Cholesterol Reducing Drugs; Statins: The Case Has Not Been Made
This is an article summary about Cholesterol Reducing Drugs know as Statins.
A Closer Look
Written by Dan Murphy, D.C., D.A.B.C.O.
TAC, Research Review , Volume 30, Issue 8
KEY POINTS FROM DAN MURPHY
1. Because statin drug therapy is likely to continue for
many years, or for a lifetime, the official written
position of the National Cholesterol Education Program
of the National Institutes of Health state, "the
decision to add drug therapy to the regimen should be
made only after vigorous efforts at dietary treatment
have not proven sufficient." "Vigorous" dietary efforts
are defined as a minimum of six months of intensive
dietary counseling before starting statin drug therapy.
2. Statin drug trials are not preceded by vigorous
dietary efforts because to do so would help people and
render statin drug therapy less effective in reducing
deaths from coronary heart disease (CHD) and other
causes of mortality.
3. In performing a clinical trial of a drug, "all-cause
mortality" is the only endpoint measure not prone to
diagnostic variance and is, therefore, not popular with
the drug company studies. Most statin drug trials do not
even look at all-cause mortality because of the
probability that taking the drugs does not alter
4. Drug company study designers search for endpoints
that are most apt to yield a positive result. "This
would not be the scientific approach but would make
sense if the aim was to make the study appear highly
5. "If a drug or other intervention neither extends life
nor improves its overall quality, then it is of no
6. "There is no rigorous reporting of all-cause
morbidity, nor of measurement of changes in overall
quality of life, in any of the [statin drug] studies."
7. Statin drug trials show absolute differences of less
than 1 percent to a maximum of 3.3 percent in all-cause
mortality between the control and treatment groups.
"These are not impressive results."
8. However, drug companies make statin drug results look
impressive "by expressing the results as relative
difference rather than as absolute difference." In a
statin drug trial of patients with existing CHD, the
difference in deaths between the statin group and the
placebo group was 3.1 percent (14.1 percent of the
placebo group died and 11 percent of the statin group).
The benefit of such results can appear to be magnified
by expressing them as relative differences, which would
be 11/14.1 = 22 percent: "The statin drug lowered the
risk of death by 22 percent (11 is 22 percent lower than
9. The small differences favoring statin drugs in
published studies "have been magnified by the manner of
presentation of results, most notably by the use of
relative differences between statins and placebo groups
rather than absolute differences."
10. Another serious problem is that the study does not
state the number needed to treat (NNT) for one patient
to benefit, which is over 100 in primary prevention
trials. This means that more than 100 patients would
have to take the drugs for one patient to actually
receive any benefit.
11. In a study where 100 patients take statins drugs,
two will have a fatal heart attack. In 100 patients
taking a placebo, three will have a fatal heart attack.
The absolute risk reduction of a fatal heart attach is 1
percent. Yet the drug company spins the pathetic results
by dividing 2/3 and publish the relative risk, which is
a 33 percent reduction of a fatal heart attack. This is
dishonest. These authors claim an honest disclosure
would be to state "if you take statins then, in seven
years’ time, there is a one chance in about 120 that
your death will have been prevented."
12. Using current available number needed to treat (NNT)
data and assuming the cost of a year of statin drugs is
$500, the cost of postponing one death by using statin
drugs is $85,500 for patients with the highest risk, to
more than $300,000 for those with the lowest risk.
13. "It is arguable that statins are cost-effective for
the small minority of people at especially high risk of
14. "Lowering the threshold to make much larger numbers
of people eligible for drug therapy has the effect of
making statins an extremely expensive means of
preventing heart disease. The case for statin drugs,
especially for primary prevention, has not been made."
Key Points are taken from an article that appeared in the
Journal of the Royal Society of Medicine
October 2004; Vol 97, Number 10, pp. 461-464
by Andrew Thompson, Ph.D, and Norman J. Temple, Ph.D.
Dr. Dan Murphy graduated magna cum laude from Western
States Chiropractic College in 1978. He received
Diplomat status in Chiropractic Orthopedics in 1986.
Since 1982, Dr. Murphy has served part-time as
undergraduate faculty at Life Chiropractic College West,
currently teaching classes to seniors in the management
of spinal disorders. He has taught more than 2000
postgraduate continuing education seminars. Dr. Murphy
is a contributing author to both editions of the book
Motor Vehicle Collision Injuries and to the book
Pediatric Chiropractic. Hundreds of detailed Article
Reviews, pertinent to chiropractors and their patients,
are available at Dr. Murphy’s web page,