Statins: are they really so good?
I CaMe TO STaTIN TReaTMeNT IN a BIZaRRe Way. I WeNT TO My BaNK TO aRRaNge a LOaN aND, HavINg agReeD THe aMOuNT, THe BaNK aSKeD FOR aDDITIONaL LIFe COveR. THe LIFe aSSuRaNCe COMpaNy, IN vIeW OF My aDvaNCINg yeaRS (I WaS 48), ReQuIReD a MeDICaL, aND eveRyTHINg CaMe BaCK TIp-TOp exCepT My CHOLeSTeROL LeveL THaT WeIgHeD IN aT a HaNDSOMe yeT SHOCKINg 9.2 MMOL/L. By Terry Maguire
I
was put on a statin and a decision on the life assurance was reserved for six weeks, at which time my
cholesterol was down impressively to 5.1 mmol/L. Then the life assurance company quoted a rate that could only apply to a ninety year old with a terminal illness, so I told them to stuff it and threatened to change banks: a tactic I should have used in the first place. I got my loan without the life premium, but now I had a cholesterol problem.
Two years later, having reflected on the science, I stopped taking the statin and I felt much better. My high cholesterol level, a genetic gift from the maternal side of the family, is not a disease, merely a coronary risk factor, so I reduced my overall risk by means other than taking a daily statin. My statin, however, gave me migraine - a condition I had never experienced before. at that time there was also a signal in the medical literature, a weak signal, suggesting that long-term statin use and degenerative brain disease might be linked. and so I stopped taking them.
Ten years later, a chest pain incident while walking on Cavehill caused me to visit my gp, who, after telling me to stay off Cavehill, referred me for a routine cardiac assessment which turned out anything but routine. I was whisked into hospital and a stent inserted into one of my coronary
arteries. I was severely admonished by a consultant for stopping my statins and was put back onto a higher dose.
Reducing cholesterol to reduce heart disease was first established in the 1980s and became an unassailable fact. The initial treatments were impossible to take and therefore statins, with their outstanding efficacy and safety, were a god-send when first introduced in the late 1980s. The now famous statin studies for example: the 4S (Scandinavian Simvastatin Survival Study) and the WOSCOp (West of Scotland Coronary prevention Study), established beyond reasonable doubt that where cholesterol levels are reduced, the number of heart attacks and heart deaths fall.
So good were the study results that current uK guidelines recommend that anyone with a ten per cent chance of having a heart attack in the next ten years should take a statin. great!
Well, actually, not so great.
Two medical authors - James Le Fanu and Malcolm Kendrick - have written critically on the safety and efficacy of statins. They use data from the main studies to make the case that, over the last 40 years, we may all have been part of a mighty medical and financial con. For heretics, they are pretty good at maths and slowly lead numeric illiterates such as me through
the details of the study numbers. The studies present population statistics showing that there is a 30 per cent reduction in heart deaths in those taking statins, but these studies prove less predictive for individuals. Individual benefit is calculated using a measure called Numbers Needed to Treat (NNT). For primary prevention (not having heart disease), 250 people must take a statin daily for five years to avoid one coronary death. That can’t be right I hear you say, but it is. a more recent review of studies by British Medical Journal (BMJ) found that three quarters of trials reported no mortality benefits from statin use and have reported no benefit from heart diseases at all.
But even if, as some trials suggest, you are less likely to die of heart disease when you take a statin, you end up dying of something else - such as cancer. even in high-risk patients, such as me, 39 people need to take a statin for five years to avoid one heart event, ie, 38 high-risk patients get no benefit. The authors of the BMJ study comment that, while the existence of such contradictory evidence usually leads to a paradigm shift or a modification of the theory (lowering cholesterol reduces deaths), this evidence has been largely ignored as it does not fit the prevailing orthodoxy.
I now realise that I have many of the listed side-effects and they are not trivial - muscle pain, memory lapses,
exhaustion. I just thought I was getting older, not that I was being poisoned by my own life-saving medicine. So I decided to stop for the month of august and now that October has arrived, I have not felt so well for ages and I am reluctant to return to my daily dose.
I am genuinely anxious readers that, if you are taking statins, you do not stop until you get the right information for yourself and then, and only then, with informed choice. Cholesterol is not all bad. It makes sex hormones and is a component of every cell in your body. Those who have high cholesterol levels get some benefit from this over the age of 60 and there seems to be protection against infection and cancer as we get older. I reason that I must die of something and, if higher cholesterol guards against cancers as I age, I will not need to worry too much about how life assurance actuaries define my chances of survival - or my ability to get a bank loan.
Further reading 1 Too Many pills - James La Fanu (amazon)
2 a Statin Nation - Malcolm Kendrick 3 Controversial New Study Reports Statins useless – Carolina Total Wellness
4 Do statins really work? - european Scientist
5 evidence-based medicine: ‘Hit or Miss’ - the new cholesterol targets (BMJ)
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