New analysis fuels debate on merits of prescribing statins to low risk peopleBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2370 (Published 26 March 2014) Cite this as: BMJ 2014;348:g2370
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I feel it ought to be pointed out that it is important not to confuse "side effect incidence being similar to placebo" with "side effects being non-existent". There is an assumption that if it isn't a physical side effect then it can be dismissed as being all in the patient's head. The recent review in BMC Medicine found that 14.6% of patients in primary prevention trials had serious adverse effects on statins and 14.9% of patients in the placebo groups. Even if we accept that as being accurate, it means that statins are as BAD as placebo in terms of side effects.
The key point is that this illustrates is how much damage we can do to people when we try to turn them into patients. Many of these people will have prided themselves with being on no medication and may well feel perfectly fit and well. To inflict drugs on them that we know will cause about one sixth of them problems should not be undertaken unless we are very confident of the efficacy of that treatment. That the debate has raged for a few weeks without, as far as I have seen, any proponent (including NICE) having issued any "numbers needed to treat" (NNT) statistics makes me very sceptical of that efficacy.
Competing interests: AW is a 46 year old non-smoking male of normal BMI with no FH of CVD who exercises regularly and yet still faces statins in about 14 years' time.
NICE guidance on statin for 10% QRISK2 does not have face validity, the current 20% is difficult enough to "sell" to patients. There is increasing evidence that the whole basis of cholesterol and CVS is being called into question, that the sub fraction of LDL that increases CVS disease increases with carbohydrate not fat ingestion, and the evidence for short bursts of intense exercise and postive effect on CVS health is being ignored. No surprise then that a number of the NICE committee who advises 10% risk for statin are related to the drug industry. I will not be advising statin for 10% CVS risk.
Competing interests: No competing interests