Cholesterol-lowering statin drugs are among the most popular prescription drugs in the world. In addition to lowering cholesterol, they also lower the risk for heart attacks.
But as I report in my Well column for Tuesday’s Science Times, there is little, if any, data showing that statin drugs prolong life in the majority of people who take them.
Men who have already had a heart attack may have the most to gain from taking a statin, studies show. But the data are less clear for healthy men, for all types of women and for people over the age of 70. In study after study, statins lowered the risk for heart attacks, but there were no differences in death rates among statin users and those taking a placebo.
Statin supporters say it would take too many people and too many years to prove that statins confer a mortality benefit. Critics say there’s not enough evidence to support asking healthy people to take a daily pill and endure the side effects and cost of a drug that, ultimately, won’t help them live longer.
The question is, does it matter? Should we expect every drug to be lifesaving? Or is preventing a heart attack enough of a benefit to justify the widespread use of statins?
Read the full column here and then post your comments below. I look forward to hearing from you.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
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From 1 to 25 of 163 Comments
It is not a great drug! I have been on statins (the latest Crestor) for the past 10 years, they have not made significant changes in my colestetol levels, but they have caused major side effects, the worst being muscle weakness and pain in my legs. I cannot stand still for more than a couple of minutes before the pain is unbearable and I have to look for someplace to sit down. There are other side effects such as weight gain, memory loss, etc. I have recently gone ‘cold turkey’ off the statins, and my hope is that the damage done is not irreversable. See “TakingLipitorAndHateIt@yahoogroups.com
— Geofffor daily updates from others impacted by this ‘poison’.
We are so obsessed with drugs and pharmaceuticals. Why take a drug if it doesn’t help? Why not try to change your diet first? My mother never let us believe that we were “sick” when we were growing up, and never let us take medication (except when I got pneumonia) we never missed a day of school, and never took antibiotics. I honestly NEVER get sick. I might take an aspirin if I have a headache and have to be somewhere, maybe, once or twice a year.
I think Americans really need to toughen up. Running to take a pill for your problems is not going to help. Listening to what your body is telling you, “change your diet! and exercise more!” will help you. Treating the symptoms and not the source with medication will only make you sicker.
— MVThanks for the interesting column, Tara. Although the evidence is preliminary, there are articles in peer reviewed medical journals documenting that the anti inflammatory properties of statins may prove to be protective against Alzheimer’s Disease, rheumatic diseases (such as arthritis and lupus), other autoimmune diseases (like multiple sclerosis) and bone fractures. All of this evidence is preliminary and statins have not yet been approved for these indications. Nevertheless the statin story may yet prove to have additional twists and turns. Statins, like all medications, have side effects, but so do all drugs. Many people suffer from these side effects, but most don’t. If, and it’s a big if, statins don’t prove effective in prolonging life span, they may prove to be very valuable in reducing the morbidity of these other disorders. Only time will tell. My suggestion is that despite the strong feelings expressed by statin supporters and critics, objective people should keep their powder dry and wait for alot of additional research.
Ken
From TPP — I agree with you that there seems to be some real potential with statins that is not fully known or understood. But I think the problem is that often pharma cos and researchers jump ahead of the evidence. We have certainly seen that with menopause hormones — there was a time older women long past menopause were given hormones to protect their hearts, and they were also talking about the Alzheimer’s benefit of hormones. But the recent evidence has clearly shown that while hormones are a reasonable option for the treatment of symptoms in recently menopausal women, older women without symptoms should not initiate use of hormones. Vytorin is another example — widely prescribed and marketed but not backed by evidence. If statins can reduce the morbidity of the disorders you cite, that will be a great thing. But show me the evidence. THanks for bringing up an important point.
— KenThis makes things even more confusing, as it seems to imply that people with high cholesterol should perhaps wait and have the first heart attack, and hope they don’t die from it, before taking statins. This study left out what seems to me to be an important question: If a statin does prevent a heart attack, which may result in heart damage and weakness even if not in death, wouldn’t that still improve quality of life? This information should also be part of the decision on whether to take them.
