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GPs should consider offering statins to all patients aged over 75, researchers say

BMJ 2019; 364 doi: (Published 01 February 2019) Cite this as: BMJ 2019;364:l522

Re: GPs should consider offering statins to all patients aged over 75, researchers say

I have several concerns about this paper.

Firstly, it appears to be a re-analysis of trials to look for associations for which the original trials were not designed.

Secondly, although repeated requests have been made for the raw data from some of them to be made available for independent analysis, this has never been done and I am puzzled how the promoters of statins can hold a monopoly.

Thirdly, only 14 of the 28 trials appear to be eligible for inclusion in the re-analysis.

Fourthly, there seem to be some errors in calculation; the reported percentages for deaths do not match the quoted absolute numbers of subjects.

Fifthly, the description of the statistical methodology seems to be designed to obfuscate and confuse and it is unscientific to reappraise trials in this way.

And, finally, the data that are presented anyway make a very weak case for statins. The overall absolute risk reduction for mortality – which is shown in the paper – is just 0.1%. Failing to quote absolute reduction (ARR) and trumpeting a large relative risk reduction (RRR) is misleading and grossly overstates benefit. If the RRR is 50% (which sounds impressive) but is based on an initial absolute risk of 5%, the ARR is only 2.5% (which is not impressive at all).

In any event the current algorithm for statin prescription will result in all patients over 75 being eligible for statins, regardless of their past cardiac history or cholesterol level. So the whole thing is a nonsense. Statins do work, but not very well, and it is highly likely that their effects are due to their anti-inflammatory properties and not to the fact that they lower cholesterol. If it was then one would expect a drug that has a dramatic effect on cholesterol, such as a PCSK-9 inhibitor, to have a dramatic effect on cardiovascular mortality. But the one major trial showed nothing of the sort, and indeed was terminated early. There are other observations which serve as Black Swans that destroy the cholesterol-heart hypothesis (which anyway is based on flawed research) and it should be abandoned.

Competing interests: I am a member of the International Network of Cholesterol Skeptics (THINCS)

12 February 2019
Andrew N Bamji
Retired Consultant Rheumatologist