Practice A Patient’s Journey

Neuromuscular degeneration

BMJ 2012; 345 doi: (Published 17 October 2012) Cite this as: BMJ 2012;345:e6880

Re: Neuromuscular degeneration

Mustafa Gunaydin, in A Patient’s Journey: Neuromuscular Degeneration [1], presented to various doctors with marked subjective intolerance of statins before later developing myositis. It seems extraordinary that his doctors seemed to be so resolutely committed to continued statin therapy for this patient. The highest published absolute risk reduction in all-cause mortality with statins in secondary prevention of ischaemic heart disease is 3.3%(4S trial [2]). This means that numbers needed to treat (NNT) are at least 30 [3].

It appears that many doctors either are not aware of the actual benefits of the medications that they prescribe, or do not understand the basic statistical implications of absolute versus relative risk reduction.

Though a population of patients will benefit from full pharmacological secondary prevention in ischaemic heart disease, the individual patient should be free to opt out, and in this case may have been wise to do so, assuming a properly informed doctor has duly counselled the patient about the actual degree of risk involved.

[1] Fisher C, Freris N. A Patient’s Journey: Neuromuscular Degeneration. BMJ 2012;345:e6880

[2] Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344:1383.

[3] Thompson A, Temple NJ. The case for statins: has it really been made? J R Soc Med. 2004; 97:461.

Competing interests: No competing interests

29 November 2012
Bernard Freudenthal
Core medical trainee (CT1)
Chase Farm Hospital
The Ridgeway, Enfield, Middlesex, EN2 8JL