— AnneThis comment is in response to Ken @3:
Ken says, “My suggestion is that despite the strong feelings expressed by statin supporters and critics, objective people should keep their powder dry and wait for alot of additional research.”
I agree with this comment, but while waiting don’t take statins unless there is a clear indication of need and benefit. Since when do we medicate before the evidence is in?
I also suggest that those who haven’t read it yet should read Taubes’article on cholesterol on the Sunday NYT op-ed page. It raises important questions regarding the entire cholesterol issue.
Science Editor
— Sci Edhttp://www.polijam.com
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The column cites a meta-analysis of statin studies, indicating a mortality relative risk reduction of 22 percent in the statin groups versus placebo. This is the percent decrease in mortality between statin groups(15.6 percent)and placebo(18.7 percent). I don’t think the math is correct.
However, the important point is that the absolute risk reduction is only 3.1 percentage points.
Relative risk reductions sound more impressive than absolute risk reductions. This is why they are used in pharmaceutical advertising.
Furthermore,the column quotes an expert stating that for every 28 patients receiving a statin, one life will be saved. Another way to put this is that if you are at high risk(the group to which the studies are applicable, you remain at high risk (although less so) if you take a statin. Nothing to write home about.
Small difference in mortality may translate into a large public health impact but only a minimal benefit to the individual patient.
This not to say that public health is not extremley important, only that the distinction should be made clear to patients when recommendations are made.
Finally, mortality is not necessarily the most important endpoint. I can think of a lot of outcomes that are worse than death: end-stage dementia, end-stage COPD, severe stroke, severe heart failure.
— Daniel PolowetzkyIn terms only of dollars, it would seem to me that preventing heart attacks is enough. Is it not wiser to have the relatively smaller cost of pills versus the immense cost incurred by emergency care, especially when it results in surgery and time in the Intensive Care Unit?
Not only that, is it not better a patients and his or her family’s quality of life and peace of mind not to have gone through the trauma of such and emergency event? Often such emotional trauma can have as great an effect on overall health and longevity as can have physiological events.
— AdrianaTPP-Hormone replacement therapy was based on observational evidence, which DID appear to show benefit. The problem was the TYPE of evidence. The Women’s Health Initiative data was based on a randomized controlled trial with about 8 years of follow up (one of the pivotal studies showing harm in hormone replacement therapy given to asymptomatic menopausal women for the purpose of disease prevention). Howcver, I suppose it is fair to say that they jumped ahead of the evidence.
— Daniel PolowetzkyIn response to science editor who says
“while waiting don’t take statins unless there is a clear indication of need and benefit. Since when do we medicate before the evidence is in?”
We do this when the current understanding strongly suggests that our theory is correct (albeit incomplete or not “proven”), one’s risk of developing the disease the medication is supposed to treat is fairly high, and the risk and costs are acceptable given the uncertainty.
We know enough about cholesterol and coronary artery disease (CAD) to be fairly certain, even if all the evidence is not in or conclusive at this point, that lower LDL means lower likelihood of symptomatic or fatal coronary artery disease. This has already been proven in the opinion of many. It is much harder to show decreased all-cause mortality. This is probably a statistical issue.
Of course if you are unlikely to ever have CAD then of course a statin will not decrease your risk of dying at an early age from CAD. But if both of your parents had CAD at a younger age and your risk profile (HTN, metabolic syndrome, low HDL, High LDL…) is worrisome, you would be nuts not to take a statin.
Sure some people have serious side effects, but millions have taken these drugs without any problem. For many of these people the potential benefit is huge even if not conclusively proven (yet) and the potential downside small.
