More Docs Wonder If Statins Are Worth the Risks
Debate Over Statins Heating Up continued...
The current debate instead focuses on using statins for patients like Chand: people between the ages of 60 and 75 without known heart disease. They have certain risk factors -- age, smoking, higher cholesterol, or diabetes, for example -- that raise their chance of having a heart attack or stroke over the next 10 years.
Studies have shown that taking statins can lower those risks in large groups of people, but the impact on a person's individual risk is much smaller.
At the same time, researchers are still in the dark about whether the side effects people have are truly caused by the medications, or if they're related to other things, like lifestyle choices, age, or even patient expectations.
“The thing that struck me about the statin data is that when you look at it, the statistics are pretty sobering,” says John Mandrola, MD, a cardiologist in Louisville, K.Y., who writes about the challenges of treating patients with heart disease. His recent post about taking a patient off her statin doubled the traffic to his blog.
“If there is a benefit, it’s a small benefit. And I just think most patients don’t really understand. They get told their cholesterol is high and ‘You should take this drug,’” he says.
After doing his own review of the research, Mandrola concluded that for lower-risk patients, statins raise the risk of diabetes in about the same number of people who might avoid a first heart attack or stroke on the drugs. And they don’t lower a person’s overall risk of an early death.
What's more, studies show 140 low-risk people would need to take statins daily for 5 years to prevent just one heart attack or stroke.
That was enough to convince him to take his patient, who was suffering from muscle and joint pains, off the medication.
A Closer Look at Side Effects
“On the one hand, it’s clear that patients report side effects -- muscle aches, pain, mental fog -- all these things have been written about. When you take care of patients day in and day out, you hear that a lot,” Mandrola says.
But studies of the drugs paint a starkly different picture. In studies where patients are randomly assigned to take a statin or a placebo pill, the rates of side effects reported by each group are nearly identical, leading many doctors to wonder if the side effects are really due to the medications or if something else, like the nocebo effect, might be at work. In the nocebo effect -- the opposite of the placebo effect -- a person suffers side effects from a fake medicine.
Dr. Rory Collins, a professor of medicine and epidemiology at Oxford University in the U.K. who has overseen the analysis of study data on statins, says the drugs are extremely safe. He’s afraid that too much focus on the side effects might discourage people from taking them when they could benefit from the medications.