A major review suggests the benefits of statins have been underestimated and their potential harms exaggerated, due to failings in acknowledging the evidence from randomised trials and the limitations of other types of studies.
The review, led by BHF Professor Sir Rory Collins and involving other world-leading cardiovascular researchers including BHF Professor John Danesh, is intended to help doctors, people with heart disease and the wider public make informed choices on the use of statins.
The authors, whose work was published in The Lancet, have reviewed over 30 years of evidence from research on statins with the intention of explaining how the available evidence on the effectiveness and safety of statin therapy should be interpreted.
When is a side effect not a side effect? Read our Medical Director's blog on the new review.
The benefits of statins
Statins are the most commonly prescribed medicines in the UK. They work to lower the level of cholesterol in your blood. High levels of ‘bad cholesterol’ in your blood can lead to fatty deposits building up in your arteries. This can increase your risk of developing cardiovascular disease, which includes conditions such as coronary heart disease (leading to angina and heart attack) and stroke.
Our Heart Matters team consider the key questions on statins.
The review concluded that lowering cholesterol by 2 mmol/L with an effective low-cost statin therapy for five years in 10,000 patients would prevent major cardiovascular events, such as heart attacks or strokes, in 1000 people with pre-existing cardiovascular disease. This is known as secondary prevention.
For primary prevention, where people are at increased risk because they have cardiovascular disease risk factors, such as diabetes or high blood pressure, the researchers found that lowering cholesterol by 2mmol/L for five years in 10,000 patients would prevent major events in 500 people. As well as saving lives, preventing heart attacks and strokes can help prevent the life-changing disabilities caused by these conditions.
Exaggerated side effects
Professor Collins and his colleagues felt the potential harms of statins had been exaggerated after reviewing the evidence. They found that by lowering cholesterol as described above in 10,000 patients can cause five cases of myopathy (one of which might progress to the more severe condition of rhabdomyolysis, if the statin is not stopped), five to ten haemorrhagic strokes, 50-100 new cases of diabetes and up to 50-100 cases of symptomatic adverse events (such as muscle pain).
These levels of side effects were found to be significantly outnumbered by the amount of deadly or disabling cardiovascular events that are prevented.
The shock of Ali's brother having a heart attack in his thirties led him to speak with his GP. Test results showed Ali had a high blood cholesterol level so was prescribed statins. Read about Ali's experience of statins.
Discuss any concerns with your GP
Commenting on the review's findings, our Associate Medical Director, Professor Jeremy Pearson, said:
"This comprehensive review reiterates the life saving benefits of statins, which vastly outweigh the rare side effects associated with the medicine. Evidence, from many objective clinical trials, shows that statins are a safe and effective way of reducing heart attack and stroke risk. And there is certainly no debate that people who have had a heart attack or stroke should be taking statins to reduce their risk of another, potentially deadly event.
"Medicine should be guided by evidence and this review will help clinicians to consider the available evidence and judge its strengths and weaknesses. Clinicians, and particularly GPs, play a vital role in advising patients so it’s important that if a person has concerns about their medication, they discuss this with their GP first."
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We currently fund around £100 million of new research in to heart and circulatory disease each year and are the largest independent funder of cardiovascular research in the UK and Europe. But we are completely reliant on the continued support and donations of our supporters to fund more research.
It was clinical trial funded by your donations that helped show the benefits of statins and led to their widespread use to save lives across the UK and around the world. Help us fund more life saving research.