Intended for healthcare professionals

Rapid response to:

Analysis

Should people at low risk of cardiovascular disease take a statin?

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6123 (Published 22 October 2013) Cite this as: BMJ 2013;347:f6123

Rapid Response:

Re: Should people at low risk of cardiovascular disease take a statin?

We thank Amrit Takhar for his thoughtful question regarding the final bullet point in the box titled “What low risk patients need to know.” The bullet states: “The side effects of statins…occur in about 20% of people treated with statins.” Dr. Takhar questions the validity of this statement because 35% of those who discontinued statin therapy due to adverse event were rechallenged with 92% of these patients continuing statin therapy 12 months later. We agree with this statement, but disagree with the opinion that we have “overstated the case against” statins.

First, as stated in the article by Zhang et al “The rate of reported statin-related events to statins was nearly 18%” in this retrospective cohort study. Second, the incidence of statin-related adverse events reported in the study is far more likely to be a floor rather than a ceiling. As noted in our article, spontaneous reporting of side effects is likely to underestimate the true incidence compared to rates determined prospectively by structured interview. Also, Zhang et al note, the incidence of side effects may have been under-reported because only the first reported statin-related event for each patient was included their analysis.

From a clinician’s perspective, the most important response to Dr. Takhar’s concern is that the incidence of statin-related side effects reported by Zhang et al was, in fact, “approximately one fifth.” For low risk patients who do not derive an overall benefit from statin therapy, the finding that many of the patients who experienced statin-related side effects could tolerate statin therapy on rechallenge does not negate the fact they experienced a drug-related side effect while taking a drug that provides them with no net health benefit.

John Abramson
Harriet Rosenberg
Nicholas Jewell
James M Wright

Competing interests: JDA and NJ serve as experts for plaintiffs’ attorneys in litigation involving the drug industry (including a statin). JDA has received payment for lectures from several universities, medical schools, and non-profit organisations. He was formerly executive director of health management for Wells Fargo Health Solutions.

12 November 2013
John D Abramson
lecturer
Harriet Rosenberg, Nicholas Jewell, James M Wright
Department of Health Care Policy,
Harvard Medical School, 39 Spring Street, Ipswich, MA 01938, USA