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Statins, saving lives, and shibboleths

BMJ 2007; 334 doi: (Published 26 April 2007) Cite this as: BMJ 2007;334:902

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Statins, Statistics And Saving Lives

Preventive medicine based on using drugs to treat risk factors is
inane. Many risk factors might be more appropriately referred to as "risk
markers", since they are merely statistical associations rather than
causative agencies. Cholesterol is a good example; with the oft cited
"for every 1% fall in cholesterol there will be a 2% reduction in coronary
heart disease. This is another deceptive shibboleth, ("a common saying or
belief with little current meaning or truth") since what this really
refers to is a reduction in relative risk, rather than absolute risk,
which is quite different.

Statin manufacturers have capitalized on this in their TV and media
blitz in the United States because of the power of direct to consumer
advertising. For example, you could be told of a statin that is safe and
will significantly "reduce the risk" of having a heart attack if taken
every day for the next five years. A study is cited showing that over
five years, patients on this statin had 34% fewer heart attacks than
controls on a placebo, which is correct, since this is relative risk
reduction. What you are not told is that 2.7% of patients on the drug had
a heart attack compared to 4.1% on placebos, so that the absolute risk
reduction is only 1.4%. Also not revealed is that if this statin is taken
by seventy-one people every day for five years, it will prevent one person
from having a heart attack - but it is not known if that person will be
you. In point of fact, you will never see a statin ad claiming that the
drug actually reduces heart attacks. In many instances, a disclaimer is
mandated stating that it has NOT been shown to prevent heart attacks or
heart disease, although this is usually in fine print.

It is quite clear that the cardioprotective effects of statins are
not related to lowering cholesterol or other lipids. (1) Thus, the current
goal of lowering LDL to an arbitrary value that is often difficult to
achieve insures increasingly higher doses for longer periods of time. (2)
This means more money for drug companies but it also insures a higher
incidence of adverse side effects, many of which have been ignored or
suppressed. (3,4) As Professor Blackman implies, what we call a health
care system is a mighty double misnomer. What we really have is a
sickness cure system. Similarly, health insurance primarily provides
compensation when we are sick, rather than health enhancement.

What is sorely needed is to make prevention a priority by emphasizing
the importance of regular exercise, proper nutrition, adequate sleep,
reducing stress and other lifestyle changes shown to reduce coronary
disease. The public would profit much more from this than from putting
statins in the drinking water, especially since statins have not been
shown to reduce coronary disease in men over 65 or women of any age.
Unfortunately, a shift to this preventive approach is not likely to happen
because of powerful pharmaceutical companies who will do anything to
perpetuate and preserve their prodigious profits.

1. Rosch, PJ. Guidelines for Diagnosis and Treatment of High
Cholesterol. JAMA. 2001;286:2400-2402

2. Rosch PJ. Determining optimal statin dosage. Mayo Clin Proc. 2003
Mar;78(3):379, 381

3. Rosch PJ. Peripheral neuropathy. Lancet 2004;364:1663

4. Graveline D. Statin Drugs – Side Effects and The Misguided War on
Cholesterol. 2006 published by

Competing interests:
None declared

Competing interests: No competing interests

30 April 2007
Paul J. Rosch
President, The American Institute of Stress, Clinical Professor of Medicine and Psychiatry, NYMC
124 Park Avenue, Yonkers, NY 10703 USA