If you are over fifty-something you will soon have to make a decision about whether or not to take a statin to bring down your cholesterol and cut your chance of having a heart attack. You will certainly be offered them.
Now according to the latest “evidence” the decision is a no-brainer. These drugs have been subject to dozens of huge trials, which have found that on average they cut your chance by roughly 20 per cent. The latest big trial reported in the Lancet, found they will benefit you even if your risk of heart disease is very low and, even more importantly, they have no risk of serious side effects. So what’s not to like?
What most people don’t understand, quite reasonably, is that a drug trial is not designed to answer the question: Should I take this drug? Instead it tells you what happens on average in a fairly large group. So trials are useful for answering an administrative question like: Are statins cost effective?
If you know the average number of heart attacks or heart operations every year and what they cost, then a big statin trial will tell you how many fewer you can expect by widespread prescribing. Then knowing the cost of a statin you can work out if they are a good deal. The latest Lancet paper many well be very useful in Whitehall but it’s not going to help you much when the doctor offers to write you a prescription.
So what should you do? The short answer is– don’t start, if you haven’t had a heart attack that is. Here are five quick reasons why not. In the next few days I’ll go into more detail on each because if you are planning to fly in the face of medical orthodoxy you need good reasons why.
1) The statistics
If statins were in a horse race you wouldn’t even consider betting on them. The simple fact is that the odds you are going to benefit are lousy. As in other gambling situations even the experts don’t agree on the exact odds, but the Lancet paper – and it says this is a good bet – puts your chance avoiding a “serious vascular event” such as a heart attack or a heart operation, at 167 to 1 – if you are healthy with a low risk that is. And you have to keep taking them for five years.
Other studies have come up with figures that are even worse. The Cochrane Collaboration report found that healthy people at low risk taking statins had a thousand to one chance of avoiding dying from a heart attack. Another found that if 10,000 people, who were healthy but at high risk, took statins for four years there was no evidence they would live any longer. The study did find 7 fewer deaths in the statin group but said that the number was so small it wasn’t statistically significant.
2 The side-effects.
Because the chances of benefitting personally are so small, it becomes very important to know your chance of suffering side effects. Here there is even less agreement among the experts. The Lancet paper is remarkably gung-ho about statin saying there was no need to worry about “possible serious adverse effects”.
Others are far less relaxed about the risks. Muscle damage has always been a concern but while the evidence from trials puts it at about 1% others, especially, clinicians who see patients on a daily basis put if far higher maybe up to 20%. And this isn’t just unpleasant, it can seriously interfere with your ability to exercise, one of the best ways of avoiding heart disease. There is also a big debate going on about statins raising the risk of diabetes. They might give you a 200 to one risk of developing it – pretty close to the benefits.
3 The missing enzyme
Then there is curious case of the vanishing enzyme CoQ10. The big statin trials never mention that statins as well as cutting cholesterol also block production of this vital substance that is vital for the effective working of muscles – the heart is a muscle and for producing energy . In Canada statin packets come with a warning about this and advice to supplement – here they don’t and GPs rarely advise it.
4 Learn to love your cholesterol
Cholesterol has a number of important functions in your body, so it seems wise not to lower it without good reason and a 1 in 167 possibility of benefit doesn’t seem that good. It is part of the membrane surrounding each brain cell – 20% of our total cholesterol is found in the brain, where it controls, among other things, the transmission of message through the nerve cells. One of the commonly reported statin side effects is memory loss and brain fog. Cholesterol is also the feedstock that the body uses to make all our sex hormones
5 It’s the lifestyle stupid
Even the most ardent statin supporters pay lip service to the benefits of changing your lifestyle – eating well, exercising and so on. But doctors are not particularly good at helping you to do that – making those sorts of changes is hard and you need support – so drugs are the easy option. But a trial involving 20,000 people found making just four of the most basic lifestyle changes – stopping smoking, drinking moderately, exercising and eating five-a-day fruit and vegetables – put an astonishing 14 years onto their life span. Compared that with going for a 167 to one chance of avoiding a heart attack and the choice really is a no brainer.