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The great statins divide

By DR ASEEM MALHOTRA | DAILY MAIL | FEBRAURY 12, 2014

The great statins divide: As go-ahead’s given for one in four adults to be offered heart drug, one doctor says this mass pill-popping is folly…

• NICE has recommended statins be made available to patients with a 10% risk or more of having a heart attack within a decade
• This would see up to 12 million patients taking the drug every day
  
• Dr Aseem Malhotra believes up to one in five patients suffer side-effects
  
• He suggests tackling obesity would have a bigger impact on lowering death rates

The man in my consulting room was in his mid-50s and had arrived complaining of severe chest pain. ‘I’ve had it for a while now, doctor,’ he said, grimacing, ‘it won’t go away.’

I glanced at his notes — an angiogram had showed that his heart was fine, while an endoscopy had revealed there was nothing untoward going on in his oesophagus or stomach. Then I asked what drugs he was taking regularly. ‘Well, nothing really?.?.?. just statins.’

That was almost certainly the culprit. I asked him to stop taking them for a fortnight, which, despite protests from his GP, he did and, lo and behold, two weeks later the patient was pain-free.

I recommended he embrace the so-called Mediterranean diet and exercise a little more, and he went away a happy and healthy middle-aged man.

If NICE (the National Institute for Clinical Excellence) gets its way, that scenario could be needlessly played out in GP surgeries and hospital consulting rooms hundreds of thousands of times a year. It would mean 12 million of us taking a little pill before bed, five million more than take statins today.

That’s five million more patients for the NHS to keep an eye on, five million more people who, despite the fact many will be in good health, have been well and truly ‘medicalised’ and face the prospect of spending the rest of their lives on daily medication.

In making its recommendation, NICE seems to be siding firmly with the drug companies and relying on industry- sponsored statistics which consistently under-report — some would even say hide — the risk of side-effects.

These statistics will tell you that perhaps one in 10,000 patients taking statins will suffer severe muscular pain as a side-effect.

In contrast, reliable data from the real world, published recently in the British Medical Journal and backed up by anecdotal evidence from my experience as a cardiac physician, suggests that the real figure for serious side-effects associated with statin use is closer to one in five.

In other words, if NICE succeeds in turning five million middle-aged and predominantly healthy men and women into statin-popping patients, then one million of them will be back — just like my fiftysomething patient — in surgeries and consulting rooms, complaining of side-effects that, as well as muscle pain, include digestive problems, short-term memory loss, erectile dysfunction, sleep disorders, cataracts (mainly in women) and even type 2 diabetes.

The drug companies will tell you how cheap statins are — just 10p a day — but that completely ignores the costs of the follow-up appointments and hospital investigations that patients suffering from such side-effects will require.

With even NICE admitting that 140 people will have to take statins to prevent just one of them having a heart attack or stroke, that’s 139 people taking them for no good reason, running the risk of unpleasant side-effects in the process while all the time taxpayers pick up the ever-growing bill for looking after them.

But NICE also seems to be ignoring serious doubts about how effective statins are.

Yes, they can lower cholesterol levels (they work by inhibiting an enzyme that produces cholesterol in the liver), but real-world data show they have absolutely no effect on either overall death rates or rates of serious illness.

The advocates of statins will point to falling death rates from heart attacks and strokes in recent years but many clinicians — myself included — believe that death rates are falling not because of the increased use of statins, but because of the decrease in smoking (a smoker is 50 per cent more likely to die from a heart attack than a non-smoker who’s had a heart attack) and more effective intervention in Accident and Emergency.

Good medicine involves the right treatment being given to the right patient at the right time, and I’m the first to admit that statins have an important role to play when it comes to the care of patients who have either had heart attacks or have been diagnosed with heart disease.

But giving them to millions of reasonably healthy people is not only medically dubious, it also risks sending out entirely the wrong message to those who, as they approach middle-age, ought to be giving very serious thought to their own diet and lifestyle.

The next big decrease in deaths from heart attacks won’t be brought about by doling out statins but by doing battle with the biggest — and still growing — health problem that we, in common with other Western nations, face: obesity.

Being overweight and having a poor diet causes more serious health problems than alcohol and smoking put together, with obesity associated with such serious conditions as type 2 diabetes, high blood pressure, cancer and cardiovascular disease.

My biggest worry about statins is that people will see them as a magic pill that allows them to tuck into three pizzas a night and umpteen hamburgers with impunity. But they aren’t. People who want to take care of  their health, need to make changes themselves.

It’s not that difficult. The Mediterranean diet simply involves more olive oil, more nuts, two to three portions of oily fish a week and lots of fruit and vegetables, while cutting out refined sugars and carbohydrates (so no white bread, rice or pasta) and processed foods laden with fats and salt.

As for exercise, I’m not talking about training for a marathon — a brisk 20-minute daily walk will do great things for your cardiac health.

Make those sort of lifestyle changes and — whatever NICE says — you won’t need those statins at all.

April 7, 2024 - Posted by aletho | Science and Pseudo-Science, Timeless or most popular