Like more than half of older men, I take a cholesterol-lowering medication called a statin. Sometimes that seems a bit strange, because I don’t have high cholesterol. My doctor prescribed it based on a formula that largely hinges on age and sex.
I’m 71 and male. Those two factors alone put me in the high-risk category for having a heart attack or stroke in the next 10 years. Most men over age 60, and virtually all of them age 68 or older, fall into this category.
I religiously take this medication because I don’t want to be the smartest skeptic in the graveyard. Yet an aggregation of the best large clinical trials shows that, for people like me without heart disease, the average statin-wrought reduction in cholesterol reduces the chances of dying from any cause by only about one-tenth of 1% (the same as 1 in 1,000).
To estimate the risk of death from heart disease, most doctors use a calculator endorsed by the American Heart Association and the American College of Cardiology. The factors that go into the calculations include the familiar warning signs: high blood pressure, high cholesterol, diabetes, and cigarette smoking. But age and sex outweigh every one of them.
In theory, the formulas estimate an individual’s risk of having a heart attack or stroke during the next decade. High risk is defined as a risk greater than 7.5%. But how accurate are these predictions? One study of more than 300,000 adults predicted that 8.7% of high-risk individuals would have a heart attack over the next five years. Yet only 1.8% of them did. The standard calculator wildly overestimates risk.
The real question that anyone taking a statin, or thinking of taking one, should ask is this: Will taking a cholesterol-lowering medication protect me from dying prematurely? The answer is a qualified yes. Many studies have shown that statins reduce the risk of dying from heart disease. But that’s not saying as much you think. The estimated benefits have been exaggerated and, worse, the side effects may have been understated.
Lots of clinical trials have been conducted in which people are randomly assigned to take a statin or a placebo (like a sugar pill) — enough to generate large meta-analyses, impartial studies of the studies. Those that focus on deaths from cardiovascular disease typically conclude that statins save lives. Others focus on death from any cause. I favor this measure because I keep my eye on my goal: I don’t want to die young. If a medicine reduces my chances of dying of heart disease but increases my chances of dying from other causes, it might not be an attractive treatment.
In the most recent meta-analysis, which included data from more than 134,000 volunteers in 28 studies, 2.2% of statin takers who experienced an average reduction in cholesterol died, compared to 2.3% of those taking a placebo. That’s where my one-tenth of 1% comes from.
To be fair, other meta-analyses have been more optimistic. One involving 71,444 people in 19 large clinical trials found that 3% of those taking a statin died from any cause compared to 3.6% of those taking a placebo. The same analysis showed the average risk of dying from heart disease was 1.7% in the placebo group and 1.2% among those taking statins, or a benefit of 0.5%.
How does this square with what you have likely heard, that statins reduce the risk of death from heart disease by about 29%? The exaggeration in benefit comes from reporting what epidemiologists call relative risk. In this case: 1.7% minus 1.2% divided by 1.7% equals 29%. I prefer to know the absolute risk, which is the raw difference between the percentage of deaths in the statin and placebo groups.
Relative risk can be used to make a small benefit seem bigger than it is. Pharmaceutical companies often use both relative and absolute risk: relative risk to make a benefit seem larger and absolute risk to make reported side effects seem smaller.
OK, maybe the benefits of taking a statin are small, but many smart doctors say a reduction of five-tenths or six-tenths of 1% is worthwhile. Yet the few published observations on people over the age of 70 do not show any statistically significant statin-related reductions in deaths from any cause.
Of course, not everyone is like me. The evidence that statins prevent heart disease deaths is much stronger for people who have cardiovascular disease and for those with diabetes. And because cardiovascular disease is the leading cause of death in the U.S. and other developed countries, a small reduction in cardiovascular disease risk can add up to a significant reduction in premature deaths across a population.
Fortunately, there has been decline in deaths from heart disease over the last 50 years, but it is hard to attribute this to statins. The sharpest reductions occurred before their widespread use.
And what about side effects? Jane Brody’s recent column in the New York Times challenged reports that many people experience unrelenting muscle pain that resolves when statins are discontinued. Most systematic studies have not clearly established statins as the culprit in muscle pain, although some studies suggest small increases in the risks for developing diabetes and cataracts. Although the concern about muscle aches is still under investigation, this problem seems real for many of the people who responded to Brody’s column.
