Being a Banter is a bit like being a member
of the American political group the Tea party. The similarity is that if you
join the group you’re obliged to follow all of the beliefs rather than simply
the ones you actually, well believe in. Tea party member believe in small
government and deregulation of markets, they are also vehemently against
President Obama and just about everything he says. These political views are
bedfellows, but what is strange is that Tea party members also all seem to
believe that climate change is not man made. This is interesting because it’s a
scientific rather than a political point and so it would be perfectly rational
to believe in the political parts of the doctrine but to disagree on the
scientific. Tea party members however almost never do.
Banters are similar to this as I’ve pointed
out previously. They have at least 3 points that they all believe in, firstly
that LCHF diets are optimal for human health, secondly that sugar is both toxic
and addictive and thirdly that statins are bad for you. These are all
scientific points and it would be reasonable to accept one or two of them
without the others but just like Tea party member, Banters seem to see it as an
all or nothing.
You don’t have to look far to find Banters
going on about the lack of benefit and the frank dangers of statins. Christine
Cronou who definitely ranks as part of the lunatic fringe likes to write about
the dangers of statins, recently warning us about 20,000 people with
side-effects and 220 deaths in the UK alone. The source of these data were none
other than the Daily Express, which is hardly a bastion of good science. Zoe
Harcombe may not quite be on the lunatic fringe but she is definitely a
self-publicist determined to make money out of LCHF regardless of the science.
She is constantly telling us about the dangers of statins and has written such
priceless pieces as ‘How statin drugs really lower cholesterol & kill you
one cell at a time’.
So what is the evidence behind statins?
Doctors tend think of two distinct groups of patients when considering statins.
There are those who have had a heart attack or stroke and prescribing for them
is called secondary prevention; to prevent a second event if you like.
Alternatively there is primary prevention which is prescribing statins to
prevent a first ever heart attack or stroke. The evidence for secondary
prevention with is overwhelming. They clearly have a beneficial effects and the
evidence is so strong that even some Banters are persuaded. The size of the
effect is not large however, whatever statins are, they certainly aren’t wonder
drugs. For someone who’s had a stroke and has a 25% chance of having another
one in 5 years a statin will reduce that risk to 20%. This is a modest effect
but one that many patients would welcome.
Debate on primary prevention is far more
intense. In fact, there is clear evidence of benefit of statins for primary
prevention, the problem is that once again the effects are modest to say the
least. A recent review looked at the data from 27 randomised trials and
concluded that on average statins reduced the relative risk of major coronary
events by 24% for each 1 mmol/L reduction in LDL cholesterol. This means that
it was reduced by a quarter from its original level e.g. reducing from 4% to 3%
risk. The effect on stroke was a little less but still 15%. Beneļ¬ts were
similar between women and men, smokers and non-smokers, in elderly and young
people, and across all levels of obesity, blood pressure, and glucose. A 24%
relative risk reduction means different things to different people but is
usually little more than a 1% drop in absolute risk. This would mean that only
1 out of every 100 people on a statin would get a benefit.
The Banters love to gloss over these modest
effects but even more so to focus on side-effects of statins. There are of
course side-effects, all beneficial drugs have them but once again it’s a
question of degree. Most side-effects are mild and if patients experience them
they can simply stop the drug and the effects go away. Very rarely side-effects
can be life threatening but this is so rare as to be outweighed by even the
modest beneficial effects.
So once again we find that the Banters
argument isn’t backed up by the data, but neither in my opinion is view that
statins are wonder drugs. As usual the reality lies somewhere in between and
isn’t sensational enough to sell newspapers or books. Statins work, but the
effects are modest. They have side-effects which are usually mild and go away
if you stop the drug. Hardly enough for a best seller.
