Do statins only work for half of patients?

A packet of statins

Research has found that after two years of taking statins, around half of patients hadn’t met the target for lowering cholesterol. But does that mean statins don’t work? We look behind the headlines.  

16 April 2019

Half of people taking statins don’t get the intended reduction in cholesterol after two years, a new study has found.

NHS guidelines set a target for statins to reduce patients’ LDL (bad) cholesterol by 40 per cent or more within two years of starting treatment. The study looked at how often this target was being met, and whether patients went on to develop heart and circulatory diseases, such as heart attacks or stroke.

The research

Researchers at the University of Nottingham analysed information from over 165,000 NHS patients in the UK who started statin treatment between 2009 and 2016. These patients did not have heart or circulatory disease but were prescribed statins to reduce their risk of developing it in the future.

They found that in half of patients (51.2%), LDL cholesterol levels dropped less than the NHS target of 40 per cent after two years. After an average follow-up period of six years, patients who hadn’t met the two-year reduction target were 22 per cent more likely to develop heart or circulatory disease than those who had achieved a reduction of 40 per cent or more.

They found that in half of patients (51.2%), LDL cholesterol levels dropped less than the NHS target of 40 per cent after two years.

The researchers concluded that it is important to understand why such a high proportion of patients aren’t getting the desired outcome from statins. They suggest that it may be because treatment isn’t being personalised enough, and that doctors should make sure they are prescribing the appropriate medication at the right dose to lower cholesterol to healthy levels. It’s also possible that some people who didn’t get the intended benefit from statins weren’t actually taking their statins as prescribed. 

The study found that patients whose cholesterol was reduced by the 40% target had higher cholesterol levels on average before the treatment than those whose cholesterol was reduced by a smaller amount. It may be that these patients were identified as higher risk so may have been prescribed higher intensity statins. They may also have been more motivated to take their medication as prescribed due to their higher risk.

The BHF view

Professor Metin Avkiran, Associate Medical Director at the British Heart Foundation, said:

If you have been prescribed statins, you should continue to take them regularly, as prescribed.

Professor Metin Avkiran, Associate Medical Director at the BHF

"Statins are an important and proven treatment for lowering cholesterol and reducing the risk of a potentially fatal heart attack or stroke. Although this study suggests that not everyone who is prescribed statins manages to reduce their cholesterol sufficiently, it doesn’t explain why. It may be that these people have been prescribed low dose or low potency statins, that they are not taking the medication as prescribed, or that they are not responding well to the type of statins that they have been prescribed.

“If you have been prescribed statins, you should continue to take them regularly, as prescribed. If you have any concerns you should discuss your medication with your GP. There are now other drugs available to help lower cholesterol levels, and it may be that another type of medication will be an effective addition or alternative for you."

How good was the research?

This was an observational study, meaning that researchers collected information about people’s statin prescriptions, cholesterol test results, and health outcomes, rather than asking people to take statins as part of a controlled trial. This means that the study can only find associations between the factors it observed – it can’t prove a cause and effect.

It’s possible, for instance, that people who did not have healthy cholesterol levels after two years of taking statins already had a higher risk of heart disease due to other unknown factors. While the researchers did take into account factors that affect heart disease risk, this information wasn’t available for all patients. For example, in most cases the researchers didn’t know whether those studied were smokers or not.

Other research has found that the effectiveness of statins in lowering cholesterol is related to whether people take their treatment every day as prescribed and the dose and type of statin they are prescribed in the first place.

How the research was reported

Newspapers were quick to conclude that statins ‘don’t work’ for half of patients, calling into question the effectiveness of these drugs which have been proven to lower cholesterol and reduce the risk of heart disease and stroke.

The BBC’s headline stated, “Statins 'don't work well for one in two people'”, while the Mirror warned, “Statins are not effective at lowering cholesterol levels for half of patients.”

This coverage sends a dangerous message to patients that statins might not be effective

A Daily Mail article began: “Half of people prescribed statins are left at high risk of heart disease because the pills fail to lower their cholesterol, a major study suggests.” It also claimed, “They found the cheap pills had no significant impact for 49% of the patients.” This is not correct: half of patients did not meet the target of reducing cholesterol by 40 per cent, but their LDL cholesterol level did go down (from an average of 3.8 mmol/L before starting statins to 3.1 mmol/L after two years).

This coverage sends a dangerous message to patients that statins might not be effective, running the risk of discouraging people from taking their life-saving medication. But the study itself said that likely reasons for the healthy cholesterol target being missed in half of patients include people not taking their medication as prescribed, or being prescribed an inadequate dose in the first place.

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, summed up the problem: "There are complex reasons why patients choose not to take their prescribed medication, and mixed messaging around statins could be one of these." 

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