Q. I’m a 69-year-old man and have taken statins for several years. I am healthy with no history of heart problems. My doctor blinds me withstatistics about the benefits of statins but I know there are also risks from taking them. Can you explain these in layman terms?
A. This is a common area of confusion. I asked campaigning cardiologist Dr. Aseem Malhotra, an expert in the prevention and treatment of heart disease, for his response…
‘Most doctors have been misinformed about statins: the true benefits have been exaggerated and the harms underplayed. Despite fear-mongering from scientists who take money from the drug companies, the overwhelming majority of patients do not receive any benefit from taking a statin.
‘There are two ways of presenting the benefit of a drug such as a statin for reducing the risk of a heart attack, stroke or death. Most doctors give your ‘relative risk’ of illness, which tends to exaggerate the benefits of the drug. You need to know your ‘absolute risk’ of illness plus the NNT (number needed to treat), i.e. how many people need to take the drug for one person to benefit. I always give my patients this figure. [See patient.info/health/ absolute-risk-and-relative-risk.]
‘For someone at low risk of cardiovascular disease, evidence shows that taking a statin daily for five years will not improve life expectancy by one day. Even with a slightly higher risk, the NNT gives you a one in 140 chance of preventing a non-fatal heart attack or stroke but it would not stop a related serious illness or give you a longer life. ‘You can estimate your risk of suffering a heart attack or stroke in the next ten years with QRISK (qrisk.org), a free online calculator, which uses factors including blood pressure, family history and the ratio of fats in your blood.
‘For patients who have established heart disease or have had a heart attack, the best case scenario is that the statin will prevent or delay a heart attack in one person for every 39 people taking the drug [NNT 39], and prevent or delay death in one in 83 [NNT 83]. The statin benefits are more likely due to its action as an anti-inflammatory [inflammation is the underlying cause of heart disease] than lowering cholesterol. Research shows high cholesterol is not a strong risk factor for a heart attack. In people over 60, there is no association between high cholesterol and heart disease. In fact, people with high cholesterol live longer. In my new book The Pioppi Diet I explain that we should stop fearing cholesterol and make it our friend: without it we die.
‘You also need to know the number needed to harm (NNH ). Up to one in 50 people will develop type 2 diabetes within a few years of taking a statin [see thennt.com]. Other side effects that affect up to 29 people in 100 are muscle pain and fatigue, also erectile dysfunction and memory impairment. These are reversible by stopping the drug or lowering the dose, but some patients suffer lifelong damage.’
EAT YOUR WAY TO A HEALTHY HEART
For people at risk of heart disease, a Mediterranean diet with a daily handful of nuts (almonds, walnuts and hazelnuts) or four tablespoons of extra virgin olive oil gives you a one in 61 chance of preventing a heart attack in five years. If you have had a heart attack, adopting a Mediterranean diet gives you a one in 30 chance of preventing death and a one in 18 of preventing an attack. I recommend Dr Malhotra’s book The Pioppi Diet, which examines the lifestyle of the Pioppi people in Italy who live long and healthy lives. The Pioppi Diet: A 21-Day Lifestyle Plan by Dr. Aseem Malhotra and Donal O’Neill is published by Penguin Books, price £8.99*.
NEXT WEEK: Dr Malhotra explains why cholesterol is good for you
Remember the old ‘Isabel who?’ knock-knock joke? The joker replies, ‘Is a bell necessary on a bicycle?’ The answer for urban walkers like me who are in daily danger of being mown down is a resounding ‘yes’. The Bike Bells in orange and olive by Orla Kiely have a satisfying warning ring and look super cute. £6 each/halfords.com.