The tricky decision of whether or not to take Statins…

I came to statin treatment in a bizarre way.  I went to my bank to arrange a loan and having agreed to 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 (average is 5.2).   I was put on a statin and a decision on the life assurance 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 gave me migraine a condition I had never experience before and there was at that time a signal in the medical literature, a weak signal, suggesting that long-term statin use and degenerative brain disease might be linked.  So, I stopped them.

Ten years later a chest pain incident 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 I was back on a higher dose.

In the1980s reducing cholesterol to reduce heart disease was first established 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 (Scandanavian 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 10% chance of having a heart attack in the next 10 year should take a statin.  Great!  Not so great actually.   Two medical authors; James Le Fanu and Malcolm Kendrick among others 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 year 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 I, through the details of the study numbers.

The studies present population statistics showing that there is a 30% reduction in heart deaths in those taking statins but these studies prove less predictive for individuals.   The 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 (be treated) for 5 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 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 I, 39 people need to take a statin for five year to avoid one heart event, that is, 38 high-risk patients get no benefit.  Authors in the BMJ study comment that normally the existence of such contradictory evidence usually leads to a paradigm shift or a modification of the theory (lowering cholesterol reduces deaths) but 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.

I am genuinely anxious that people reading this and taking statins do not stop until they get the right information for themselves 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; there seems to be protection against infection and cancer as we get older.   I reason 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.

Links:

(1) James La Fanu Too many pills

(2) A statin Nation.

(3) Carolina total Wellbeing cholesterol controversies

(4) European scientist controversies cholesterol

(5)  BMJ Evidence-based medicine Hit or Miss: the new cholesterol targets

(6) Other scientists respond to the BMJ report

Photo by TheUjulala is licensed under CC BY-NC-SA