Are statins really of little benefit to healthy people?

The study summarises previous research from the same authors, looking at people in Ireland who are eligible to take statins.

That research found that based on current guidelines, for every 400 people prescribed statins, one of them will avoid a heart attack or other serious event. Europe-wide guidelines on prescribing statins have changed in recent decades so that more people are now eligible for statins that in the past.

The current guidance is that people should be recommended statins if they are considered to have a 10 per cent or greater risk of developing heart or circulatory disease within the next 10 years (or for anyone with type 1 or 2 diabetes). The previous guidance was that the risk threshold should be at least 20 per cent developing heart or circulatory disease within the next 10 years. It was estimated that in the UK, this change meant that additional 4.5 million people could be eligible for statins.

The article has been widely reported as “doling out statins may be harmful to the healthy”, but that isn’t demonstrated by the study.

Other major studies such as the West of Scotland Coronary Prevention Study have previously shown that taking statins in line with guidance does reduce death rates and rates of heart and circulatory disease amongst people who don’t already have heart and circulatory disease.

The authors' main conclusion was that greater awareness of the gaps in the evidence could help doctors and patients make more informed decisions together. Their previously published systematic review of randomised trials for prevention of cardiovascular disease in people at low risk noted that the absolute benefit or risk depends on each person's own health and risk factors.

They recommend that people being offered statins should be given more information about their individual chances of benefiting from the drugs, and of possible side effects, such as muscle and joint pain.

The authors' original research was led by scientists at the National University of Ireland Galway, and was published in the British Medical Journal.

How the study was reported

Newspapers were eager to declare that giving statins to people with a low risk of heart disease could do more harm than good.

The Sun reported that ‘giving statins to healthy people is a waste of cash’, and The Express’s headline read ‘Statins may be harmful to the healthy, warn experts’. The Times claimed that ‘doling out statins may be harming healthy people’.

These claims are not supported by the study. The study highlights a gap in our understanding of how much effect statins have on people at low risk of heart disease. It does not provide any evidence to suggest that prescribing statins is definitely wrong for people at this low risk.

Most news outlets also reported an example from the study of a woman with a 1.4% risk of developing heart disease in the next 10 years, saying she would get only a tiny benefit from statins.

But this is not a particularly useful or relevant example. Someone with this level of risk would not be offered statins on the NHS, as her risk is well below the 10% baseline set out in guidelines.

The BHF view

Professor Metin Avkiran, associate medical director at the British Heart Foundation, said: "The evidence from numerous independent clinical trials going back more than two decades shows that statins are an effective way of people reducing their risk of a heart attack.

The evidence from numerous independent clinical trials...shows that statins are an effective way of people reducing their risk of a heart attack.
Professor Metin Avkiran

"We already know that the benefits are even greater for people who have already had a heart attack or stroke.

"An important area of debate here relates to the magnitude of benefit provided by statin treatment in people who are at relatively low risk and whether that benefit outweighs the risk of side effects.

"People who fall into this category should arrive at a decision together with their GPs."