A new study reviews harms and benefits of statins treating patients with elevated LDL cholesterol
The benefits were were shown to greatly outweigh any harms of taking the drug
Harms linked to the drugs were considered 'tiny'
The thought that comes to mind when you hear the word “statin” may depend on your age. Below the age of 40 and you may not have come across them, but for everyone else, these drugs can be something they love, or equally as often, loathe.
But a major review, published Thursday, has found that the benefits provided by the drugs, and lives saved, have been underestimated – and the harms over exaggerated..
Statins are a class of drugs used to reduce low-density lipoprotein, LDL cholesterol, within the body. They are prescribed to people with high LDL cholesterol, when levels are above two to three milliliters of cholesterol per liter of blood. These individuals are at risk of cardiovascular diseases such as heart disease, stroke and heart attack. The drug works by inhibiting the enzyme involved in the body’s ability to produce this form of cholesterol.
They are a common prescription among the 73.5 million adults with high LDL cholesterol in the United States. Among the US population, 26% of adults were using statins in 2012, according to the Centers for Disease Control and Prevention. Globally, raised cholesterol levels are estimated to cause 2.6 million deaths each year, according to the World Health Organization.
But statins have a reputation that precedes them, with people often worried about taking them, or going as far as declining them, without always knowing the evidence behind their decision. There have been reports of the drug causing side effects that include an increased risk of hemorrhagic stroke, muscle pain and weakness and diabetes, causing acceptance of the drug to be split.
The new study conducted analyzed all available evidence on the safety and efficacy of statin therapy, to provide the evidence needed to help people make their decision. It was decidedly in their favor.
“Statins have had a huge impact on reducing cardiovascular events,” said Rory Collins, BHF professor of medicine and epidemiology at the Nuffield Department of Population Health, part of the University of Oxford.
“There are many misleading claims about statins … [but] people tend to underestimate the benefits,” he said.
How beneficial are they?
After reviewing all the available evidence on the harms and benefits of statins, the study had a few key findings, including one based on the daily use of 40 mg of the drug atorvastatin for five years and by 10,000 patients. Among these 10,000 patients, the study predicted the drug would prevent 1,000 people having major cardiovascular events (heart attacks, strokes and coronary artery bypasses) who had pre-existing heart conditions. The same regimen would also prevent 500 cardiovascular events in people who are at increased risk, due to diabetes or hypertension for example, but haven’t had a heart condition.
“You avoid 1,000 or 500 people having a heart attack, stroke or similar,” said Collins.
When put into perspective in the United Kingdom, Collins added that among the 4 million people with previous heart events, and 2 million people at increased risk in the country, 80,000 heart attacks would be prevented each year, while 600 might develop myopathy (a rare condition involving muscle pain, tenderness or weakness that can be severely disabling and sometimes fatal).
A further analysis found that for each 1 mmol/L reduction in LDL cholesterol made using statin therapy, the risk of coronary deaths and heart attacks, strokes and coronary bypass procedures is reduced by approximately 25% for each year the drugs are taken after the first year.
But one concern among some experts, and opponents, is the eventual use of statins to treat people who have high cholesterol, but have not had previous cardiovascular issues and do not have diabetes of hypertension, meaning more people take them than needed. Fewer studies have shown that statins reduce the risk of cardiovascular diseases in healthy people with high cholesterol.
What about the harms?
The study also reviewed the occurrence of side effects, such as muscle pain, hemorrhagic stroke and myopathy, to identify whether the controversies around the use of statins are warranted.