Everyone Should Be On Statins!

This is the mantra of the medical profession.

When I am seeing patients basically every man over the age of 60 and every woman over the age of 75 is advised to be started on a statin.  The algorithms on my computer (anyone with a QRISK2 score over 10% is advised to start on a statin as per the national guidelines) tell me to give it to them.

It seems that every few weeks there is a news article singing the benefits of taking statins.

Just to step back for a moment.  Statins are a group of medications which lower cholesterol.  Lowering cholesterol, it seems is associated with lowering the risk of death from a heart attack or a stroke.  Statins have always been controversial as such a large number of people are advised to take these medications.

I think statins are a perfect example of a drug class which has a lot of evidence espousing its benefits but little evidence showing that it may be harmful.  As I wrote in my previous blog post, the absence of evidence is not the same as evidence of absence.

The fact is that studies will show that statins “cut the risk of having a heart attack by X%”, but the hidden side effects and long term health disadvantages are not measured and in a lot of cases cannot be measured.

For example are statins associated with breast cancer?  Are they associated with bowel cancer?  Does it increase the likelihood of other diseases such as diabetes?  How about if you’re already a diabetic, does it make your diabetic retinopathy worse than if you weren’t on a statin and cause earlier blindness?

None of these questions have answers and they never will have an answer until it becomes painfully obvious as drug companies and the scientific community will always go looking for evidence which should result in treatment.

What do I do with my patients?  I explain that guidelines advise that they should be on a statin as it may decrease their chances of a heart attack or a stroke.  But I also tell them of the possible listed side effects and also explain that “all medications have side effects and risks which vary from person to person” and that if he/ she doesn’t want to continue it then they are free to stop at any point”.