The truth about statins

I recently read an article in a very well-known Portuguese newspaper on the use of statins by a Portuguese Cardiology Professor, Dr. Fausto Pinto, who was the President of the European Society of Cardiology.

Today, as I was thinking about a subject to write about, this subject popped into my mind. As the Professor asks: why do people not want to accept the truth?

Statins are a class of drugs used to reduce low-density lipoprotein, LDL cholesterol, within the body. They are prescribed to people with high LDL cholesterol, when levels are above acceptable values. These individuals are at risk of cardiovascular diseases such as heart disease, stroke and heart attack. The drug works by inhibiting the enzyme involved in the body’s ability to produce this form of cholesterol.

Globally, raised cholesterol levels are estimated to cause 2.6 million deaths each year, according to the World Health Organisation.

Cardiovascular diseases are the principal cause of morbidity and mortality all over the world.

Tens of thousands of people die every year because claims about statins’ side effects left them too afraid to take these potentially life-saving drugs. By refusing to take them, people put themselves at risk of heart attacks and strokes.

Roughly six million people in Britain are thought to take statins, preventing 80,000 heart attacks and strokes every year. However, another six million should be taking the drugs, says Prof Sever, whose work involved academics from Oxford University, the London School of Hygiene and Tropical Medicine and Queen Mary University London and is published in the Lancet medical journal.

How beneficial are they?
A study reviewing the harms and benefits of statins when treating patients with elevated LDL cholesterol concluded that benefits were shown to greatly outweigh any harm from taking the drug.

For those who have had a heart attack or stroke, statins slash the chance of a second attack, saving an estimated 7,000 lives in Britain a year and some experts say the risk of side effects is small and that only one in 2,000 people suffer muscular pain.

A major review has found that the benefits provided by statins, and lives saved, have been underestimated and the harms overexaggerated.

People are often worried about taking them, or going as far as declining them, without always knowing the evidence behind their decision.

A reliable study analysed all available evidence on the safety and efficacy of statins’ therapy to help people make their decision, and it was decidedly in their favour.

“Statins have had a huge impact on reducing cardiovascular events,” said a professor of medicine and epidemiology at the Nuffield Department of Population Health, part of the University of Oxford. “There are many misleading claims about statins…people tend to underestimate the benefits,” he said.

For 10,000 patients taking regularly a statin for five years, the drug would prevent 1,000 people, who had pre-existing heart conditions, from having major cardiovascular events (heart attacks, strokes and coronary artery bypasses). The same regimen would also prevent 500 cardiovascular events in people who are at increased risk, due to diabetes or hypertension for example, but haven’t had a heart condition.

A further analysis found that for each 1 mmol/L reduction in LDL cholesterol made using statin therapy, the risk of coronary deaths and heart attacks, strokes and coronary bypass procedures is reduced by approximately 25% for each year the drugs are taken after the first year.

What about the harms?
As with any other medication, statins have secondary effects and the most relevant are the “myopathies” (muscle pains with evidence of muscle lesion) that occurred in five of the 10,000 patients treated after five years of continuous treatment; this effect being reversible in 4/5 cases when the medication is suspended. Sometimes all that it takes is for the doctor to try another different type of statin.

Although the reality is that harms associated with statins are low, patients should still be correctly informed.

The reality is…
The medical community considers that, after antibiotics, statins were the pharmacological group that has more strongly contributed to prolong the life expectancy of the general population.

It is worrying that although there is evidence, beyond doubt, that suspending statins in patients that have indications to take them increases significantly the number of cardiovascular events that these people will suffer. Regrettably many people will die for believing in unreliable “friendly gossip”.

The medical community has no doubts that statins were an extraordinary progress in fighting the scourge of cardiovascular diseases and these are certainly our most frightening enemy.

Best health wishes,
Dr. Maria Alice

|| [email protected]
Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International
Medical Service / Medilagos. Medical Director – Grupo Hospital Particular do Algarve