Tag Archives: absolute risk reduction

Are You Sabotaging Your Heart With Statin Drugs?

No, you are not “sabotaging” your heart with statin drugs. Neither are you “wrecking” your heart.

But that title probably got your attention if you are taking a statin drug and thought that it was helping your heart.

Typical appearance of Newsmax Health. Note that  the offer to assess cardiac risk is a self-serving promo of the book on natural cardiac cures written by the author of the article on the left which summarizes only the negatives of bypass surgery
Typical appearance of Newsmax Health. Note that the offer to assess cardiac risk is a self-serving promo of the book on natural cardiac cures, written by the author of the article on the left, which summarizes only the negatives of bypass surgery

This question is prominently displayed on the Health portion of a news website called Newsmax, that somehow interrupted my web surfing today. If you click on the banner, you will get to listen to the words of Dr. David Brownstein, “America’s most popular family physician.”

Dr. Brownstein, in my opinion, should more properly be termed “one of America’s most popular quacks, charlatans and purveyors of misinformation in order to market useless junk.”

What Brownstein says can be found on multiple similar sites across the internet which are promoting “alternative” or “natural” approaches to high cholesterol.

His claims can be summarized as follows:

  • statin drugs do nothing to protect you from heart attacks
  • statin drugs “weaken your heart,” muscles, cause fatigue and lower your sex drive, damage your kidneys and liver
  • statin drugs prevent the formation of cholesterol which is essential for brain, sex hormone and vitamin D production
  • 1/2 of people with heart attacks have normal cholesterol levels
  • CHF is increasing in frequency and it is related to an increase in statins and consumption of sugar and refined carbohydrates
  • Big pharma has perpetrated the biggest fraud in medical history on the American public by brainwashing doctors, beginning in medical school, to prescribe statin drugs

These claims resonate with patients who are reluctant to take medications and who feel that “natural” approaches to prevention and treatment are superior.

Brownstein uses a combination of alarmist rhetoric and pseudoscientific jargon that appeals to those seeking alternatives.

Let’s look at his claims.

Do Statins Prevent heart Attacks?

Statins unequivocally prevent heart attacks in patients who have had heart attacks or have evidence of advanced vascular disease due to atherosclerosis. This is called secondary prevention and there are almost no cardiologists/scientists with any credibility who dispute the value of statins in secondary prevention.

The only specific study that Brownstein cites is the ASCOT-LLA study, published in 2003 which looked at ten thousand patients with hypertension, no heart disease and low or normal cholesterol levels, half of whom got 10 mg of atorvastatin and half a placebo.

This was a primary prevention study and showed such a benefit of the atorvastatin on reducing heart attack and coronary deaths that the study was stopped early, at 3.3 years at which time 154 patients receiving placebo versus 100 receiving atorvastatin had had heart attacks or died from coronary disease.

This was a highly significant reduction in events. There are several ways to look at this data and present it to patients; Brownstein implies that “Big pharma” presented the most favorable way, which is that there was a 36% reduction in relative risk.

The absolute risk of an event in the atorvastatin group was 1.7% (2.7% in the placebo group), so the absolute risk reduction was from 2.7% down to 1.7% or 1%.

To help better understand the data, we can also look at the number needed to treat (NNT). The NNT is the inverse of the absolute risk reduction. So for the ASCOT trial, the absolute risk reduction was 1%. 1 divided by 1% is 100 — 100 people would need to be treated with atorvastatin (the generic of Lipitor) over the study period to prevent one heart attack. (For more discussion on the NNT check out this blog post and this paper on its limitations)

lipitorUnderstandably, Pfizer, the makers of atorvastatin, prominently displayed the 36% relative risk reduction in their direct to consumer marketing campaigns (featuring Dr.Robert Jarvik (proclaiming himself a doctor in direct to consumer videos), although he was never a licensed physician (see here for interesting discussion on the controversy that ensued)).

Until, the FDA compels them to do otherwise, big pharma will project their products in the most favorable light possible.

However, it is debatable whether presenting data to patients using absolute risk reductions or NNT info plus relative risk reductions results in better choices. As Mcalister has pointed out:

“For example, many British patients with atrial fibrillation who were likely to benefit from anticoagulant therapy because of their risk profiles and their similarity to the participants in randomized trials supporting the efficacy of warfarin declined warfarin therapy when presented with the data about their absolute risks and benefits.”

ASCOT really makes a strong case for taking a statin drug to prevent heart attacks, even in those with normal or low cholesterol levels, not the opposite, as Brownstein has implied.

Do Statin Drugs “Weaken” The Heart Muscle Or Cause Heart Failure?

After criticizing the now infamous “Seven Nations Study” of Ancel Keys, which found high fat consumption in countries with high rates of heart attacks, Brownstein trots out the weakest imaginable argument for statins causing heart failure: heart failure has increased in the last decades, statin use has increased, therefore statins are causing heart failure. 

Correlation does not equal causation!

There is no compelling evidence that statins cause heart failure or weaken heart muscle.

In fact, a recent review of heart failure and statins concluded that statins, while not reducing mortality in heart failure, do have favorable effects on reducing the rate of hospitalization for heart failure and increasing the strength of the heart muscle.

Statins may not be as beneficial in patients with heart failure, but they definitely don’t cause heart failure.

Much of the misinformation about heart failure and statins arises from sites like Life Extension, which promotes sales of its own preferred brand of vitamin CoQ10, ubiquinol. (According to their website, though, this is for altruistic reasons: “We at the Life Extension Foundation take a different view. Keeping our members in a youthful state of longevity is the most efficient way of maintaining the revenue stream we need to fund our scientific research projects. We had no problem reducing our margins to provide members with the clearly superior ubiquinol form of CoQ10.”)

As is typical for this slick organization (see my previous post here), the writing has the veneer of science but is all pseudoscience with references that are outdated, irrelevant or meaningless.

Statin Side Effects

I’ve written about statin side effects and the decision to take them based on analysis of risks and benefits here and here.
By far, the most common thing we see is myalgia, aching of the muscles, and this is reversible.
The bottom line is that the benefits of statins far outweigh the risks if you are at very high risk for heart attack and stroke.  The risks outweigh the benefits if you are at very low risk.
For those in the middle, I advocate a search for subclinical atherosclerosis either by vascular screening or coronary calcium detection.

Misinformation and Scare Tactics on the Internet

Brownstone is not the only purveyor of dangerous misinformation on Newsmax’s Health website. There seems to be a concerted effort to promote quacks and charlatans and any information on this website is suspect.

A good rule of thumb if you are searching for credible health information on the web:

Avoid sites that use scare tactics and inflammatory rhetoric to induce you to stop your prescription medication and buy a health newsletter or nutraceutical.

By the way, Big Pharma has not brainwashed me.

I have no ties to industry.

I stopped taking any pharma food or money years ago.

Listen all y’all, it’s not a sabotage!

-Boyishly yours,