— Howard MDI had a HA (resulting in three emergency stents) in February while on a 100 mile bicycle ride. I had low cloresterol, low blood pressure, low heart rate and was a very fit cycling athlete at 66 years. The muscle pain, lack of energy and vitality associated with Lipator was awful. I quit Lipator (without my wife’s knowledge) on Christmas day and now starting to feel decent again. I would rather have a decent life than continue with the statin.
— PatKen those are nothing more than wishful thinking popcorn studies that come out of statin pharma marketing departments. (But you knew that, right?)
Tiny three letter words like ‘may’ proliferate in those dung heaps.
Where do they come from? Happy ad sales people scatter press releases around the newsroom. Bored staffers rearrange them and presto, it’s a medical study. It must be. They put it in the Science section of the NYTimes, didn’t they?
— CarolAlas, in spite of all medical advances the mortality rate hovers at about 100%. If you don’t die of heart disease you die of somthing else, but hopefully as late in life as possible.
— Steven B Tamarin MDToo bad you’re not doing your homework. Primary prevention trials definitely show reduction of major events like heart attacks and strokes as well as actual deaths. For instance, look at the Heart Protection Study. This pooling of old data with metaanalysis is simply not adequate. Although you can quibble the apparent smallness of the effect–this is the essence of preventative therapy. Even saving one life out of 100 every 5 years add up to 6 lives out of 100 over a lifetime–that is a big number when you figure that cancer only kills 20 of out 100 people. Too bad even the New York Times has fallen prey to the general mistrust of the Healthcare profession. Instead of picking on statins, you might try figuring out whether any randomized outcomes-based studies has ever demonstrated a mortality benefit to exercise or weight loss. Even better, try applying the same level of proof you are demanding on breast-feeding. You’ll be surprised.
From TPP — I think you need to check your facts. The Heart Protection Study did show a mortality benefit, but it is not a primary prevention study. My story states clearly that there is a mortality benefit in secondary prevention (among those who already have established cardiovascular disease.) Here is a LINK to the Heart Protection Study which shows that it studied 20,536 UK adults (aged 40-80 years) with coronary disease, other occlusive arterial disease, or diabetes. If you have a citation on a true primary prevention study that shows all-cause mortality benefit, I’d like to see it. I do know that the body of evidence, as indicated by the 2006 Archives of Internal Medicine study linked to in the original column, shows that there is no mortality benefit for middle aged men in primary prevention. And there is clearly no mortality benefit for women in either primary or secondary prevention.
— longjohnsThis is in response to Anne @4
If statins do decrease heart attacks but then cause the patient to die from hemorrhagic stroke from low cholesterol levels, then would you say that patients are better off taking statins? Gary Taubes’ book “Good calories Bad Calories” mentions that in 1986, just 1 year after NIH launched the National Cholesterol Education Program advising low-fat diets for everyone over 2 years old, epidemiologist David Jacobs of the University of Minnesota, Twin Cities, visited Japan. There he learned that Japanese physicians were advising patients to raise their cholesterol levels, because low cholesterol levels were linked to hemorrhagic stroke. At the time, Japanese men were dying from stroke almost as frequently as American men were succumbing to heart disease. Back in Minnesota, Jacobs looked for this low-cholesterol-stroke relationship in the MRFIT data and found it there, too. Also, men with very low cholesterol levels seemed prone to premature death; below 160 milligrams per deciliter (mg/dl), the lower the cholesterol level, the shorter the life.
— Occam’s RazorI have taken zocor and zetia. With each drug I had muscle spasms and weakness in my legs and back. Because of these side effects, I had to curtail my exercise. I even bought a cane because if I got to the ground for any reason I couldn’t get up without help.
Meanwhile because I was taking medication I didn’t pay that much attention to my diet. I know, I know, they don’t absolve one from doing so, I just didn’t. So I went from an LDL of 103 to an LDL of 180 in a year. I was put on the first statin because the 103 was too high. I don’t know where they get these figures, but 103 has to be better than being a cripple.
