One problem with all the trials of statins is that they look at the probability of still being alive after x years. But that’s not really the question patients want answered. Patients want to know how much longer they can expect to live if they take a statin every day for the rest of their lives. Is it weeks? months? years? decades?
Considering that statins do have known side effects, with muscle pain being the most common and widely recognized, and considering that many people think it’s annoying to have to take a pill every day, they generally want to know the size of the benefit before they decide whether to take the drug or not. Unfortunately, the answer to that question is hard to extrapolate from the studies, due to the way in which they have been designed. Saying that a drug decreases your risk of dying by x over five years doesn’t really tell you anything about how much longer you can actually expect to live.
In 2015, a group of researchers looked at the data from the statin trials and re-calculated the effect in terms of increased longevity. The study was published in the British Medical Journal, and it was funded by the University of Southern Denmark. One of the authors had significant conflicts of interest, having received money from multiple different pharmaceutical companies that produce statins.
All randomized trials comparing statins to placebo, and that also fulfilled the following three criteria, were included: They had to have at least 1,000 participants, they had to follow patients for at least two years, and they had to provide a survival curve. The reason a survival curve was necessary was because the increase in longevity was extrapolated by calculating the area between the survival curves for the statin group and the placebo group. I think the other two criteria are also reasonable – statin studies looking at mortality with less than 1,000 participants and that don’t even follow patients for two years are leaving too much up to chance.
The authors identified eleven studies that fulfilled the criteria, of which six were investigating statins for primary prevention (i.e. to treat people without known atherosclerotic disease) and five were investigating statins for secondary prevention (i.e. to treat people who had already had heart attacks, or in some other way clearly manifested atherosclerotic disease). These eleven studies together included a total of 92,135 patients, so the data are robust. Participants in the studies were followed for between two and six years. Most of the major statin trials (4S, WOSCOPS, ALLHAT, LIPID, ASCOT-LLA, JUPITER) were included in the analysis.
So what were the results?
Life was prolonged by between -5 and 19 days in the primary prevention trials (yes, that’s -5, as in minus five. In one of the studies people taking a statin lived five days shorter than people taking a placebo). In the secondary prevention trials life was prolonged by between -10 and 27 days (yes, again that’s -10, as in minus ten).
When everything is averaged out, people taking a statin for primary prevention lived three days longer than people in the placebo group. People taking a statin for secondary prevention lived four days longer than people in the placebo group. The average follow-up period in these studies was around four years, so if you assume that statins have a linear life-prolonging effect that grows with time (rather than petering off after a while, which is likely), then you can expect to live around one day longer for each year of treatment.
Huh? That’s disappointing. You take a drug dutifully, which your doctor has told you is vitally important, and it prolongs your life by mere days. The results are especially disappointing when you consider that most of the eleven trials were industry funded, and industry funded trials usually show better results than are seen in the real world. So most likely the real world benefit is even smaller than the tiny benefit found in these trials.
And remember, this analysis was done by people with financial ties to the pharmaceutical industry. If even people who are friendly with industry say that statins only prolong life by mere days, we can probably trust that the benefit really is that tiny.
As mentioned at the beginning of the article, statins are not completely free of side effects. So even if you are willing to take a drug every day that has an extremely marginal effect on longevity, then that benefit needs to be weighed against the risk of side effects.
You might also enjoy my article about whether statins save lives, or my article about whether the cholesterol hypothesis is dead.
Tragically hilarious
If you were to spend 3 minutes a day taking a statin, going to the medicine cabinet, opening the bottle, putting water in the glass etc.; if you were to do that 3 minutes a day for 5 years, you would spend 3.8 days taking the statin. In return you would get, maybe, a few days extra. Maybe. If it would be more than 3.8, who knows?
My favourite book on this topic –
The Great Cholesterol Con by Dr Malcolm Kendrick exposes the statin industry for what it is.
‘Statins are the so-called wonder drugs widely prescribed to lower blood cholesterol levels and claim to offer unparalleled protection against heart disease. Believed to be completely safe and capable of preventing a whole series of other conditions, they are the most profitable drug in the history of medicine. In this groundbreaking book, GP Malcolm Kendrick exposes the truth behind the hype, revealing: high cholesterol levels don’t cause heart disease; a high-fat diet – saturated or otherwise – does not affect blood cholesterol levels; and, the protection provided by statins is so small as to be not worth bothering about for most men and all women.’
Given that he published the book in 2008 and big pharma haven’t sued him into poverty tells us his assessment is provably correct.
Very interesting and quantifies the actual benefit. I gave up on a maximum dose of Lipitor some 5 years ago following a prescription from 2009 when I had my heart attack. I’m not so sure statins provide any benefit whatsoever whereas I do know they have long term side effects which I decided did not warrant their use. I now feel even more vindicated by this report. Thank you.
