Statins reduce cholesterol, and this is said to be the primary mechanism through which they reduce the risk of ‘cardiovascular’ events such as heart attacks and strokes. When used in clinical practice, statins can be given to people with or without prior history of cardiovascular disease. Giving statins to people with a history of cardiovascular disease (e.g. a prior heart attack or stroke) is known as ‘secondary prevention’ and generally gets better results than giving it to people with no such history (known as ‘primary prevention’). For example, statins in secondary prevention have been shown to reduce overall risk of death, while in primary prevention they have not.
A review published this week looked again at data from secondary prevention studies [1]. The purpose of the review was to pool the results of several (11) studies to see if there was any difference between the results obtained in women compared to men. There were statistically significant reductions in the risk of things like heart attacks, strokes and overall risk of death in men.
But in women, the results were different: there was no significant reduction in the risk of stroke nor overall risk of death. Even in the secondary prevention setting where results are generally best, no woman appeared to have her life saved by taking statins.
Now, one reason for this result might be that there were not enough women in the studies used in the analysis to detect a change. That might be true and we can’t tell one way or the other, unfortunately. Another explanation is, of course, is that statins don’t save lives in women, even in those at high risk of cardiovascular problems.
There’s a very interesting commentary that accompanies this review, written by two researchers from the London School of Hygiene and Tropical Medicine [2]. The researchers are keen to persuade us that statins work just as well in women as in men. They cite two meta-analyses which show benefit in terms of heart events (such as heart attacks) and ‘vascular events’ (total number of events such as heart attacks and strokes). However, the quoted data cannot tell us anything about risk of stroke alone, and crucially does not tells us anything about the key matter in hand: whether statins actually save women’s lives.
The researchers then go on to draw our attention to a study which was excluded from the most recent analysis (the so-called Heart Protection Study). The researchers add this into the data and appears to improve the results. The thing is, though, even when they put in this study, overall risk of death in women was (again) not reduced by a statistically significant amount.
But that does not matter to the researchers, because they maintain that statistical significance is not important. With this stance, these researchers cut themselves adrift from a central tenet of the scientific method and the interpretation of results. It seems some scientists, in order to positive spin on unexpected or undesirable results, will take a distinctly unscientific stance.
References:
1. Gutierrez J, et al. Statin Therapy in the Prevention of Recurrent Cardiovascular Events: A Sex-Based Meta-analysis. Arch Intern Med. 2012;172(12):909-919
2. Taylor F, et al. Statins Work Just as Well in Women as in Men: Comment on “Statin Therapy in the Prevention of Recurrent Cardiovascular Events”. Arch Intern Med. 2012;172(12):919-920
“statistical significance is not important”
In studies regarding cholesterol reducing drugs, this has been the case since MRFIT and WHO studies in early 1980’s.
The title of last study should read
“Statins Work Just as BADLY in Women as in Men”.
Slainte
Given the constant demand that we ‘rationalise’ NHS services to provide ‘maximum value for money’, why doesn’t the government invest in some rigorous research into statins and their massive cost to the NHS? Is it a) such a ‘minority’ view that it does not even appear on the radar of the medical establishment? b) a question that is side-lined due to the on-going propaganda of (often) unscientific data that supports mass medication? or c) a question that does not have an end-result of lining the pockets of multi-million/billion dollar companies with sophisticated lobbying interventions at government level? I’ll be believing b) and c) until there’s totally unbiased evidence to tell me mass interference with the body’s bio-chemistry is a healthy option!
A press report on a paper (abstract, actually) of a “small observational study” given at the recent American Diabetes Association meeting is as follows: “ADA: Statin Use Tied to Faster Plaque Buildup.”
Here’s the link: http://www.medpagetoday.com/MeetingCoverage/ADA/33191
Some commentators suggest that this could be a good thing, because calcified plaque can be more stable, so not to worry about the higher calcium scores of the authors found. Huh?
What should we make of this report, recognizing its limitations?
Some years ago I experienced a uncomfortable ( like muscle cramp) pain in the left side of my chest which lasted about 10 seconds. This “symptom” occurred about two or three times over a twelve month period, usually when I was seated in a chair and would stop when I stood up and rotated my arms and / or briefly massaged the “cramped “area.
At no time did I feel nausea / fever / pins & needles sensation or been physically active & apart from the brief stitch like sensation and generally felt ok.
My GP recommended a treadmill stress test, which failed to reproduce any symptoms and pronounced my condition as normal.
Over the next two years I experienced brief “chest pain discomfort” on about four occasions and had another treadmill test which found my condition as normal.
Two years later: Following this period I did not have any more trouble however my GP ( on studying my health record & discussion with me) referred me to a heart specialist who gave me an angiogram with the finding that I hid slight signs of plaque in one of my heart arteries. I was prescribed LIPITOR (Tablets) 20 mg (blister) and Aspirin tablet 100mg daily.
Since then I then I have read you book “Waist Control” and (Blogs) subscribed to your website.
I have followed your report on the adverse findings of statins with much interest and consequently stopped taking Lipitor four weeks ago with no adverse affects.
As matter of interest I have not had any chest pains in the last 12 months and am on no other medication. I am 77 years living and my GP tells me of good health for my years.
Regards – M Vandeleur
On the subject of statins the drug companies and the government have found a new way to medicate the nation. Applying for my travel insurance I was asked if I had high cholesterol and if so was I taking statins. So now even the insurance companies think we should be taking them!