Now I’m off both drugs and eating carefully and slowly starting back to exercise. But I still keep the cane in the back of my car because I’m not back to normal yet.
— Leprechan KidAs one who comes from a family with lots of plaque-related heart problems, I suspect I should have been on statins far sooner. Maybe I would have mitigated my most pressing current health problems.
— Barnegat LeightIt is said that plaque flourishes from cholesterol.
Take away one, avoid the other.
So, if we found a drug that absolutely prevented cancer, and then we did a 4-year study with 1000 young patients and found no mortality benefit, should we not use it? Or is it a bad study with patients not at high enough cancer risk, so that 1000 patients followed for 4 years don’t show a statistically significant reduction in cancer?
From TPP — You make an excellent point that speaks to how difficult it is to assess the value of drugs used for prevention. It generally takes a long time to show benefit. Drugs that treat cancer are easier to prove because cancer acts quickly. You would see obvious trends in four years. But say we believe a drug prevents cancer, and in a four year study it showed a far lower rate of cancer diagnosis, but no difference in mortality at the end. It seems like a great drug though right. What if that study lasted for 10 years, and found patients were far less likely to die of cancer, but heart failure rates shot up? We would no longer think that the drug was lifesaving. This is the fundamental question with statins. Are we not seeing a mortality benefit simply because statin trials haven’t lasted long enough? Or is that people who take statins eventually develop other problems, and that the heart protection benefit is canceled out by other changes, so in the end, everyone dies at the same rate? We don’t know the answer to this question.
— frank chathamI have no financial interest in statins. Most of the studies showing a benefit from statins are gold-standard: prospective, randomized double-blind, placebo-controlled, with intent-to-treat statistical analysis.
These studies are therefore more believable than most of the studies showing no morbidity and mortality benefit. These latter studies are mostly retrospective and observational in design, and therefore not as reliable.
FROM TPP — True that RCT’s can give you the most specific answers. But “these studies,” the randomized, double-blind placebo-controlled trilas with intent-to-treat statistical analysis to which you refer, don’t show an all-cause mortality benefit either, at least not for primary prevention, for women or for people over 70. In fact, the Prosper study shows a statistically significant 25% increase in cancer among elderly statin users. Should we just take that at face value because it was shown in an RCT? The medical community has dismissed that finding based on further meta-analysis, because the trend hasn’t shown up in any other study. So the studies that you cite as “most believable” paint an even worse picture. If the trials had shown a mortality benefit or come close, the pooling of data would create a big enough group to find out if sample size is the problem. I’m interested in hearing your further thoughts on this.
— jackI am 71 years old. Six years ago I had a physical exam, the first in many years. The results were disturbing — a long list of risks including high cholesterol; high blood pressure; a spot on a kidney thought to be a cyst but maybe a tumor; high PDF and prostate cancer risk; no colonoscopy for 30 years. I gave myself up for dead. The signs on the old highway were right: “The end is near.” “Prepare to meet God.” Six months was all I wanted but I expected less. But I am still here, six years later. Since that phusical exam numerous research has disproved old ideas. And now we have the cholesterol controversary. If we wait long enough everything will be disproved. For myself, it is surely possible that one of the above named risks will do me in. Or maybe I will get run over by a car today. Nobody knows for sure about anything in the medical business (except the drug companies need to keep producing new pills to sell to a willing public). Medicine is more of an art than a science. For now I will just keep walking 4 to 5 miles a day, try to keep a good diet and my weight normal. keep stress out of my life and enjoy the good health that I have. If it doesn’t result in a longer, healthier life, I’m happy with the pill-free 71 years I’ve had — especially the good health.
