Last week we reported on the publication of a comprehensive scientific review in The Lancet that balanced the harms and benefits of statins. This week, the experts give their view.
Associate Professor David Sullivan is from the Department of Chemical Pathology, Royal Prince Alfred Hospital, and the Central Clinical School, University of Sydney
“This review is wonderful news because it has the capacity to prevent the major causes of death and disability in Australia whilst providing immense savings to the cost of healthcare. It does so by restoring a balanced perception of statin therapy. The review establishes that statins prevent large numbers of fatal or serious irreversible heart attacks and strokes with very little in the way of side-effects. Treatment, which would prevent 500 to 1000 such events per 10,000 patients, would only result in a handful of serious muscle problems, most of which would be reversible.
The review also puts the rates of new-onset diabetes and muscle discomfort into perspective. It summarises the reassuring evidence that statin therapy carries no threat to memory, cognitive function and the risk of Alzheimer’s Disease, and reaches the conclusion that warnings concerning such possibilities should be withdrawn.
An accompanying article by the Editor of The Lancet discusses the importance of accurate interpretation and reporting of scientific evidence and bemoans the fact that, in the UK, 200,000 patients were estimated to have stopped taking a statin in the six months after adverse media coverage. It will be instructive to see whether the media give this positive and reassuring message about statin therapy the prominence it deserves.”
Professor Mark Wahlqvist is an Emeritus Professor of Medicine at Monash University and Past President of the International Union of Nutritional Sciences
“In a monumental review of a major field of drug therapy, statin use in people with elevated blood cholesterol , or at increased risk of cardiovascular disease, appears vindicated. That’s good news at the moment for socio-economically advantaged people in places where there are sustainable, affordable and accessible health care systems.
But the question of why we ever needed this billion dollar industry is not , understandably, canvassed. What is less understandable is that the much lauded clinical trials methodology as definitive has not provided comparable head -to-head studies of environmental factors, personal behaviours and statins. That means where we live, who we are, our diet, exercise and more.
That is not where the money is!
So where health care costs need to be addressed, the answer presented is ‘the costs of the drugs are falling‘, not what the relative universal health and global health economics of non-pharmacological approaches might be.
For example, we have known for almost as long as statins have been available , that if body fatness increases, their effects on artery health are less evident. What do diet and exercise do to the need for and dose of statins?
By this, we don’t mean vitamin pills, we mean food patterns associated with longevity and health, we mean daily exercise shown in equally impressive Lancet reports to be favourable in the face of obesity, heart disease and diabetes.
And what about ethnicity and statins? North East Asians, at high risk of hypertension and haemorrhagic stroke, are not as likely to benefit from statins – especially if they have lower cholesterol.
This population-wide risk is a serious omission from the Lancet report. Without these caveats, the next we will learn is that we are all expected to take statins from a younger and younger (and older and older) age, irrespective of our food culture, personal behaviours and medical history. Let’s know for whom the statin bell tolls!