October 7, 2022

To Your Good Health: Healthy lifestyle changes may reduce need for statin | Lifestyles

Dear Dr. Roach: Would you comment on some information I discovered about statin drugs, which I think reveals some nefarious numbers on behalf of the drug companies?

So far I have found two reports that say the actual number of people who have heart attacks after being placed on Lipitor was reduced from 3.1 percent to 2 percent. This was a study of thousands of people over 10 years and was done by the drug company, not an independent lab. The drug company selling the statin drug claims that a reduction from 3 percent to 2 percent is a 33 percent drop.

I beg to differ on that. If my chances of having a heart attack drop from 3 percent to 2 percent, I say that is a 1 percent drop. So I quit taking the drug because of the long-term side effects. I also changed my diet to eliminate sugars and highly refined carbs, and I am eating a lot of dark green veggies. I keep my weight under 140 pounds, which is still a few pounds over my natural weight (about 135 pounds). I am 5 feet, 9 inches and have always been very thin.

I had a heart attack and triple bypass 11 years ago, even though my blood pressure was 125/80. My current cardiologist wants to up my statin drug from 40mg to 80mg. I am 78 years old and very healthy. — Anon.

Answer: An old expression is that there are three kinds of lies: lies, damned lies and statistics. What you are calling nefarious, the drug company calls marketing, and both ways of looking at it are true, as long as you understand what is being said.

The original study that looked at the effect of a statin drug in people with heart disease showed that after 5.4 years, the risk of dying was 12 percent in the group randomly assigned to statin, and 8 percent in the group randomly assigned to placebo. The paper called that a 45 percent relative risk reduction, but I would call it a 4 percent absolute risk reduction. Other studies (there have been many that have consistently shown benefit) did not show as great an improvement (33 percent relative risk reduction is more common than 45 percent), but you have to look at both the length of time a study goes on and how sick the subjects in the studies are.

You may still think that it’s not worth taking the drug to go from a 12 percent risk of death to an 8 percent risk of death over five years. I know which group I’d rather be in, so I recommend a statin to a person who has that high an absolute risk. I would never recommend a statin to a person with a 3 percent 10-year absolute risk. Most authorities recommend a statin once their 10-year risk is above 7.5 percent.

You mention long-term risks. Muscle aches cause discontinuation of statins in many people (who are then at increased risk for heart attack compared with those who continue statins), but persistent symptoms after discontinuation are rare.

People at high risk of heart attack and stroke benefit from statin therapy, but the amount they benefit depends on how much risk they have. Those with a prior history of heart attack or bypass graft are at high risk and likely to have much more benefit than harm from a statin. People without a history of heart disease have less absolute benefit, and so a careful evaluation, including assessment of lifestyle issues like diet and exercise, is critical. I have had many people who no longer met criteria for a statin once they made some healthy changes to their lives.

— Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.