— George YAt cholesterol levels below 160mg/dl (4.2mmol/l) overall mortality is higher than at any other level. In short, a low cholesterol level is associated with the highest mortality rate in both men and women - at all ages. This is a finding that has been confirmed in all studies done so far - and never contradicted by any study. In the Framingham study (longest observational study in the area of heart disease) a falling cholesterol level was the most significant factor for increased risk of heart disease. A 20% fall in the first 14 years of the study was associated with a 534% increased risk during the next 18 years. It was also associate with a 400% increased risk of death from any cause (overall mortality)
In Japan, in the last fifty years the average cholesterol level has increased 25%, the rate of heart disease has fallen 60% and the rate of stroke has fallen to 1/7th that in 1960. Mainly due to a decrease in haemorrhagic stroke.
No primary prevention study on statins has shown any benefit on overall mortality (men or women). And it is not because the studies are too short, or too small. There is now considerably more than 500,000 treatment years of data in this area which is far more than for any other class of drugs - ever. Indeed there is any effect, it is towards increased, not decreased, mortality (in primary prevention).
The facts go on and on. And I can quote hundreds upon hundreds of them. All of which completely contradict the cholesterol hypothesis. These facts can all be found in peer-reviewed mainstream medical journals. How on Earth the cholesterol hypothesis can still exist is almost beyond me. It stands as the perfect testiment to the observation that ‘It is the art of self-deception that we practice the greatest invention.’ Plus the fact that a multi-billion dollar industry rests on it - of course.
From TPP — Thanks for taking time to comment Dr. Kendrick. Dr. Kendrick is the author of the book The Great Cholesterol Con. The British Medical Journal recently published a head-to-head debate between Dr. Kendrick and Dr. Scott Grundy, of the University of Texas Southwestern Medical Center in Dallas, asking whether women should be prescribed statin therapy. Dr. Kendrick argued against the practice. The BMJ debate can be found HERE.
— Malcolm KendrickMy doc suggested I (age 58) take statins based on my slightly high cholesterol numbers .
I resisted. I was skeptical. The thought of taking pills the rest of my life sounded offensive…and…the doctor never asked about my family history. With 2 siblings on my father’s side (now 88) and 10 on my mother’s side (died of lung cancer 20 years ago) there was a lot of history. None died of a heart condition.
After a year or so of urging he finally had me go for a carotid artery scan to see if there was any plaque in the artery. I asked the technician if she was able to measure the thickness of a plaque deposit. She replied, “yes.” I asked how thick it was. She said, “what plaque.”
Are docs so deep in the drug industry forest that they can’t see the trees?
— Bill PStatins survival benefits might be in question because high LDL is not the only risk factor for heart disease. Therefore the solution might be to check for other known risk factors such as lipoprotein A, homocystein etc. and correct as needed to prolong life.
— Sergey Kalitenko, MDcomplications of “impotence” now too!(another push for viagra?).
why not also trumpet “terrorism” to deter use.
cardiologists have advocated putting statins in the drinking water for years.
at $7 a generic prescription - just do it!
jqmd
— jquellman mdFrom TPP — Click here for a link to a review article on statins and erectile dysfunction.
I have resisted statins and opted to use niacin, per Kowalski’s “8 Week Cure” It’s cheap and effective, but also frustrating as there are no studies comparing this method’s effectiveness with statins. I’m sure its because drug companies are making so much money on statins, they don’t want people going for the cheaper niacin.
— Mollie SimonsHelp please! Here are my numbers 184 total triglycerides
— Cara219 total cholesterol, hdl 63, ldl 119. Faithfully taking Tricor for over a year, was “holiday eating” now on a low fat, high fiber, low carb diet with exercise walking 1-2 miles daily. Two weeks before my labs during the holidays I was running 1 and 1/2 miles and walking 1/2 every other day, but eating badly. Have cut out red meat since 11/18/07 also. Dad had 2 heart attacks age 59, mom had a silent heart attack in her mid sixties (also has enlarged heart). I am 41 years of age minimal fat around mid section, non smoker and I want to be off statins! Any suggestions? Also taking niacin, multivitiman and lots of fish oil. I truly appreciate any suggestions.