Do Statins Really Prevent Heart Attacks, Strokes and Death? 

What do statin companies promise?

Statin drug manufacturers love to make huge promises. Take our drug and it will decrease your risk of a heart attack by 36%. Take our drug and it will lower your risk of dying by 9% or your risk of a stroke by 14%. If you've been paying a copay and taking a statin for years, and maybe suffering side effects for over a decade because you thought you were getting a 36% reduction in your risk of a heart attack, the real numbers may make you angry.

What did the JAMA Internal Medicine statin study look at?

This study was published in JAMA Internal Medicine in mid-March 2022. It is a systematic review and meta-analysis of statin trials whose data was publicly available.

What you may not know is that many statin companies fund their own research and then keep the results private. They don't share them with the public, and they don't even share them with other researchers or medical institutions. That smells a little fishy. These researchers were able to find 21 statin trials where the data was available, with more than 143,000 participants in all.

Why does the study use "hard endpoints"?

Many statin trials like to talk about soft endpoints, like "cardiovascular events." That's a subjective measure that doctors can say yes or no to. This study looked at only three hard endpoints that nobody can deny: dying, having a documented heart attack and having a documented stroke. Either you died or you didn't.

When you look at the research based on those three hard endpoints, you find very different numbers than you've seen in the ads for Lipitor, Zocor, pravastatin and others.

Does lowering LDL with a statin lower your risk?

The researchers found no clear link between how much a statin lowered LDL and your risk of death, heart attack or stroke.

What is the difference between relative risk and absolute risk?

This is how drug companies mislead you. In the graph from this study, the tall bars are the relative risk reduction:

• Death from any cause: 9% relative risk reduction
• Heart attack: 29% relative risk reduction, still not 36%
• Stroke: 14% relative risk reduction

Those are the numbers that get advertised, the numbers they tell doctors and the numbers you end up hearing. So you think, if I take a statin every day for years, pay the copays and suffer the side effects, at least I'll cut my heart attack risk by a third.

Now look at the tiny bars beside the tall ones. Those are the absolute risk reductions:

• Death from any cause: 0.8%, which is almost background noise
• Heart attack: 1.3%
• Stroke: 0.4%, not even a 1% absolute reduction

What if the Lipitor ad had said, "We lower your risk of a heart attack by 1.3%. Pay your $25 a month copay and reap the benefits"?

What are the side effects of taking a statin every day?

By taking a statin every day you are:

• Lowering your testosterone level, which is a bad thing for men and for women
• Raising your blood sugar levels, which is a bad thing for all humans
• Lowering your levels of coenzyme Q10
• Increasing your risk of severe muscle aches, even muscle breakdown, and liver damage

There's a whole host of other side effects. Some doctors will say the side effects aren't that bad, but lawyers looking for a juicy class action lawsuit don't chase drugs that don't have lots of bad side effects.

Who designed the statin trials?

In my view, every trial included in this meta-analysis was conceived by the drug companies, designed by the drug companies, performed by researchers paid to some degree by the drug companies, and interpreted by researchers who were on salary for the drug companies or had received a grant from them, and the drug companies also paid the costs of publishing.

I wonder what the number would be in an independent randomized controlled trial. My prediction is that the benefit for your risk of dying, having a heart attack or having a stroke would be 0.0%.

Does your doctor understand relative versus absolute risk?

You might think, "I don't understand relative versus absolute risk, but my doctor went to medical school." A survey cited in the BMJ found that nearly a third of doctors asked misread these risk numbers (BMJ, 2010: https://www.bmj.com/content/341/bmj.c4830). So your doctor probably doesn't understand it either.

That's why I encourage you to print out this study and take it to your next visit. When your doctor tries to give you a statin, say: "Doctor, you think this statin is going to decrease my risk by a third. Did you know it only reduces my risk by about 1%? Is it really worth all the side effects for me to reduce my risk by potentially 1%?"

Who actually benefits from a statin?

The researchers found the absolute benefits are modest compared with the relative numbers. In my opinion, the average person taking a statin for years receives no meaningful clinical benefit. I think it's time to tell it like it is. Unless you have had a previous documented heart attack, and are taking a statin for secondary prevention, you are not going to benefit in any meaningful way from a statin. Otherwise, it's costing you time, money and side effects without doing you any good.