Once upon a time, the rhetoric around statins was relentlessly positive. More recently, though, I think there’s been increasing numbers of doctors and commentators expressing concern about the limited effectiveness of statins, as well as their known but perhaps under-recognised risks. A few weeks back an Australian documentary aired that featured several quite-conventional doctors and academics who expressed considerable scepticism about statins. You can see the documentary on YouTube here.
I’ve noticed reports this week from doctors who have expressed concern that since the airing of this documentary, many patients have taken matters into their own hands and stopped their medication. The general tone of these reports is been that the documentary has encouraged individuals to put their lives in perilous danger. But let’s leave the rhetoric aside for the moment. What are the real risks of stopping statin medication? Does stopping a statin really increase the risk that someone will ‘have a heart attack and die’?
The great majority of people taking statins have no history of heart attack or stroke, and the idea of taking statins is to prevent such an occurrence – so-called ‘primary prevention’. In this context, statins do not save lives. For healthy individuals, then, the evidence shows that countless individuals might stop their statins, but not one of them will lose their life as a result.
What might happen to the risk of having a non-fatal heart attack, though? Well, the data here shows that in primary prevention, 300 people will need to be treated with statins for a year to prevent one heart attack [1]. So, if someone were to come off their statins for a year, the risk of them having a heart attack as a result are actually tiny (about one third of one per cent). Even if we multiply this figure over several years, the risk still remains very low.
In individuals with a prior history of heart attack or stroke (‘secondary prevention’) the benefits of statins a greater. In this context, for example, statins do reduce the relative risk of death (particularly from heart attack). However, again, this benefit needs to be taken in the context of underlying risk. The data show that if 200 people were to be treated with statins for a year about one person would be spared a heart attack. If 100 people were treated, only about one life would be saved over the next five years [2]. Taking all benefits into consideration, over five years of treatment, 96 per cent of people would not benefit at all.
This means, again, that if even if someone has had a prior heart attack, stopping statins is actually quite unlikely to usher in a heart attack or earlier demise.
It’s only by taking a cold hard look at the data and understanding it in real terms that we can make an accurate judgment about the supposed risks of stopping statins. I think we doctors do a huge disservice to people by either not being aware of the data or giving patients a false impression of the risks of stopping statin therapy.
References:
1. http://www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease
2. http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/
