7 Things You Should Know Before Taking A Statin

Well, here’s the logic and outcomes used in the trials which evaluate if these little pills are indeed worth taking. It’s not my place to prescribe or make a decision for you.

That decision always should come down to the individual after considering the possible benefits and possible harms. They will decide if it’s a good idea for them. In this piece I’m looking at exactly how you can make that decision. If you take medications, or know significant others who do, then this could be an important bit of reading for you.

Here’s the seven things you need to know before you decide to take a pill. This applies to any pill, not just statins. 1. How drug trials are run and why The standard for understanding the effectiveness of a drug is the randomised controlled trial (RCT).

In an RCT participants in the study (sometimes also called subjects) are randomly assigned to the treatment (getting the drug) or the placebo control group (get a sugar pill which isn’t the drug). Both groups take their “medication” for some time and then we look at how things differed between the groups. If a lot less “events” (like heart attacks) happen in one group over another, then we might be prepared to judge the treatment as either beneficial or harmful depending on how things happen.

If, say, the treatment group has less heart attacks than the control group, that means the drug is somehow reducing the chance of a heart attack. If more people in the treatment group get, say, cancer then the treatment is harmful.

It is important to realise that you can get benefit and harm at the same time – e.g. reduced heart attack, but increased cancer. If the drug is beneficial then the researcher, clinician, and you the consumer then have to make a judgement about whether it’s worth taking the drug for the benefit and possible harms. For example, how many people will benefit from taking the drug? How many people suffer adverse events (harm) 2.

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What happens in a typical statin trial? Here’s how it might work. You eventually end up with say 2000 people (with raised LDL-C cholesterol) in the trial. You randomise half to drug treatment (1000) and the other half are placebo control.

After 5 years you follow up the group and discover that 10 people in the treatment group (they got the statin) had a heart attack, 20 people in the control had a heart attack. So that sounds good right? Yes, of course, half the number of people in the statin (treatment) group had heart attacks.

So that would usually be expressed by the change in relative risk of having a heart attack. If we do that we can say that taking the statin drug reduces your chance of a heart attack by 50%. And that’s the way it is generally reported in the scientific literature and explained to you by your doctor.

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That’s only one way to think about the beneficial effects. There are several more. Read on. 3, What about expressing the outcome as absolute risk? Presenting people with the same numbers in a totally different way, called absolute risk, might make you think differently.

What these same numbers mean is that if you are in the control group you have a 98% chance of NOT having a heart attack over five years, and if you take the stain you have a 99% chance of not having a heart attack in the next five years. In other words, the drugs gives you a 1% decrease in your chances.

Sounds very different – would this affect your decision to take the drug? 4, Number needed to treat Another way to express the same data is to think about how many people would have to take the drug for one person to benefit. In this case 1000 people took the drug for 10 less heart attacks. The number needed to treat (NNT) is 1000/10 = 100.

100 people need to take the drug for one person to benefit. Does that do anything different to your decision making? 5. Adverse events? So no matter which way you play with presenting the numbers, there are still 10 fewer heart attacks in the treatment group.

These are 10 real people having 10 less heart attacks. Heart attacks cost money, aren’t fun and mean you will probably die earlier with more suffering than if you didn’t have one.

So if there weren’t any harms through side effects then it’d probably still be a no brainer. We could give them to all sorts of people. We could consider adding it to the water supply (some people have suggested this!).

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Some of the common harms assessed in statin trials are cancer, myopathy (muscle pain and poor function), and diabetes. Using the same hypothetical trial above (we’ll look at actual trials in the table below later), let’s say 10 people in the statin group got cancer over the 5 years and 1 person in the control. 20 got diabetes in the statin group, 10 in the control, and 100 showed myopathy in the statin group and 30 in the control.

So the side effects in the statin group are generally higher for muscle pain, cancer and diabetes. This is a consistent finding in such trials. Would these numbers change your mind about the benefits versus harms?

Again you could express all of these as relative risk (1000% increase in cancer, 100% increase in diabetes, 333% increase in myopathy). Or you could be more sensible and show a 0.9% increase in the chances of cancer, 1% in diabetes, 7% in myopathy. In a third way, you could express this as number needed to harm. How many people need to take the statin to be harmed (suffer an adverse event)?

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The number needed to harm is 100 for cancer, 100 for diabetes, and 14.3 for the muscle pain. One in every 100 people taking the statin will get cancer, one will et diabetes and 1 in 14 will suffer muscle pain caused by the drug.

6. Putting it all together The website thennt.com gives summary data for statins as well as other drugs for you to consider. It takes recent trials data and meta-analyses to figure this all out. This is a great place to start if you want a summary of what’s going on.

I have copied their figures for statin benefit vs harm in both numbers and percentages for people who haven’t had a heart attack (called primary prevention) and second for people who have already had a heart attack (called secondary prevention). Statin Drugs Given for 5 Years for Heart Disease Prevention (Without Known Heart Disease) Benefits: Expressed as NNT None were helped (life saved) 1 in 104 were helped (preventing heart attack) 1 in 154 were helped (preventing stroke) Benefits: Expressed as percentages 98% saw no benefit 0% were helped by being saved from death 0.96% were helped by preventing a heart attack 0.65% were helped by preventing a stroke

P.S. A few readers have asked which books & cookbooks we actually reach for — it's What The Fat? / What The Fast? Book Series; take a look here if you want the current details.