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Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2197 (Published 20 May 2010) Cite this as: BMJ 2010;340:c2197

Rapid Response:

What does this mean for a Polypill for all?

The study reinforces the clear Cardiovascular benefits of Statins as
well as the added bonus of a modest reduction in cases of Oesophageal
Cancer but I wonder how well published this will be by the media or
whether once again the side effects to muscle, liver and eyes will take
the eye catching headlines?

It is also worth considering what impact this study will have on
proposals to introduce polypills which would include a statin. Considering
the increased risk of acute renal failure caused by Statins and the fact
that a Polypill would include both a statin and an Ace inhibitor -
notorious for causing Acute or Acute on Chronic Renal failure in patients
I wonder how many additional adverse events we may cause. If nothing else
this latest study should make us question how wise a pill for all maybe.
Whilst it is important to note the increased risk of acute renal failure
it is also important to consider how many patients do we ourselves send
into renal failure whilst in hospital, particularly peri and post
operatively? I also learned a valuable lesson to always look for other reasons for the well known side effects of Statins. In one case, deranged LFT’s and mild myopathy were detected but when the Statin was stopped, the LFT abnormalities persisted at a lower level because of an early stage Cholangiocarcinoma; were it not for the Statins causing a greater elevation the carcinoma may not have come to light until incurable.

The study does overlook one important “side effect” which was
recently highlighted in a Meta-Analysis by Sattar et al1, that of
increased risk of Diabetes. It was noted in this study that the benefits
of Statins in moderate to high risk patients still outweigh the 9%
increased incidence risk of developing Diabetes but the media snapped on
the finding warning patients they would develop Diabetes, led by the Daily
Mail2.

1. Sattar, N. Et al. Statins and risk of incident diabetes: a
collaborative meta-analysis of randomised statin trials. Lancet. 2010 Feb
27;375(9716):735-42. Epub 2010 Feb 16.

2. Hope, J. Statins ‘raise your chance of Diabetes’... but the benefits
still outweigh risks, say doctors. Daily Mail 17th Feb 2010

Competing interests:
None declared

Competing interests: No competing interests

07 June 2010
David G Samuel
F2 Trauma and Orthopaedics
Prince Charles Hospital Merthyr Tydfil CF47 9DT