I’m an M.D. in the US. Statins are a great example of the corruption and ignorance that has pervaded medicine — and the disinformation about COVID-19 is just the latest farce. I wouldn’t take a statin if you put a gun to my head.
I constantly see women (even those in their 80s-90s) for whom statins have never shown any benefit for either primary OR secondary prevention, on statins — who have never had a cardiovascular event. It makes me want to scream!
Medical doctors in general are ignorant because they don’t understand statistics, didn’t pay attention in medical school, and simply follow the herd.
For those who want to read a good summary of the whole statin debacle/farce, which has continued for years and shows no signs of letting up, read Malcolm Kendrick, MD’s book “The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It.” Statins likely cause a significant amount of dementia among those who take them, among other diseases.
I am hopeful that one day the general public will finally wake up and be able to discern that most of the conventional medical advice they have been fed for the last several decades is complete garbage. Probably silly of me, but we can always hope.
Thanks to Sebastian for being another one of the few voices of reason and truth.
I echo the recommendation to read Malcolm Kendrick’s book ‘The Great Cholesterol Con’. I also urge folks to add this site, Kendrick’s site and Ivor Cummins’ site to your browser favorites. I read these 3 sites all the time and feel I am getting info that’s not available elsewhere.
BTW Dr. Rushworth has an interesting interview with Ivor Cummins at ‘The Fat Emporer’. Check it out.
I refused statins years ago after a short period of use, when I suffered muscle and joint pain. I then discovered the possible link to cancer – I had already had cancer. Statins also lower ubiquinol levels which is essential for cellular energy production. My heart is damaged from the effects of mercury exposure, so lowered ubiquinol levels would have been bad news. Good job, on both counts, that I did my homework. I was able to stand up to the bullying approach of the doctor who told me I was unintelligent refusing to take statins
So what folks here make of the so-called Polypill which is claimed to cut heart disease mortality by 1/3rd?
https://www.statnews.com/2020/11/13/big-study-supports-cheap-combo-pill-to-lower-heart-risks/
Made up of atenenol, ramipril, a statin and hydrochlorothiazide and aimed it seems at poor countries cos it’s ‘cheap’ (33c a pil).
No evidence it reduces overall mortality, so why take it and risk the side effects that destroy quality of life?
Sebastian on the other hand there is evidence that consuming a reasonable amount of , uncooked, olive of has real benefits viz the heart- and is hardly a hard thing to do 🙂
https://www.bbc.co.uk/programmes/articles/tWtLcz30LZm3YTk5VfZ307/is-olive-oil-really-good-for-me
The tragedy is that we all allow ourselves to be duped and lied to, by our trusted health-givers. I believe that this near-universal disease is labelled as ‘Doctor-knows-best’.
My husband, an intelligent, strong, fit and mobile man, reported a sudden and rapidly-occurring memory loss to his GP within weeks of being persuaded to take Lipitor, and was vehemently told, “It can’t possibly be the drug; don’t stop taking the drug”, by his misinformed GP, who was obviously unaware of the originally fraudulent study that historically gave birth to the entire statin industry.
The tragedy – to my mind somewhat akin to slow murder – is not that it doesn’t prolong life, but that a disabling, debilitating nightmare of a life can then ensue for a decade or more. Whether or not one discontinues the statin, the widespread mental or physical harms have begun.
Even with current censorship on the Internet and an attempted silencing of free speech, there are a multiplicity of ethical and informed writers, researchers, scientists and medics (thank you Sebastian, you are not alone), who are doing their utmost to inform and prevent gross medical harms.
And to momentarily slide off-topic if I may, an example of the black-comedy aspect now is (as from yesterday’s news bulletins), that it may soon be deemed a criminal act to post, for example, anti-vax messages online. What else are we going to be told that we must not talk about!? Perhaps they would shoot us all at dawn – a neat way to avoid Covid.
Important information. As Ioannidis has remarked many years before “the greater the financial incentive the most likely the research is biased”. Can you imagine the financial incentive of a pandemic? Remdesivir administered to millions? Vaccines touted as the only remedy? I wonder when someone from Sweden will look with the same sharpness to the campaign against the early treatment of COVID-19, ignored in Sweden, in the face of real results from countries that use it: China, Cuba, Venezuela, Turkey, India besides isolated results from groups treated around the world, in Spain, Brazil, US, Portugal, etc.
Like the email but where the really long studies.this one was just a few years.hardly long term.Tim in U.K.ps Not being negative but what do arteries look like after years on statins.are they kept clear compared to not having them
Hi Tim,
True, but the biggest effect is usually seen at the beginning of treatment. Even if we assume a linear increase in benefit, you would still only get 30 days extra of life after 30 years of treatment.
