I keep thinking that I’m missing something here. Some magical number that makes these drugs to lower cholesterol worth the hype.
I’ve read all the studies and I’ve seen the numbers, but I don’t read ALL of the medical literature that gets published on statins. So maybe I missed the one that showed that statins are worth all the hype and the new recommendations.
There has been much pushback on the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on reducing atherosclerotic cardiovascular disease risk. The arguments include conflict of interest (8/15 panelists had financial ties) and overzealous interpretation of the data. Here are the scenarios when moderate to high dose statins should be used:
- Anyone with low-density lipoprotein (LDL) cholesterol levels >190 mg/dL.
- Anyone from 40 to 75 years or age with type 1 or 2 diabetes.
- Anyone aged 40 to 75 years with LDL cholesterol levels between 70 and 189 mg/dL and 7.5% or higher estimated 10-year risk of atherosclerotic cardiovascular disease.
- Moderate-dose statin treatment in anyone with an estimated 10-year risk between 5% and 7.5%.
This pretty much covers everyone.
But this aren’t the problem. Or rather, the problems.
First, the queen of all twisting of the data has to do with cholesterol. If you remember how this all started years ago, it was all about total cholesterol. Everyone needed their total cholesterol checked so that we could see whether or not they needed drugs. The entire, laser-like focus on preventing heart disease kept total cholesterol in the crosshairs. We did this, spending mass amounts of money on “educating” doctors and patients that total cholesterol = heart disease = statins.
It got embedded deep. Really deep.
It was not until 10 years later that anyone asked whether lower total cholesterol with drugs was preventing heart attacks and deaths. Turns out they didn’t work really well. Actually, they sucked. So much that these new guidelines do not even take total cholesterol into account. Basically, the suggestions were that we don’t need to look at markers anymore, but we just treat for the sake of treating because the research shows that these drugs help to reduce deaths.
Which brings us to the second problem. They suck at preventing death.
And they did not hide this in the recommendations, as you can see in this review article on the subject. The numbers are given as “NNT,” or number needed to treat over 5 years to see a benefit. This number helps us to understand how many patients need to be treated to benefit a single patient. As an example, using steroids in an acute asthma attack will save 1 person from going to the hospital for every 8 treated, so a NNT of 8. This is considered pretty darn good. Acid blocking drugs in a bleeding stomach ulcer to prevent another episode of bleeding? 15. Probiotics for preventing C. diff infections? 25.
You get the idea.
So what about the use of statins? Here’s the numbers:
- Dying from all causes NNT 138
- Having a cardiac event NNT 49
- Dying from cardiac causes NNT 88
- Having a stroke NNT 155
- Developing diabetes NNT 98
The saddest part about all of this is that society and medicine has degenerated to the point where we are willing to accept a treatment that is so poor that we have to treat 88 people for 5 years to prevent a single death. And the costs to prevent that single heart attack are staggering (think about the costs of 5,280 months of statin drugs).
With these recommendations, we have given up on the hope that the American public can and will make the necessary lifestyle changes to protect their hearts and have instead leaned more heavily on the use of drugs for “prevention” of heart disease.
That is the saddest part of all of these recommendations.