why statin treatment is so entrenched in medical care in the UK relates to the fact that general practitioners are remunerated by the Government for this practice. As the authors point out, offering doctors financial incentives may coerce doctors into persuading patients to accept such preventive treatments. There is evidence that this sort of remuneration actually changes health care practice [2]. As the authors of this paper state, whether this improves actual health care is not always so clear.

References:

1. Mangin D, et al. Preventive health care in elderly people needs rethinking
BMJ 2007;335:285-287

2. Petersen LA, et al. Does pay-for-performance improve the quality of health care? Ann Intern Med 2006;145:265-72

7 Responses to Doctors question the use of statins in the elderly

  1. Roderick Mallia 10 August 2007 at 12:23 pm #

    It’s a well known fact that the more you live, the greater your risk of developing cancer. If these statins do reduce the risk of anyone getting some nasty cardiovascular disease (which has been proven), they inveitably increasing the life expectancy. This will inevitably means that these patients do have a greater chance of developing a cancer. So cancer might not be a side effect of the statins themselves, but of a longer life.

    That being said, I fully agree that such a ‘selection’ should be clearly pointed out to the patient prior to initation of therapy and the patients themselves instructed on how to minimise these risks (of course, if they do intend on going on with the therapy after an informed decision). What I find particularly strange is the financial incentive given to the doctors for prescribing statins. Any idea on why this is done?

  2. Matty Maccaro 10 August 2007 at 3:12 pm #

    Thanks so much for consistently putting out this message. I am trying to recover from statin induced myopathy and it is quite difficult. I’d like to refer your readers to Beatrice Golomb, MD, PhD, Statin Effects Study which has been ongoing for about five years at the University of Calif. at San Diego. People must realize the inherent problems statins can cause, many are far more serious than imagined. Also the research indicates that 85% of physicians dismiss symptoms as being statin related. Such is the power of the pharmeceutical companies to convince doctors to administer these statins.

  3. Roderick Mallia 11 August 2007 at 8:17 am #

    “Such is the power of the pharmeceutical companies to convince doctors to administer these statins.”

    True, but you can’t blame these companies. Ultimately it’s the doctor’s fault if he fails to read the small print or make a serious evaluation about the pros and cons of certain drugs. It’s ironic that when we speak of drugs the first thing that comes to mind is ‘side-effects’ and yet, many doctors fail to see that side effects do exist in reality and not only in literature.

  4. Hilda Glickman 12 August 2007 at 2:13 am #

    There are natural ways to reduce cholesterol if needed. Why not try these first ? Also as statins lower CoQ10 why is this not given with them? Lastly if so many people ‘need’ statins why is no-one asking. ‘What is going on here here?’

  5. Harry 13 August 2007 at 2:16 pm #

    What is interesting is that the Government had a policy of not funding preventative ‘medicines’ on NHS. For example Malaria medication and vitamins to name a couple.

    Goal posts seem to have been moved for the statins for some reason!

  6. helen 13 August 2007 at 10:34 pm #

    “If these statins do reduce the risk of anyone getting some nasty cardiovascular disease (which has been proven), they inveitably increasing the life expectancy. ”

    what has been proven is that statins can help a very small percentage of “men” around the age of 40 who have already had a heart attack. there is no proof that statins assist anyone else at all – indeed there is overwhelming proof that statins cause more problems than they could ever fix & are totally useless for women & the elderly. it has also been proven in many studies (visit pubmed) that cholesterol does not cause heart disease it has also been proven in numerous studies that elderly with high cholesterol live longer. Also statins stop the liver creating a very necessary to cellular health coenzyme Q10, which is why cancers & other diseases tend to pop up the cells aren’t strong enough to function properly. So you do the math & use your brain if your doctor insists on writing you a prescription for a non existant “dis-ease” then either, tear up the prescription, change doctors or have the doctor come up with real proof not just his verbal assertion that the drug is okay & that a perfectly natural fat is bad for you. Maybe they should be looking at what is causing your body to create it’s repair tool (cholesterol) things like inflamation & cell damage in the heart area, mostly caused by things like sugar (carbohydrate), too much omega 6 (polyunsaturated fat), trans-fats, tobacco, stress etc not the saturated fat you might eat in your diet.
    the fact that doctors make money out of prescribing various drugs via what amounts to a bribe then that alone should get you to question the validity of the doctors knowledge. Doctor is not spelt G.O.D. they are not the whole source of knowledge on illness & it’s prevention or treatment (sorry Dr Briffa no insult intended as you do prove some doctors actually give a damn about people’s health & it isn’t just a job for making money).

  7. Marie 14 August 2007 at 6:32 pm #

    “many doctors fail to see that side effects do exist in reality and not only in literature”

    I think that was very accurate. I have not eaten any statins myself but my father (died in 2003), my mother and my boy friend (died 2007). Those were to people who made me interested in doing my own “research” and that is something which I will recommend everyone.

    Many of the side effects of statins can easily be ignored as related to old age etc.

    Here are som of the books I have read and the home pages that I visit regularly.

    The Cholsterol Myths by Uffe Ravnskov
    http://www.ravnskov.nu
    Also search on his name and http://www.thincs.org (he is the head of this international, cholesterol sceptic organisation)

    Lipitor – thief of memory by Duane Graveline
    http://www.spacedoc.net
    He has also written another book – can´t remember the name.
    Lots of information.

    http://www.medications.com + drugs + Lipitor or any other statin´s ame + side effects.
    Very interesting reading, I assure you. Hundreds of patient stories.

    http://www.statinalert.org

    The Great Cholesterol Con by Antony Colpo
    also search on his name

    I am so glad there is the Internet because where I live in Sweden, there is very little independant information about drugs and no consumer organisations.

    I have also read an interesting book about a certain type of antibiotics, quenelones (Cipro, Ciprofloxacin and others) – Bitter Pills by Stephen Fried. Recommended.

    There is also a lot of information on http://www.fqresearch.org.

    I have also read Gillian Sansons – The myth of osteoporosis – Overdosed America by John Abramson, The Truth about the Drug Companies by Marcia Agnell, Death by prescription by Ray D. Strand.

    I am happy no know English well enough to get through them without too much pain.

    So my advice is – do some research on your own – read books, search on the Internet etc.

    Good Luck!

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