Should 50 year olds be taking statins?

Today’s meta-analysis apparently presents a good case for giving those over 50, at low risk for heart disease, statins for the rest of life. But it fails to accurately take into account side effects.

The gist of the meta-analysis, published in the Lancet, carried out by researchers at Oxford University, is to argue that those at low risk of heart disease should be on statins. However, the figures quoted in terms of risk reduction aren’t that impressive. Low risk is often spoken of in terms on one’s cholesterol level. Arguably to increase the market for statins, ‘healthy’ levels of cholesterol have come down over the years. Statins are effective at lowering the so-called ‘bad’ LDL form of cholesterol, but are pretty lousy at raising good HDL cholesterol levels. Not surpisingly, this study uses LDL cholesterol levels as the measure of impact of statins.

In terms of one’s LDL cholesterol score is normally below 1.8; medium risk below 2.6; and high risk above 3.4mmol/l. What they mean by low risk in this study isn’t made at all clear in the paper, but the average LDL of those studied is 3.7mmol/l which means that, overall, participants in the study started at high risk.( I’ve put in an email to get some clarity on this but the contact person for the study is on holiday!) This is important because the only thing new thing about this analysis is the recommendation for low-risk people to take statins. We know they have small benefit for those who’ve had heart attacks. Anyway, if you are at apparent low risk (below 5% risk of a cardiovascular event in next five years) then apparently 1 person in 180 will not suffer a non-fatal heart attack as a result of taking statins for five years in they lower their LDL cholesterol by 1 point.

If you were at slightly higher risk (5 to 10% risk of cardiovascular event in next five years), and lowered your LDL cholesterol by an even higher 1.5mmol/l then 1 in 50 would not suffer a non-fatal heart attack as a result of taking statins for five years. The authors say that ‘this benefit greatly exceeds any known hazards of statin therapy.’ I don’t agree with this statement because it greatly depends on what you mean by known hazards. For example, many studies report 10 to 20 per cent of statin users having significant side-effects, usually muscle pain. Other side-effects are mental confusion, heart failure, myopathy (an extreme version of muscle pain) and a 10 to 20% increased risk of diabetes.

Even if only 2% of people suffered then, for every person who will benefit, one will be harmed. At 10% you are looking at at least five being harmed for every one benefiting, or, in the previous ‘low risk’ example, eighteen harmed for one to benefit. Is that really worth it? But if lowering LDL cholesterol is really what makes a difference why not do it more safely? Omega 3 fats lower LDL cholesterol, as does supplementing high dose niacin (B3) and eating a low GL diet, high in soluble fibres. For example, taking 2 grams of niacin (sustained release to avoid blushing, prescribable as Niaspan) lowers LDL by 15%. Only 12 weeks on a Low GL Diet lowers LDL cholesterol by an average of 13%. Increasing omega 3 and soluble fibres in your diet further lower it. These measures are associated with reduced risk of heart disease, and many other diseases besides.

While this study suggests that the lower you go with cholesterol the better, this makes no sense since cholesterol is a vital nutrient, both for the brain and body, as well as being the precursor of several hormones, including vitamin D. The side effects of too low a cholesterol level, according to other studies, include suicidal depression and aggression, an increased risk of stroke and mortality. All these are somehow magicked away in this meta-analysis. That just doesn’t make sense to me. One of the study’s key authors professor Colin Baigent says “If we want to prevent heart attacks and strokes that come out of the blue in people with no previous evidence of problems — and about half of such events happen in the absence of any prior history of disease — then we have to identify and treat people who are currently healthy but are known to be at increased risk of developing heart disease.” I couldn’t agree more and that is why I always recommend testing for homocysteine.

It predicts two thirds of cardiovascular deaths in the elderly while cholesterol testing doesn’t. That’s why heart attacks come ‘out of the blue’ because we are not measuring the right indicators of risk. In Germany they run millions of homocysteine tests a year. Very few GPs in the UK test this well established risk factor. I’ve had so many people report massive improvements in their cholesterol and homocysteine scores, and their health, in a matter of weeks. Contrast this with these supposed benefits that come after years of drug taking. It’s this kind of all round strategy that Jerome and I recommend in Ten Secrets of Healthy Ageing.

I suppose the idea is that if enough people can be persuaded to take drugs for the rest of their life, at a considerable cost to the NHS and profit to the pharmaceutical industry, the net apparent but unproven result is less heart disease events and less cost to the NHS? Is this really as good as it gets for prevention? What about all those people with side-effects? Aren’t they going to visit the GP and increase NHS costs? It’s an Orwellian world we are heading into where people are fed food that makes them sick, then drugs to mitigate the damage. Needless to say most of the studies used in this meta-analysis are pharma funded. This certainly smells like a clever piece of marketing to get doctors prescribing to everyone over 50.