Intended for healthcare professionals

CCBYNC Open access
Editorials

Statins, news, and nuance

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3379 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3379

Re: Statins, news, and nuance

It is vital that journalism, particularly medical journalism, expose the public to ongoing controversies in medicine. I cite the exposure of Study 329 and the Polderman affair which resulted in the claim that 800,000 deaths occurred as a consequence of flawed research being used in an official guideline. This paper was removed for review never to be seen again. Unfortunately the reasons for the claim are not known but the 800,000 deaths remain. My own research into this based on the original study suggest that based on a population of 500 million over a number of years and the number of surgical procedures involved it could have been <1% which could have been due to several other factors but because of the removal we are left with 800,000 deaths These are not the only examples of this practice some which I have previously mentioned.

However, my attention was drawn to a study first published in 2008 (PHARMACOGENETICS OF SLCO1B1:POPULATION GENETICS AND EFFECT ON STATINS by Marja Pasanen) (https://helda.helsinki.fi/bitstream/handle/10138/22995/pharmaco.pdf?sequ...)
by Dr Duane Graveline (https://www.spacedoc.com/articles/statin-damage-gene?utm_source=June+26%...

To quote him:
"This all has to do with a genetic combination known to geneticists as the SLCO1B1 polymorphism, specifically the variant c.521CC genotype – affectionately known as “SNIPS” to workers in the field – special genetic combinations having very special effects.

"It appears that some of us are born with various genetic combinations that greatly increase sensitivity to statin drugs. The question now is just how great this genetic factor is. A massive study out of Finland comparing Finns with the rest of the world provided insight, chilling in its implications.

"This all has to do with a genetic combination known to geneticists as the SLCO1B1 polymorphism, specifically the variant c.521CC genotype – affectionately known as “SNIPS” to workers in the field – special genetic combinations having very special effects.

"This particular variant form has some rather remarkable effects on the pharmacokinetics (the action of drugs in the body) of different statins. Its greatest effect was on the plasma concentrations of simvastatin (Zocor). It also had increased the plasma concentrations of atorvastatin (Lipitor), pravastatin (Pravachol) and rosuvastatin (Crestor). Large differences in frequency of these genetic combinations exist between different populations. The highest frequencies of these variant genotypes were found in the U.S.A. (24% average, 18–32% range) with similar but slightly smaller figures for Europe (18% average, 14–23% range). The smallest frequency of this variant genotype was Sub-Saharan Africa (1.9%average, 0.7–4.8% range)."

Clearly this would account for the 20+% incidence of adverse reactions so stubbornly denied be some researchers based on a RCT whose patients were selected on statin tolerance.

As he says, Is it not remarkable that this has not been picked up by now by the pharmaceutical industry eight years after its publication. Or is it just another case of "what damages our profits does not exist”?

This surely is sufficient proof that journalism must present scientific controversies.

Competing interests: No competing interests

29 June 2016
Michael J. Hope CAWDERY
Retired veterinary researcher
None
Portadown