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Hello. This is a response to the many requests I get to make a video about statins. This isn't a video about how statins work, nor is it an in-depth exploration of all aspects of the topic. It's just my attempt to summarize the most important facts in as short and as accessible a video as possible, so that you will end, hopefully, feeling more able to make an informed decision about whether statins are right for you or a loved one.
It's about understanding how we think about things that work now versus things that work over a long period of time, like years or decades. Antibiotics, opening a blocked artery, defibrillating a patient, reattaching a severed limb: the effect of those things is obvious for anybody to see. But taking a tablet now, which doesn't make you feel any better and may make you feel worse, is for a negative payoff, i.e., something doesn't happen in the future. That requires a completely different way of thinking, which is quite counter-intuitive and frankly difficult. If a statin does its job properly, you'll never feel any different. But cardiovascular disease causes a third of all deaths. It's the worldwide number one killer, so we should be getting this right and not relying on hot takes and opinionated pundits.
I'm a cardiologist. I work here in the UK, where I receive exactly the same salary irrespective of what procedures I do or drugs I prescribe, and I receive no money from the pharmaceutical industry at all. The only gain or loss to be made here is to you, not me. I want to help anyone viewing achieve their best possible health, but my job is not to tell you, nor my real-life patients, what to do. My motivation for making this is that so many videos about statins online, both pro and anti, are either unclear, confusing, or just plain wrong. A quick tip about people with very strong views that you'll find online about anything health-related: just check if they're selling something, like a book or a diet plan, and then ask yourself if they are truly neutral.
This video is about statins for primary prevention. That's people who've been told they should take a statin to prevent the first instance of something like a heart attack or a stroke. They are otherwise healthy and have not had a cardiovascular event before. So if you've been told, or your loved ones have been told, that they're at risk and should start a statin, please keep watching. This video is for you. It's not a video about secondary prevention, where you've already had a heart attack or a stroke, in which case the evidence for a statin preventing a second event is overwhelming, and even the most vehement opponents of statins do not suggest otherwise.
Maybe your doctor has suggested statins and you've heard them say it'll help you, but perhaps in a vague way. You've also heard other people say the benefit is negligible. You've heard about side effects, and maybe you've experienced them yourself. Maybe you've tried a statin and then had to stop. There are many hours' worth of things to say about statins, but if I had to boil down the core message to the simplest possible terms, it goes something like this.
A newspaper article will state that statins only offer a small extension in life, an average of seven months. In the context of a lifetime, I agree that sounds pretty unimpressive. But that suggests statins give everyone a small, pointless benefit, evenly spread across everybody who takes them. That's not correct. Let's imagine a thousand people and give them all statins. Seven hundred of those people will die from non-cardiovascular causes, so statins won't have any effect. Obviously, if you die from cancer, the fact that you took a statin for 10 years beforehand is pretty irrelevant. Out of the 300 who do die of cardiovascular disease, 200 will probably die around the same time they would have without a statin. The remaining 100, so one-third of all cardiovascular deaths, will live on average 70 months longer than they would have without statins. That's six extra years of life or more, depending on which figures you look at. But because it's only 100 out of the original 1,000 we started with, the overall average is 70 divided by 10, which comes out at that seven months.
In other words, for 10 people taking a statin, nine won't really get any significant benefit, but one will get a huge benefit. Having heard that, you might say, "Well, I don't think I want to take one," and that would be a reasonable position to adopt. But ask yourself whether you'd enter a lottery with these odds. In the UK, the National Lottery has about a one in 14 billion chance of winning the jackpot. Statins offer a one in 10 chance of winning six to ten extra years of life, which in my opinion is a windfall.
You may say entering the lottery doesn't have side effects, so let's consider them. A very elegant study was published last year, with no funding from industry, which demonstrated something I have tried with my patients, having got the idea from the internet, actually in a slightly different context: something called an N-of-one study, where you perform a little mini study in a specific patient in question, rather than trying to apply population-based figures to a single person. The study gave patients who had already suffered side effects from statins a year's worth of bottles: four months of a statin, four months of an identical dummy tablet, and four months of nothing. They didn't know which was which. What the study found was that there was no significant difference between the side effects experienced with the dummy tablet versus the statin. But there was a big difference between the months they were taking tablets versus the months they weren't, in terms of side effects. This is the nocebo effect: genuine, unpleasant effects from taking tablets even if the tablets are inactive. Just as Venom is the evil twin of Spider-Man, or Luigi is to Luigi, the nocebo is the placebo effect's evil twin. The side effects aren't caused by an inherent property of the statin molecule, but by taking tablets. When you feel muscle pains, you're not making that up. But the results of this trial, as well as dozens of others looking at side effects, show that you can safely reintroduce statins, and with reassurance, side effects mostly go away, which is what they observed in the trial.
So there are four pieces of information to take on board. Let's summarize.
Number one: statins have a real beneficial effect, but it's a small course correction that occurs over a long period of time. Over a year, the reduction in risk is small, and it's not a particularly useful way to look at a chronic disease. But over 10 years or 20 years, it can add up to a lot.
Number two: statins save millions of lives when applied to populations. But if you ask me whether it will save your life, I can't tell you that, and it's true to say that most people who take statins won't derive a benefit.
Number three: some people who take statins will derive a huge benefit.
Number four: side effects are absolutely real, but they're not caused by any inherent property of statins. They're caused by taking tablets, the nocebo effect.
The decision is, of course, yours. You are in charge of your health. We as medics are here to help provide information and give advice, but it's always your decision. If you were my patient, and this is pretty much exactly how I present the information to my own patients, my job isn't to exert pressure on you but to try to communicate your risk and let you decide, in conjunction with me. If you have a genetic predisposition to high cholesterol, a significantly abnormal cholesterol blood test, you're diabetic, you've got a strong family history of heart disease, then even if you're already a healthy weight, eating well, and exercising, I would say your risk profile is very high in spite of your best efforts, so your benefit from a statin will correspondingly be higher. But if you're a bit overweight, sedentary, eating junk food, and maybe have a little bit of high blood pressure, I would say your risk is more moderate. If you were not keen on starting a statin straight away, there are several other things we can address first, which will almost certainly benefit you more. But remember, presenting this as a dichotomy is false, which I see happen a lot. Just because there are lifestyle factors to address doesn't mean statins shouldn't be taken or considered. You can add the benefit of both, but if you want to do one thing at a time, that's okay too.
Some people don't mind taking a statin and have the view that every little helps. Some people try a statin, maybe switch to a different one, and they don't agree with them, and even after reassurance they want to stop. Some people say, "Look, doc, I know it may help me, but I really like not being on tablets. I feel fine. I'd rather not take a statin." These are all fine, as long as that decision is an informed one based on correct information, not Facebook posts, not quacks hawking books, and not YouTube videos, and yes, I realize the irony of saying that. Don't unquestioningly accept any prescription. It's always a two-way discussion between you and your doctor. But equally, don't believe the legion of people online who say statins are poison and just tools to make money for Big Pharma. Knowledge is power, provided your sources are reliable.
I hope this has helped.