Statins are among the few drugs that have consistently been endorsed by distinguished panels of scientists and physicians. The problem is that both doctors and patients have focused on medication while paying too little attention to the remedies that might do much more for cardiovascular (and whole-body) health. We know what they are: regular exercise, prudent diet, and not smoking or quitting cigarettes. The most optimistic estimates say that taking a statin could add a year to the average person’s life expectancy. Not smoking could add nearly 10 years and quitting increases life expectancy by reducing the chances of emphysema, many cancers, and heart disease.
Although my doctor checks my cholesterol every year, it remains low and taking a statin will have a very small, if any, effect on my life expectancy. What’s worse, my doctor has never asked if I smoke cigarettes, exercise regularly, or eat a healthy diet. Asking the right questions may open opportunities to save more lives. Research shows only about half of current smokers report that their doctor recently recommended that they quit.
Most of the ways we can extend our lives have little to do with pills or even with the health care system. High school dropouts, for example, have average life expectancies about a dozen years shorter than individuals with advanced degrees. A landmark study that linked IRS tax records to death records from the Social Security Administration found that men in the top 1% of income live 14.6 years longer than those in the lowest 1%. For women the difference was 10.1 years. And the effects of income on life expectancy systematically increased between 2001 and 2014.
Perhaps such indicators are why guidance from the American Heart Association and the American College of Cardiology was recently revised to place much stronger emphasis on lifestyle and social determinants of health
It would be wonderful if a pill could wipe away big threats to our health. But to achieve that goal, we need more than medicine.
Robert M. Kaplan, Ph.D., is a faculty member at Stanford University’s Clinical Excellence Research Center, a former associate director of the National Institutes of Health, former chief science officer for the U.S. Agency for Healthcare Research and Quality, and author of “More than Medicine: The Broken Promise of American Health” (Harvard University Press, 2019).
How do you know that you don’t have heart disease? Your doctor won’t be able to tell you until you have a 50% blockage. By that time you could be long dead of a heart attack. If plaque in your artery wall breaks off and a clot forms leading to heart attack or stroke, it could kill you. You could have that plaque right now and not know it. You should get a CIMT immediately, an ultrasound that measures plaque in your carotid artery walls at different points, not just blood flow in the artery and a CAC. Low cholesterol doesn’t prove that you don’t have heart disease.
“I religiously take this medication because I don’t want to be the smartest skeptic in the graveyard.”
I respectfully submit that one’s skepticism regarding reports of severe, even deadly adverse effects from statins is more likely to send one to the graveyard than skepticism regarding the benefits.
Within weeks of starting a low-dose statin, I experienced foot cramps, but since I was working out quite hard, training for a trip to Everest Base Camp, I didn’t recognize that this was a side effect of the statin.
I also experienced a tightening up of the Achilles tendons and other joints, such that my physical therapist suggested assisted stretching exercises. He knew that I was on a statin. The first session, their “assistance” tore my left hip labrum. Over the next months, I snapped a tendon in my wrist, tore a shoulder labrum, and eventually got a blood clot in my calf, which was assumed to be a muscle tear and received friction massage.
At exactly 7 months of 20 mg simvastatin, I woke screaming in the middle of the night, both legs locked up like blocks of wood, unable to move, feeling tissue tearing in my Achilles tendons. Forget the Himalayas: I never walked comfortably or unassisted around the block after that night.
Statin drugs, in those genetically predisposed, trigger horrific diseases. Because we have no compulsory system for tracking adverse effects of medications, we simply don’t know how common this is…but by coincidence I know of one local person who died of rhabdomyolysis, two local physicians who lost the ability to walk unaided, and another guy at my health club who went from stair-climb racing to being unable to walk down a single flight of stairs.
The BMJ had an article a few years back that concluded that the adverse effects of statins were much more common than generally acknowledged. In a radical response, Rory Collins, whose lab receives a heaping ton of money from Pfizer and Merck demanded that the article be removed. Not corrected, but something new: entirely removed.
There is a DNA test to determine one’s predisposition to statin adverse effects, so we know that it’s genetically related. Some people are 17,500% more likely to have bad issues.
You’ve written such a detailed and, in many ways, objective article that I wish you’d read “Overdo$ed America” by Dr. John Abramson of Harvard, or “Deadly Medicines and Organized Crime” by Peter Goetzsche. The corruption that the pharmaceutical industry has brought to our healthcare system is profound. The dean of Yale Medical School, for example, received over $500,000 one year from pharmaceutical corporations, and I’m sure his case is anything but unique.
You’re not so far off from my age, now 76. My health was taken from me at age 68, so 8 long years of pretty consistent misery, pain, and worse of all fatigue. Autonomic neuropathy is part of the package: BP ranges daily from 60/85 to 90/160, sometimes much higher; freezing cold in a down parka in a room at 85 degrees, then sudden full-body sweats in a room at 60. Muscle cramps every day, pretty much every part of my body.
