Skip navigation
Link to Back issues listing | Back Issue Listing with content Index | Subject Index

Mythbuster: statins and event severity

The problem
Results
Comment

Myths and legends come in a variety of forms, and sometimes they astound. Faced with an older woman with raised cholesterol and a family history of heart disease, most of us would think of statins as being an important part of risk reduction. How would you then react when she told you that a doctor had informed her that taking statins might reduce the risk of something happening, but that if it did happen she would be left as a "vegetable"? She should choose whether to take a statin, and had chosen not to.

The problem

Now the first problem is that you don't know what was actually said to her, nor the context in which it was said. And you are not absolutely sure what was meant or how it was meant to be taken, or taken to be meant.

One interpretation is that she has been correctly told that statins reduce the risk of heart attack and stroke, but that should heart attacks or stroke actually occur in people taking a statin, those events would be much more severe. How might we look for evidence that this is a myth or true? Some suggestions:

  1. Do a literature search for statin and event severity, using infarction, stroke, and combinations of words to try to find case reports. The logic here is that doctors are anything but daft, and that in the last 10 years or so, when statin use has become ever more widespread, someone, somewhere, would have noticed an epidemic of severe heart attacks or strokes and made the connection.
  2. Examine the large randomised statin trials to see whether any have reported on severity of events compared with placebo.
  3. Look at any other studies with statins that might have been expected to comment on event severity.
  4. Ask your friends if they have any better ideas.

Results

Bandolier tried all four of these. The results we found were as follows:

  1. Several hours of searching and reading of abstracts found not a single case report alleging that statin use resulted in more severe outcomes for heart attack or stroke.
  2. The heart protection study [1] enrolled 20,000 high risk people in a randomised comparison of simvastatin 40 mg daily and placebo for an average of five years. A quarter of them were women, and almost a third over 70 years. There were 444 strokes in those taking statins, and 585 in those taking placebo, a reduction in frequency of 25%. The authors also helpfully reported stroke severity (Figure 1). Severity of strokes that occurred was exactly the same in those on a statin as those on placebo. This is solid evidence that there was no increase in stroke severity with statins.



    Figure 1: Stroke severity occurring in statin and placebo users in Heart Protection Study [1]













  3. A study of events in the 30 days after admission in patients with coronary artery disease and chest pain treated with statins throughout (369 patients) and not having a statin before or after admission (1151 patients) was related in Bandolier 113. The events seven days after admission are shown in Figure 2. Not only were there fewer events in total in those who were on a statin, but those that occurred were, if anything, less rather than more severe.


    Figure 2: Outcomes within seven days of admission to hospital with chest pain in statin users and non-nusers [2]














  4. None of Bandolier's friends who were asked about this had any other knowledge of any evidence that could support the proposition that statin use led to worse outcomes. All were mystified by the suggestion.

Comment

This is one myth that can confidently be busted. Not only is there the clearest and most abundant evidence that statins reduce the risk of heart attack and stroke in people at almost all levels of risk, but there is also compelling evidence that outcomes are no worse with statins.

References:

  1. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled study. Lancet 2002 360: 7-22.
  2. C Heeschen et al. Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation 2002 105: 1446-1452.

previous or next story