Are Statins Effective?

I am not a medical professional ...

But the the people who wrote the studies referenced below are.

Three years ago, I was prescribed statins and after I began taking them I soon felt as if I had aged 10 years in only weeks (mainly fatigue, muscle aches and weakness). Now, just as there is a placebo effect, where the benefit you get from taking a drug is derived not from the drug, but instead from your expectations about the effect of the drug, there is also a "nocebo" effect where the harm you get from taking a drug arises from your expectations, as well. I was well aware of the possible side effects when I began taking statins so, I would not totally discount the very real possibility that I was suffering a nocebo effect.

I began to read every abstract and non-paywalled study I could find on statins and their effectiveness. I had had a heart scan several years prior and my score was 0% and my research indicated that, for me at least, statins were of very dubious value. My absolute risk reduction from statin therapy was miniscule and certainly not worth the risk of side effects and I stopped taking them. What I did not expect to find, was the substantial amount of disagreement, within the medical community, about the both the effectiveness of statins and the risks of statins. (As an aside, I do not believe that physicians are allowing a patient to make an informed health care decision when they inform that patient that a medication reduces their chances of X disease by 50% (this is known as relative risk reduction) without also informing the patient that this 50% figure derives from the fact that their chances of X disease will drop from 2 in 10,000 to 1 in 10,000 (hence a 50% reduction). This is known as absolute risk reduction.)

Recently I revisited this topic after coming across a recent peer reviewed study in the Expert Review of Clinical Pharmacology. This led to a couple of other articles I would like to cite, only one of which was paywalled.

Let me start with an excerpt from the abstract of a paywalled study (found here):

"In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 ... Statins inhibit the synthesis of vitamin K2, ..., which in turn protects arteries from calcification. ... Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated."

That's nothing. An absolutely scathing non-paywalled study can be found here. The contempt which the authors hold for the drug industry is barely disguised. The primary thrust of the study is that none of the clinical trials of statins, which have taken place after health authorities tightened the regulations for such trials in 2005, have shown any substantial benefit from the use of statins.

From the abstract:

"A strong controversy has emerged about the reality of safety and efficacy of statins as stated by company-sponsored reports. ... To evaluate this, we first reviewed RCTs [author:clinical trials] testing the efficacy of statins versus placebo in preventing cardiovascular complications and published after 2006. Our systematic review thereby identified four major RCTs, all testing rosuvastatin. They unambiguously showed that rosuvastatin is not effective in secondary prevention, while the results are highly debatable in primary prevention. ... We then examined the most recent RCTs comparing statins to each other: all showed that no statin is more effective than any other, including rosuvastatin. Furthermore, recent RCTs clearly indicate that intense cholesterol-lowering (including those with statins) does not protect high-risk patients any better than less-intense statin regimens. As for specific patient subgroups, statins appear ineffective in chronic heart failure and chronic kidney failure patients. ...[W]e found that once secondary analyses and subgroup analyses are excluded, statins do not appear to protect diabetics. As for the safety of statin treatment – a major issue for medical doctors – it is quite worrisome to realize that it took 30 years to bring to light the triggering effect of statins on new-onset diabetes, manifestly reflecting a high level of bias in reporting harmful outcomes in commercial trials, as has been admitted by the recent confession of prominent experts in statin treatment. In conclusion, this review strongly suggests that statins are not effective for cardiovascular prevention. The studies published before 2005/2006 were probably flawed, and this concerned in particular the safety issue. A complete reassessment is mandatory. Until then, physicians should be aware that the present claims about the efficacy and safety of statins are not evidence based." [Emphasis added].

Finally, this brings me back to the study which restarted my review if this topic. Also, non-paywalled, it can be found here. I suggest you download the PDF version which has additional charts. From the abstract:

"For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit."

If you make a note to memorize the acronyms as they are initially defined the above study is not too difficult a read and contains a good summary of the harmful side-effects of statins.

I'm not claiming that the above referenced studies are the end word on this topic, but, the authors are highly credentialed medical professionals and the poor performance of the clinical trials, since regulations were tightened, in establishing the efficacy of statin treatment is certainly worth consideration by you and your doctor. Certainly, any decision you make with respect to statin therapy should be made only after consultation with your doctor.