How Effective Are Cholesterol Lowering Statin Drugs?

Disclaimer

This post is not intended to diagnose or suggest treatments of any medical ailment. If you are currently on a statin drug, do not discontinue using it. Consult your prescriber if you have any questions regarding your prescription.

Statins are medications intended to lower cholesterol and therefore reduce the risk for coronary artery disease. That is if the convention of believing that lower cholesterol levels protect us from heart attacks, which, as we will see later, is in question. Statins have been the best-selling prescription drug class in the U.S. and include atorvastatin, the best-selling prescription drug in the world – indeed in history. In the 2008 paper "Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism" by Beatrice A. Golomb, M.D., Ph.D., and Marcella A. Evans, B.S., they are reported to have well-documented benefits to cardiovascular disease in many groups. (1) Well documented does not equate to highly protective. However, pharmaceutical companies trump up the apparent effectiveness of their drugs with statistical sleight of hand.

Relative Risk Versus Absolute Risk

The pharmaceutical industry uses a bit of trickery to inflate the effectiveness of their products. One of the tools they use is called "Relative Risk." The relative risk (also called the risk ratio) of something happening is where you compare the odds for two groups against each other. Although relative risk does provide some information about risk, it doesn't say anything about the actual odds of something happening. On the other hand, "absolute risk" does. (2) To give an example, If the control group get a disease at a rate of two per one thousand, there is an absolute risk of .2% of getting said disease. If the experimental group taking a drug has only one person per one thousand who gets the disease, there is an absolute risk of .1% of getting the disease while on the drug. Relative risk then compares the .2% number directly with the .1% number. In my example, .1% is 50% less than .2%. So, the relative risk here is 50%. Drug companies will report that you can lower your chance of getting a disease by 50%. In fact, the difference between the absolute risks of 2/1000 and 1/1000 is statistically insignificant.

A Closer Look At The Effectiveness Of Statins

Let's look at statin drugs specifically. In the May 10, 2012, New England Journal Of Medicin article "Statins: Is It Really Time to Reassess Benefits and Risks?" by Allison B. Goldfine, M.D., she claims that "the net cardiovascular benefit for people at high cardiovascular risk strongly favors statin use." (3) A table in the article shows that 1.98% of people taking statins had a major coronary event. In the control group, 2.67% had a major coronary event. The difference is precisely .69 percentage point difference. Not significant. However, if you compare the relative risk of 1.98% to 2.67%, you get a relative risk of 26%. This number is misleading the public, and perhaps many healthcare professionals into believing that certain drugs are way better than they are. I have nothing against Dr. Goldfine. She is not trying to pull the wool over our eyes. She is just using the accepted method of how professionals talk about the effectiveness of medications.

Numbers Needed To Treat

I spent several hours going over the numbers until I was comfortable presenting my findings here today. Luckily, there is a website called TheNNT.com that does the work for you. The name of the site comes from the term "Numbers Needed to Treat," which means the number of people that must take a drug before one person sees a benefit. When you search for statins, there are two different pages. One of them reports the NNT of patients who are "at-risk" for cardiovascular disease, and the other page reports the NNT on patients that are not, but take the statins anyway. Let's look at the at-risk group first. 1 in 83 were helped (life saved), 1 in 39 were helped (preventing nonfatal heart attack), and 1 in 125 were helped (preventing stroke). This translates to an absolute risk of 1.2 percent better chance of having your life saved while on statins after you have already had a heart attack. A 2.5 percent chance that you will not have another heart attack, and a .8 percent chance you will not have a stroke. I think you can see that statins are no wonder drug. They also give the risk of the most common side effects. You have a 2% chance of developing diabetes, and a 10% chance of damaging your muscles. I personally believe these numbers are essential. If you take a statin, you almost have the same chance of not getting a heart attack while developing diabetes at the same time. Not a great statistic. However, TheNNT gives the green light to take statins if you have known heart disease despite these small numbers.

Now let's look at their page called "Statins in Persons at Low Risk of Cardiovascular Disease." No statistically significant mortality benefit was seen. 1 in 217 (.46%) avoided a nonfatal heart attack, 1 in 313 (.31%) avoided a nonfatal stroke, 1 in 21 (4.7%) experienced pain from muscle damage, and 1 in 204 (.49%) developed diabetes mellitus. TheNNT does not recommend taking statins if you have low risk (thank god).

Is High Cholesterol Causing Heart Attacks?

The whole premise that higher cholesterol numbers statistically correlate to cardiac disease risk has been under question for a decade or more. A national study has shown that nearly 75 percent of patients hospitalized for heart attacks had normal cholesterol levels. (4) If taken for what it is, this one study casts serious doubt on the cholesterol-heart attack connection. For a better understanding of which "numbers" are more informative on your blood lipid panel (cholesterol test), see my post called Cholesterol: How To Interpret Your Numbers.

The Role Of Inflammation In Heart Disease

I stand with other healthcare practitioners in the belief that heart disease is linked to chronic inflammation, much of which can come from the mouth. I talk all about this in my post called CRP,  Cardiovascular Disease And Periodontal Disease: A Triad of Trouble. The development of atherosclerosis is due to systemic inflammation caused by severe gum disease. The intensity depends on the magnitude of systemic inflammation caused by severe periodontitis and other areas of inflammation in the gut. Changes in cholesterol are not seen with increased inflammation, the severity of atherosclerosis is due to the severity of systemic inflammation, not cholesterol numbers. (5) As I stated in my blog on cholesterol numbers, cholesterol tests do have validity when appropriately interpreted. I recommend finding a good functional medicine practitioner. One who can put the bigger picture together for you. As always, don't neglect your mouth, as periodontal disease can lead to coronary artery disease.