Last year, the United States Preventive Services Task Force (USPSTF) published its latest statin guidelines in JAMA (Aug. 23/30, 2022). The statin bandwagon has gathered speed, but the data leave a lot to be desired. I think you might be shocked to learn that the medical world has embraced statin-type cholesterol-lowering medication with such enthusiasm, given the surprisingly slight benefits described by USPSTF. First, though, let’s consider how this policy affects individuals. We heard from a reader with an alarming story.
Prescriptions as a Birthday Present:
Q. When I turned 65, my doctor prescribed a blood pressure pill and a statin. I asked why, and the answer was “happy birthday!” What? Just because of my age, drugs are automatic?
My blood work results prior to starting the meds were one point above the optimal range on cholesterol, and 2 points over on the lower blood pressure number. In my book, I was normal.
Not long after starting the drugs, I started losing muscle and my legs became weak. Then every morning after urinating I would be doubled over with pain.
It puzzled me that I was on a combination blood pressure medicine that contained a diuretic, even though I was not retaining fluids. I saw a new doctor who changed the meds.
I also began drinking hibiscus tea. My blood pressure is better than ever. Why should a birthday mean you have to start prescription medications?
A. The American Heart Association and the American College of Cardiology have established an algorithm to determine cardiovascular risk. Age is a key part of that calculation. Even men who have good numbers for cholesterol and blood pressure may qualify for a statin as they become older. We agree with you that age should not automatically trigger a prescription.
Your symptoms concern us, though. Muscle weakness and abdominal pain could be a signal for muscle breakdown related to a statin. That condition has a fancy name, rhabdomyolysis, which is just as scary as it sounds. Please ask your doctor to check your kidney function.
You may find helpful information in our eGuides to Blood Pressure Solutions and Cholesterol Control and Heart Health. There is evidence that hibiscus tea may help lower blood pressure, working through the same mechanism as some popular medications.
What Is the USPSTF and Why Should We Care?
The United States Preventive Services Task Force (USPSTF) describes itself as:
“…an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services.”
On August 23, 2022, the USPSTF issued this bulletin:
“Task Force Issues Final Recommendation Statement on Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
People 40 to 75 at high risk for CVD should take a statin; people 40 to 75 at increased risk should decide with their healthcare professional whether to take a statin”
The Bottom Line from the Task Force:
“Statins effectively and safely prevent first heart attacks and strokes for some people.”
The average person reading that statement would believe that if he or she were to take a statin, it would “prevent a first heart attack and/or a stroke.” The kicker in the sentence is “for some people.” I will get to that in a moment. It is really important and goes to the heart of our concerns about statins.
How many people will actually avoid a heart attack or stroke if they take a statin for primary prevention? And how many people will have their lives extended by taking statins? To me, those are the critical questions! Read on to find out.
What Is Primary Prevention?
These are people who have not had a heart attack or been diagnosed with heart disease. They may have “risk factors” such as high blood pressure or elevated cholesterol levels. But these are people have not had a cardiovascular “event.”
The Media Fuels the Statin Bandwagon:
Most science and medical writers never bother to actually look at the data published in journal articles. Even if they did, would they understand what it means? Journalists generally read the abstract and possibly the conclusions and figure their jobs are done. That is insufficient!
Headlines from the USPSTF Bulletin:
“Task force reaffirms guidance for statin use”
“USPSTF Recommends Statins for Primary Prevention of CVD in Adults”
“’Conservative’ USPSTF Primary Prevention Statin Guidance Finalized”
“Statins needed for those at high risk of heart attack, stroke, expert panel reiterates”
Digging into the Data Fueling the Statin Bandwagon:
Based on 26 studies of statins, the USPSTF concluded that people taking statins have a slightly lower chance of dying prematurely. It recommends that doctors prescribe statins to healthy people between 40 and 75 years old if they have at least one risk factor and their chance of developing cardiovascular disease [CVD] over the next 10 years is 10% or greater (JAMA, Aug. 23/30, 2022).
Despite this recommendation, there was no statistically significant reduction in death from heart disease among study subjects taking statins. Please read that sentence again.
After reviewing all the best data over the last several decades, the experts at the USPSTF report that:
“The estimate for the association with cardiovascular mortality was not statistically significant.”
