I have lost count of the number of people who have been recommended to use statins but subsequently decided to stop taking them. There are two reasons normally used to justify these regimes, namely:

  • You are at high risk of having a heart disease, which may well be fatal.
  • You have survived a heart attack, so you need to take statins so that you reduce the risks of having another one.

Most people have a high degree of trust in the medical and health professions so that the advice/recommendation is usually accepted as credible.

However more and more doubts about the effectiveness and safety of these drugs has emerged in recent years, which places many patients in a difficult position. In this blog, I will attempt to provide an objective narrative on what is known about these drugs.

All-cause mortality (ACM)

It is unfortunate that most of the information on the benefits of statins is focussed on the heart disease. In my opinion, the only reliable information is limited to deaths. Anything which is based on symptoms must be disregarded because it is based on subjective judgements and therefore is not reliable. It is also essential to have comprehensive details on all causes of death. If the treatment does actually reduce the incidence of deaths due to heart disease but there is a corresponding increase in deaths due to some other cause such as cancer, then that is very small comfort. So it is essential to have the information on ACM to assess the value of statins or any other drug for that matter.

Those with known heart disease

An excellent source of data is the NNT website (1). Based on an evaluation of the relevant scientific publications, for those who already suffer from heart disease, the benefits of statin therapy in terms of the Number Needed to Treat (NNT) are as follows:

 

  • 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
  • 1 in 83 were helped (life saved).
  • 1 in 39 were helped (preventing non-fatal heart attack).
  • 1 in 125 were helped (preventing stroke).

Similarly the harms caused by statins are:

  • 1% were harmed by developing diabetes**
  • 10% were harmed by muscle damage
  • 1 in 100 were harmed (develop diabetes).
  • 1 in 10 were harmed (muscle damage) (2).

 

These numbers may come as a shock to many who tend to accept that when they take a drug that they personally will be affected. I am sure many will be surprised to learn that 82 out of 83 people will not experience any benefit. On the other hand, all are exposed to the risks of adverse side-effects (ADRs), with at least 10% having to cope with muscle damage.

 

Those without prior heart disease

When statins are used as a preventative measure, the effect on death rate is zero, while there were marginal benefits with respect to preventing heart attacks and stroke:

  • 98% saw no benefit
  • 0% were helped by being saved from death
  • 0.96% were helped by preventing a heart attack
  • 0.65% were helped by preventing a stroke
  • None were helped (life saved).
  • 1 in 104 were helped (preventing heart attack).
  • 1 in 154 were helped (preventing stroke).

Nevertheless the ADRs were same as shown above:

  • 1% were harmed by developing diabetes**
  • 10% were harmed by muscle damage
  • 1 in 100 were harmed (develop diabetes).
  • 1 in 10 were harmed (muscle damage) (3).

In addition, there is evidence that even more severe ADRs may also occur even if the chances of this happening are relatively small. The experiences of Dr Duane Graveline, an astronaut, are very worrying. There are lots of very disturbing case histories of those who had extremely bad experiences when treated with statins (4).

Benefits v risks

It should be clear that the advantages of taking statins are extremely limited and I strongly suspect are very much smaller than most people have been led to believe, especially for those who do not have heart disease. Even for those few whose lives are “saved” this only means that death has been postponed. Dr Malcolm Kendrick has shown that this life extension is a quite simply a matter of days and if you are extremely fortunate you might survive for an extra month, which is not exactly a big deal (5).

If not statins, then what?

The idea for this blog was triggered by my recent visit to the French city of Lyon, which is where the Lyon Heart Study was conducted. In this investigation, volunteers who had already had a heart condition were divided into 2 groups and each one allocated to different diets. Full details are given in a blog I did a few years ago (6).

Table 1. Death rates in the control and experimental groups

  Control Experimental  
Cause of   death Number Rate Number Rate Relative   Rate
Cardiac 19 1.37 6 0.41 0.35
All 24 1.74 14 0.95 0.44

 

Note: The rates are given per 100 patients per year of follow-up; they were calculated from a follow-up of 1383 and 1467 person-years for mortality in the control and experimental groups, respectively.

The diets of the 2 groups are shown in Table 2. In any investigation of this type it is difficult to identify which particular changes in diet have contributed to the very significant improvements in the prospects of the experimental group which have been observed. The increase in omega-9s was largely due to increased consumption of olive oil. There was also a reduction in the intake of omega-6s and an increase in that of the omega-3s. The net effect of this was to reduce the omega-6:omega-3 ratio from 18.3 to 4.3. In the light of our existing knowledge the authors considered that this was the critical factor.

Table 2. Nutrients in the control and experimental groups

  Control Experimental
Total calories 2088 1947
Total fat,% E 33.6 30.4
SFA, %E 11.7  8.0
PUFA, %E 6.1 4.6
Omega-9, %E 10.8 12.9
Omega-6, %E 5.3 3.6
Omega-3, %E 0.29 0.84
Alcohol, %E 5.98 5.83
Protein, g 16.6 16.2
Fibre, g 15.5 18.6

 

Conclusion

A reduction of over 50% in the death rates from all causes is absolutely outstanding. This dwarfs anything that can be achieved by statins or any other type of medication. Any benefit from statins is minute compared to this result. Once the potential damaging side effects are factored into the equation it simply does not make sense to use these drugs. It is also crucial to appreciate that the Lyon Heart Study is not necessarily the last word on what is the ideal diet. There may well be scope for further improvements by reducing the intake of sugar and carbohydrates generally. We still have a lot to learn about the optimum ratio of the different types of fat.

In addition to diet, there can be enormous improvements in health by taking even moderate exercise. A sedentary person can reduce ACM by a factor of 3 by taking regular exercise (7).

By focussing on statins to the exclusion of all other aspects of lifestyle that can be so much more effective, we really have got things out of proportion. So to answer the question posed by the title to this blog, I will definitely NOT be taking statins. In the light of the information presented here, I cannot understand why anyone would possibly agree to use them.

References