Scaremongering about statins by doctors could have caused 2,000 deaths, said a report last week. These would be the lives lost through people listening to the debate on the drugs and deciding to ditch them and risk a heart attack or stroke. The health watchdog Nice recommends statins to prevent cardiovascular disease in those with high risk (greater than or equal to 20% at 10 years) and intermediate (greater than or equal to 10% at 10 years) risk.
I should declare my conflict of interest. I work for the BMJ, purveyor of statin scepticism. The medical journal has raised the blood pressure of Professor Peter Weissberg, medical director of the British Heart Foundation, who said at a press conference this week that the BMJ was opposed to medicalisation of the “normal population”. The BMJ entered the statin debate in 2013, publishing an article that said (I paraphrase) that the benefits of statins were overstated, while their side-effects were undercooked.
The rate of side-effects such as muscle pains quoted in the article (18-20%) was hotly disputed by some cardiologists and epidemiologists. It was later revised to up to 9%. The “lives lost” figure is taken from another BMJ paper published this week, extrapolated from GP data showing 200,000 people may have stopped taking statins because of the media furore. However this, like the initial BMJ paper, is based on observational data – so doesn’t prove cause and effect. It also, most importantly, ignores that people of sound mind might actually decide to stop taking statins for other reasons.
The solution
The answer isn’t a quick yes or no, but a conversation to have with your doctor. If you had that conversation with Dr Malcolm Kendrick, a GP from Macclesfield who has researched and written about statins, it would go like this: “If I was taking a tablet every day for the rest of my life, I would want to know how long I would have extra to live. If you take statins for five years and you are at higher risk, then you reduce the risk of a heart attack by 36%. But if you rephrase the data, this means on average you will have an extra 4.1 days of life.” He warns that the risks are based on old data when heart attacks were more common – one study found that risk calculators overestimated the risk by four or five times.
Even the Nice decision support tool for patients says that if 100 people at intermediate risk (greater than or equal to 10%) took statins for 10 years, then four people would be saved from having a cardiac event or a stroke. This may be enough for you. But it should be your decision and not a given from anyone.