As to your second point, studies have clearly shown that statins increase calcification of arteries. They don’t decrease it. This is uncontroversial.
Kindly cite your sources for those of us that are just learning about Statins. Thank you!
Thank you Dr. Rushworth.
Is your goal to have clear-appearing arteries or to live with a good quality of life?
The studies show that statins do not meaningfully extend lifespan, and further can have severe side effects that destroy quality of life. That is all that matters.
Dr. Marcia Angell in 2004:
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”
I take Atorvastatin,so this is stunning. But I’m left wondering how they worked out the -5 to 19 days. If the studies lasted up to six years, weren’t there lots of participants, both placebo and statins takers, who lived longer than the study? Could there be a clearer beneficial effect over a longer period?
Hi Allan,
Yes, most participants were still alive at the end of the studies, so the data were extrapolated from the survival curves. As I said, if we assume the benefit continues to grow in a linear fashion, then you would gain one extra day of life per year of treatment. However, in reality, most treatments show the strongest benefit at the beginning, and then the size of additional increases in benefit wanes with time, and it is more likely that statins follow this pattern.
This is odd. So people took statins because they want to live longer, but on the other hand we have a society that don’t respect older people anymore and send them to nursery homes as early as possible. And old nowadays means often that you just reached 50. So why should i live longer than ??
Not that I think the LDL-C is the clever level to pull, myself completely happy with my 385mg/dl of total cholesterol (because of HDL 101 and TG 92). But. As I pointed out to Dr. Kendrick, Dr. Demasi and Dr. Harcombe before, Kristensen et alter only estimate the average survival gain achieved by everybody on the treatment arm (dead or alive) within the trial’s running time. Yes, that means all survivors to placebo are contributing with the value ZERO to that average bringing it down. I explain it thoroughly here.
Hi, Sebastian. It’s been a pleasure to read your blog. Thanks god you don’t write it in swedish. Here in Brazil I try my best to explicite these things about conflict of interests and pharma influence over researches and physicians. The statins are a good example of this. Who would take for life a medicine that only brings 3 days more of life (and you spend much more days of your life taking it and working to pay for it). Not to mention the very small (for me) effect on all cause mortality in the meta-analysis on an individual basis. For me, the answer to this problem is to reduce the NNT and only prescribe statins for the people who really need it (high risk and secondary prevention). But it’s just my point of view and everyone should be free to have one. Keep on your great job!
Hi Sebastian
interested to see you apply your expertise to cardiovascular medicine!
The problem with this study is that the authors only assessed the survival benefit gained during the study itself – clearly nonsensical. The benefit per patient in this analysis is in fact somewhere between 0.8 and 3 years of life, on average. I think that’s quite good!
Just wondering why you didn’t explore this angle.
Best, Knox (the video artist)
Hi Knox,
Where do you get 0,8 to 3 years from?
Hi Sebastian
Before I tell you, can I ask if you think that would be a good outcome? Does that change your opinion on the use of statins in this setting?
Thanks!
Knox
Of course, if statins add a few years to life that is obviously much better than if they add a few days. I’m not inherently anti-statin, I’m pro-evidence.
Hmm. To be honest, reading a few of your articles – and I have found crucial errors in all your articles that I’ve read – I think you are more of a contrarian than pro-evidence.
What training in cardiology do you have to give the medical advice in your article? The evidence for statins is clear, the only debate is how low the level of risk a patient should have for starting statins for primary prevention.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31357-5/fulltext
Unfortunately the formatting of the web page prevents me from long answers – will follow up in another message.
I have the same training in cardiology that all medical doctors have. What training do you have?
The article you are linking to is not a study. It is not evidence, it is someone else’s interpretation of the evidence.
And as for finding errors, if you find something you think is an error you should share why you think that is the case. Maybe it will turn out that you’re the one making an error.
From the authors of the paper you cite:
“We can hardly disagree about the limitations pointed out by Dr Chang et al and by Roger Marshall. We emphasized in the discussion section that the postponements (or increment in restricted mean survival) calculated by us were restricted to the trials’ running time, usually in the order of 5 years. We fully agree – and have emphasized in our paper – that they do not answer the question on what would be the benefit from a lifelong statin treatment… If we applied a hazard ratio of 0.89 as we found in the meta-analysis of included trials, we arrived at 0.8 years’ postponement of death for lifelong statin users, starting at age 62. Chang arrived at 3.0 years for the LIPID trial.”
So – your post is way wide of the mark. Which patients do you think should take statins?
Hi Sebastian, is there anywhere in the studies where it talk about correlation between taking statins and reducing heart attacks?