In other words, statins did not prevent deaths from heart attacks. That was after looking at data from 12 trials involving 75,138 patients. The number needed to treat (NNT) was 769. In other words, one person out of 769 might not have died from a heart attack if he took a statin for several years. But that stat is unreliable, as it was not statistically significant.
Do you not find that information amazing? I do. Statins are billed as life savers. I have heard from people who were fired by their doctors because they did not want to take a statin. Their doctors believed that they were on a suicide mission if they would not take a statin. And yet the USPSTF readily admits that statins do not prevent deaths from heart attacks.
What About Heart Attacks Themselves?
There is data to suggest that statins can prevent heart attacks. The critical question is how many?
As you read above, the USPSTF states:
“Statins effectively and safely prevent first heart attacks and strokes for some people.”
So, how many heart attacks are prevented?
According to the data published in JAMA:
“fatal or nonfatal MI (12 trials, n = 75,401; RR, 0.67 [95%CI, 0.60 to 0.75] at 2-6 years; I2 = 14%; ARD, −0.85% [95% CI, −1.21% to−0.47%]; NNT, 118”
OK, I admit that all that statistical information is hard to interpret. Here is the bottom line. The number crunchers looked at 12 trials involving 75,401 patients. To prevent one heart attack (MI aka myocardial infarction), 118 people needed to take a statin for several years.
Cardiologists think that is terrific. Maybe so. But I wonder about the 117 people who get no heart attack prevention benefit.
When the USPSTF states, “Statins effectively and safely prevent first heart attacks and strokes for some people,” we wish they would tell readers precisely what they mean by “effectively” and “some people.”
Another Voice on the Statin Bandwagon:
Lest you think I am blowing smoke, here is what Dr. John Abramson and his colleagues report after reviewing statin data. This analysis is published in his book Sickening: How Big Pharma Broke American Health Care And How We Can Repair It. You can listen to our interview with Dr. Abramson at this link.
He asked the question:
“Does statin therapy provide a net benefit for people at low risk of cardiovascular disease?”
“Our [Dr. Abramson & co-authors’] findings, published in the British Medical Journal in October, 2013 showed that statin therapy provides very little or no net benefit in this population:
• no significant reduction in mortality (the overall risk of death)
• small (though statistically significant) reduction in the risk of nonfatal heart attack and stroke – 140 people with low risk (less than 20 percent fiver-year risk) must take a statin for five years to prevent one nonfatal event (NNT = 140)
• no reduction in serious adverse events (events serious enough to cause hospitalization overall”
USPSTF Position on Statin Side Effects
These experts maintain that statins are unlikely to cause serious side effects such as diabetes or muscle pain (JAMA, Aug. 23/30, 2022). They base this judgment on the data reported from clinical trials.
The panel members concluded that there is not enough evidence to determine whether statins are helpful for people over 75. The same is true for younger adults whose ten-year risk for cardiovascular disease is under 10 percent. Doctors are urged to use their best judgment in such cases.
Controversy About the Statin Bandwagon:
The recommendations from the US Preventive Services Task Force generated some controversy within the medical community. There were four editorials accompanying the publication in the JAMA family of journals.
One cardiologist expressed her disappointment that the recommendations were not more aggressive. She would like to see statins used earlier and for patients at lower risk (JAMA, Aug. 23/30, 2022).
Another group of doctors also expressed disappointment in the recommendations, but for completely different reasons. They point out that statins do not reduce deaths from cardiovascular causes. In addition, they say, the task force recommendations overlook the differences between men and women, with women getting less benefit.
Moreover, they worry that the conclusion that statins have no significant adverse reactions is at odds with their clinical experience. Many patients in their practices report side effects associated with these drugs. In particular, they cite an observational study in which 10% of people taking statins reported muscle pain. They recommend more emphasis on helping communities facilitate healthy eating, physical activity and beneficial social interactions (JAMA, Aug. 23/30, 2022)
What Is Your Position on the Statin Bandwagon?
We would love to hear from you. Please remember that this discussion is only about “primary prevention.” These are people who have not had a cardiovascular event or been diagnosed with heart disease.
Have you taken statins? Did you avoid side effects or did you experience an adverse reaction. Please share your story in the comment section below. If you think this article is worth sharing, please send it to friends and/or family. Just scroll to the top of the page and click on the icons for email, Facebook or Twitter. And if you think our free newsletter is important, please encourage your contacts to sign up. Here is a link. Thank you for supporting our independent voice.