We are repeatedly told that we must have low levels of blood cholesterol (TC) if we wish to reduce our risks of developing heart disease. In fact this is the rationale which underpins a key element of the NHS policy. This means that if your TC is considered to be too high (above 5.0Mmol/L) you may well be prescribed drugs in order to reduce it. So it not in the least surprising that many people have been advised to take TC lowering drugs such as statins. There is little doubt that these drugs are effective in lowering TC but the critical question which has to be addressed is:

“Does this medication actually improve health?”

In BLOG 8 I referred to several research reports which conclusively demonstrated that death rates due to all causes increase as the TC goes down. What is more there is no reliable evidence that there are significant increases in the all-cause mortality rate at relatively high levels of TC. In fact there are very strong indications that in those over 60, especially in women, the higher the TC value the greater the life expectancy.

In the light of this information it is evident that the fundamental justification for lowering TC levels just does not stand up to critical evaluation. Nevertheless it is still possible that the statins may be beneficial. The key factor to consider is the impact on all-cause mortality. Fortunately there is a website which provides some hard-nosed relevant information which is

www.thennt.com

NNT is an abbreviation of the term “NUMBER NEEDED TO TREAT”. The results are prepared by a group of physicians which has developed a framework and rating system to evaluate various therapies in terms of the benefits and harms to the patients being treated. Only the highest quality studies are used in the evaluations. No outside funding or advertisements are accepted.

The conclusions with respect to statins used as a heart disease prevention measure are as follows:

  1. Of those with existing heart disease who took statins for 5 years
  • 96% saw no benefit
  • 1.2% were helped by being saved from death
  • 2.6% were helped by preventing a repeat heart attack
  • 0.8% were helped by preventing a stroke.

On the other hand, 0.6% were harmed by developing diabetes and 10% were harmed by muscle damage.

2. Those without prior heart disease who took statins for 5

  • 98% saw no benefit
  • 0% were helped by being saved from death
  • 1.6% were helped by preventing a heart attack
  • 0.4% were helped by preventing a stroke

The incidence of harm was the same as in those with known heart disease as shown above.

It is immediately clear that there are benefits to those who already have an existing heart condition but it must be emphasized that these are relatively small. Essentially it means that 50 people have to be treated for 5 years for one person to benefit, which is not exactly a big deal! However for those without heart disease there is absolutely no improvement in life expectancy. When this is placed against the risks of the damaging effects, it is doubtful if many people would be enthusiastic about using these drugs if they were fully aware of this information.

It really does beggar belief that the use of these drugs by the NHS/GPs is so widespread and therefore costly despite the marginal benefits, which only apply to those with an existing heart condition.