Health: A new spin on statins

Q I’m a 69-year-old man and have taken statins for several years. I am healthy with no history of heart problems. My doctor blinds me with statistics about the benefits of statins but I know there are also risks from taking them. Can you explain these in layman terms?

A This is a common area of confusion. I asked campaigning cardiologist Dr Aseem Malhotra, an expert in the prevention and treatment of heart disease, for his response…

NEXT WEEK: Dr Malhotra explains why cholesterol is good for you.

14 Replies

I liked the link on Absolute Risk and Relative Risk that was given in the article.

I know the difference between the two, but I know people who don't!

Now I have to try and remember the difference 😊

Humanbean, thanks for the link, but I still don't understand it! Here's the final paragraph:

"Treatments for medical conditions are often quoted in the press along the lines ... "New treatment reduces your risk of X disease by 25%". Whilst this sounds good, it usually refers to the relative risk. However, the benefit really depends on how common or rare the disease is. A large reduction of relative risk for a rare disease might not mean much reduction in the absolute risk. For example, a 75% reduction in relative risk for something that has a 4 in a million absolute risk of happening brings the absolute risk down to 1 in a million."

The last example is a disease that has a 4 in a million absolute risk.

If you take the treatment you're reduced to a 1 in a million absolute risk.

The reduction in risk is clearly 75%. But in the paragraph it says the 75% reduction is relative risk rather than absolute risk. But the reduction is clearly also a 75% reduction in your absolute risk as well, as the numbers have been given?

Or are they saying that the problem is expressing this as a percentage change, which makes it look like a very large number. Whereas if they stated it in terms of the actual numbers it sounds like a small change?

Am I missing something here? Thank you in advance for looking over all this!

Suppose there is a rare, horrible disease called X. On average, the disease afflicts 4 people in a million in a lifetime. 4 in a million or 0.0004 are both ways of expressing the absolute risk a person has of getting X. A tiny risk and you wouldn't worry about it under normal circumstances.

Suppose your risk of getting X can be reduced by 75% by using a special, expensive toothpaste for your entire life. Reduce 4 by 75% and it reduces to 1. If you use this toothpaste for life, the absolute risk of getting disease X in a lifetime falls from 4 in a million to 1 in a million.

If a pharma company told you that your absolute risk of getting disease X was 4 in a million spread over your entire lifetime, and you could reduce the risk to 1 in a million, would you be impressed? Would you care? Would you be inclined to buy the toothpaste? I certainly wouldn't. So pharma companies in this situation would never mention absolute risk of getting such a disease.

But if you were not told the absolute risk of getting the disease, and instead were just told the reduction in risk is 75% when using the toothpaste for life, then if X is particularly scary you might be inclined to buy it. Because a 75% reduction in risk sounds HUGE. But the reduction is a relative risk, not an absolute risk.

When pharma companies or doctors mention risk they rarely tell you the absolute risk they usually mention relative risk. And they don't tell you they are using relative risk reduction, they just use the phrase "risk reduction". According to Dr Kendrick in his book Doctoring Data surveys have shown that doctors are no better at working out what is absolute risk, what is relative risk, and what the difference is than the public is.

It is also standard policy to use absolute risk when mentioning risks of a treatment because they sound small, but when mentioning benefits they use relative risk because they sound huge. And none of these switches from absolute to relative and back again are highlighted or made clear. Even Dr Kendrick has mentioned that it is often very difficult to work out absolute risks of something happening, and is often difficult or impossible to work out which type of risk is being used.

Another thing that is frequently done is to quote statistics for different periods of time. So you might be told an absolute risk reduction over a year rather than a lifetime risk. (Your absolute risk of getting a cold in a single year is a lot lower than the absolute risk of getting a cold in your lifetime.)

Pharma companies and scientists writing papers will use every trick they can think of to make you think their drug or their research is relevant and important. And they have all sorts of ways of pulling the wool over your eyes. They can mention relative risks of side effects while mentioning a competitor's product, and mention only absolute risks of side effects when mentioning their own. And you probably won't know they have done this.

I won't bore you with the details hb, but I used to be able to sell investments in a similar way. I couldn't now, even if I wanted, because of the regulated to the hilt financial services legislation.

Bothers the h*ll out of me that whilst I could have just made people poor, Big Pharma and their rote learned medics can and do kill people by blinding them with lies, damned lies and statistics.

Such as, 'you are in range. (Subtext) Go away'. :)

Thank you HumanBean, that makes it a lot clearer. I must get hold of Malcolm Kendrick's book!

So.......having done this test it appears that my weight is the factor for increasing my risk of a heart attack...nothing about T3 (!!) but my argument that no T3 increases my weight, ergo I should take it is irrelevant? I have stated for a while that I feel the weight increase impacts adversely on my health...I was on 20mcg T3, given statins to compensate, felt good, still on statins but no T3. No wonder we all get confused/angry/fed not one swear word!

My father has been on statins for five years following surgery for an aortic aneurysm (NB up to this point his cholesterol levels were perfect; everyone who has had such surgery is automatically put on statins).

Since then he has developed muscle weakness - especially in his legs - and memory loss. During a short term trial withdrawal of the tablets the change was palpable - the problems disappeared almost overnight and he could walk far more than when on the statins and he was much sharper mentally. However, his cholesterol levels increased during the trial period so he was put back on a reduced dosage. Lo and behold, the muscle weakness and memory problems returned.

It has got to the stage that he is now unable to go on walks, which he had been in the habit of doing in the past, so is gaining weight.

Here's the irony - the very tablets supposed to prevent heart disease is causing side effects that prevent him from exercising which is supposed to prevent heart disease.

When are the medics going to see the idiocy of their logic?

What's more, they keep coming out with 'reports' claiming the efficacy of statins and denouncing the side effects. The latest such report published a few weeks ago stated that these side effects were to do with the 'precebo effect' in that people were expecting specific side effects, so these came to pass.

In other words, the side effects don't actually exist; they have been expected to exist by the patient so when they start to take the statins they experience the problems they expected. So... the side effects are all in their mind, not in reality.

If this is true, then there must be a case of mass hysteria throughout the UK given that the high proportion of people on statins are complaining of muscle weakness and memory loss, among other problems.

Well, at least men as well as women are implicated in the 'all in the mind/hysteria' scenario. Makes a change.

Also having an effect on hormones as cholesterol is needed for the formation of all hormones.

Am sure you are aware that Big Pharma have highly paid writers who produce the positive spin when things look bleak.

I am a Dr Kendrick fan too ....

So am I love his reviews

And calcification of the arteries (and therefore heart disease) is one of the side effects of statins - just read all of Dr Malcolm Kendrick's blog about statins.

I notice that Dr Malhotra advocates - like many others - the Mediterranean diet and recommends the Pioppi diet. Having recently been to Italy and enjoyed their cuisine and witnessed the lifestyle, it's occurred to me that it's not just the Mediterranean diet that is responsible for their good health - all the Vit D from plenty of sunshine for most of the year must have a lot to do with it too.

And a laid back approach to life.

I suspect that Vit D deficiency in the UK is a major contributing factor in ill health so the doctors need to address this far more than they are currently doing - and in tandem with advocating a healthy diet.

I moved to Crete in 2004 and tested insufficient for VitD a few years later. Mediterranean folk stay out of the sun at peak times and only holidaymakers wear shorts ! - so they are usually well covered up !

I spent 14 weeks in Italy from May until August in 2014 and a few months later was diagnosed with Vitamin D deficiency. I have never been able to reach a logical reason why this happened.

J 😊🍀

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