We old folks are the perfect demographic to make money off: who gets excited about the sickness and disease of an old man? Best of all, we’re beaten down and exhausted. Some fight back. Stopped Our Statins has been headed by a great older guy. But mostly we give up.
I’d like to keep fighting. I appear strong, and I imagine that if this disease had a cure (like the DNA modification that recently helped a young woman with sickle cell disease) that I might get ten or more great years of life, instead of this diminished series of days and nights I now experience. There are a lot of us, but we’re unable to be strong advocates for ourselves.
How about someone like you looking into our situations? It’s my belief that we are the sad by-product of a vast medical experiment. Read John Thyfault’s studies of how statins cut the benefit of exercise, measured at the mitochondrial level. What’s happened to us might serve as a means to learn about diseases similar to ours. Intentional use of humans as guinea pigs or lab rats is prohibited, but intentionally or not, we have been used. Help us to have our lives’ diminishment and our suffering serve a purpose… and maybe even to regain something of what would normally have been the rest of our lives.
I think he just made a strong case on how effective Stains really are in health benefits. Whereas the negative side effects on your health are much higher. Seems to me these drugs are highly questionable. Most would prefer a 50 50 toss of the coin 50 % benefit in my drugs effectiveness at the very least? https://www.thennt.com/nnt/statins-persons-low-risk-cardiovascular-disease/
In the USA we don’t track the adverse effects of prescription medications. Oh, you can voluntarily self-report to the FDA, but of course very few people do. So we simply don’t know how common adverse effects from statins are.
I, however, do know how utterly devastating they can be. Diseases like Statin-Associated Autoimmune Myopathy are known, but there are other equally horrible diseases triggered by statins that are yet undiagnosed.
Statins for secondary prevention vs for primary prevention are different things. Statins for different age groups, same. Big Pharma has got about 1/3 of Americans on statins, and there is no doubt in my mind that the risk/reward ratio is nothing like those who profit from the drug claim.
If you’d like to learn more, or better yet, report your own experiences, go to StatinStories.com.
The primary problem is poor math skills and lack of information.
Studies exclude many patients, why?
Generally from side effects and lack of body response to the drugs, when 30- 70% of patients removed from a study, it does not apply to class/subset it states it does.
.1% absolute risk change for a 20% side effect risk and that side effect is now quoted at 70% will never go away.
Do the math. 15% risk of damage and .1% reward. Statins may have value after your heart attack, but for primary prevention, the odds of damage that will reduce you quality of life and may also reduce your ability to exercise which increases your odds of longer life span; are 150:1. It is a sucker bet.
If you get any negative side effects from statin use, stop taking it.
The negative effects are blown off by every doctor I have dealt with. I have yet to hear a single one discuss the drug. It is always take this. No discussion of ApoA tests, no discussion of calcium tests, no discussion of how to eat past low protein and low fat and high carb.
Every one but 1, I have dealt with is a pharmaceutical whore pimping pills.
The only two studies on life span with detail is you gain 3-5 days more life and and one that is short critical details; that says you can expect 2-6 months with the least healthy getting the 6~ months at best, added life.
I can do better with diet and exercise.
And my favorite males parts work, my brain is no worst, I do not have to pay or visit a doctor.
Statins are and were a scam on most patients.
I am left wondering why you take a statin when in your own words: “people like me without heart disease, the average statin-wrought reduction in cholesterol reduces the chances of dying from any cause by only about one-tenth of 1% (the same as 1 in 1,000).”?
Why would anyone partake of this ‘Statin Poison’ My health has been damaged by these insidious drugs.https://www.irishtimes.com/news/health/no-evidence-high-cholesterol-causes-heart-disease-say-doctors-1.3627093
I launched Lipitor in 1997. It may be more due to high CRP levels. 0-2 is normal. Mine was 0.3. Also if pt. had high LOL and doc doesn’t offer a drug to lower it…and pt. has an MI…he is on the hook for a lawsuit!
Bob, have missed hearing your statistical analysis and interpretation since grad school. Great article. As you know, John falls into the age category you were discussing. He tried every statin over time with the severe muscle pain, so discontinued. He takes a couple of heart meds now, but mostly quite a few pharmaceutical strength supplements recommended by his cardiologist. It’s been interesting to watch the philosophical changes as my father had a massive coronary in 1968, with no drugs available and limited treatment options, so he passed at 52. It’s been helpful to see the continual advancements available to John, but we have far to go.