What are the benefits of statins in terms of prolonging life?

Question

Recently the UK government suggested that all adults over the age of 50, without exception, would benefit from taking statins.

I have an elderly female relative who may, or may not have had a minor cardiac event (the diagnosis is still out) and low blood pressure. It has been suggested to them that they would benefit from statins and have asked me (a former biologist) to find out more.

I've had a look at the mechanisms of action, which seem clear. But the clinical data is somewhat confusing.

It seems we can state with certainty that a small but significant number of users report relatively minor side effects, and a very tiny minority have serious ones.

In term of the benefits, however, the picture is much less clear. I have found a variety of statistics about how they reduce cardiac events but what this translates to in terms of length of life and quality of life is not stated.

One article I looked at suggested that on average, someone at high risk of heart disease taking statins for 30 years would only live an extra 9 months.

The author of that site has a book to sell, and may have an axe to grind. But there are several other articles out there - such as this, and this and this - which make worrying claims about statins being both more unsafe and less beneficial than clinical trials suggest. In particular there seems very limited evidence of any benefits to women.

I am inclined to treat these as alarmist nonsense - they have that sense of hysteria about them. But given that the authors look legitimate, that clinical trials data do not appear to agree with one another (widely varying in the percentage of users reporting side effects, for example), and that this is a relative, I wanted to get a second opinion.

So - can someone please crunch the numbers and tell me what the benefits of statin use are in terms of life years and quality of life? Is there any benefit for women with or without heart disease? And is there any basis to some of the alarmism around their use?

Answer 1

I suspect I won't be crunching as much numbers as you'd want me to, however here are some basic points:

• Statins have shown a clear ability to improve the blood llipid profile.
• Their use in primary/secondary prevention for cardiac events is justified by the belief that less blood lipid will leave less lipids to clog the arteries with. This is an old paradigm, and it is debated, even if we nowadays indeed give statins to all (potential) cardiac patients. There is evidence for a positive effect of those drugs, but it is not undisputable.
• An enormous amount of money is made from statins, and the pharma pushes very hard for their use.
• They do have undesirable effects, but those appear mostly early, so patients are usually well monitored for them and they mostly pose no real threat.

On the subject of women: women before menopause are protected from cardiac events by their hormone profile, and would therefore likely benefit very little from statins at that time. After menopause, women present the same cardiac risk as men do. I do not know if studies have shown a difference in outcome for statins in postmenopausal women. If you want to know more, I advise you to go searching for it on Pubmed

DISCLAIMER: The above does not represent professional medical advice, and is subject to debate.