Mayo Clinic’s visualization tools can help you determine if cholesterol-lowering statin drugs are right for you.
“Practitioners have an obligation to inform patients about the risks and benefits of interventions available to patients. However, despite the patient wants this information, doctors rarely communicate how to convey absolute information, such as the number needed for treatment, the number needed for harm, the harm, or the extension of life,” meaning, for example, the number of people who are actually actually helped by a particular drug, or how long each drug can live.
If the doctor only informs the patient about a relative reduction in risk (for example, if the pill reduces the risk of a heart attack by 34%, then 9 out of 10 agree to take it. However, give the same information as absolute risk reduction – “1.4% fewer patients with heart attacks” agree to only 4 out of 10 take the drug drops. And if they are using the number needed for treatment, only 3 out of 10 patients will take the pill. So, if you are a doctor and you really want your patients to take the medication, which statistics are you going to use?
Using relative risk statistics to inflate profit and absolute risk statistics to downplay side effects is known as a “statistical deception.” To see how research is rotated to achieve this, let’s take an example. In my video, the true benefits of statins and side effects are 1:49 below, and the risk of heart attack incidence over 5 years is significantly lower, with placebo-randomized study participants compared to those who took the drug. If you want your statins to sound better, use relative risk reduction (24% lower risk). If you want to make your statins sound bad, use absolute risk reduction (3% less heart attack).
You can then flip for side effects. For example, the researchers found that 0.3% (1 of 290 women in the placebo group) suffered from breast cancer over five years compared to 4.1% (12 of 286) in the statin group. Therefore, prostatin spins may be a 24% reduction in heart attack risk and only 3.8% lower in breast cancer, while antistatin spins may be just 3% lower in heart attacks compared to a 1,267% higher in breast cancer risk. Both depictions are technically true, but if you choose, you can see how easily you can manipulate people if you choose how you present risks and benefits. Therefore, ideally, we would use both relative and absolute risk reduction statistics.
In terms of profit, when compiling many statin tests, the relative risk reduction appears to be 25%. So, if your 10-year risk of a heart attack or stroke is 5%, taking a statin will reduce your absolute risk by 1.25%, or if you need the number you need for 80 treatments, taking a statin will bring you around 80 people who will avoid a heart attack or stroke by taking the medication for the next 10 years. As you can see, as the baseline risk increases and increases, the absolute risk reduction is greater and greater despite the same 25% risk reduction. And because there is a 20% baseline risk, in my video, as seen below, if you are taking medication, you’re going to have a 20-minute chance of avoiding a heart attack or stroke over the next 10 years.
So, they are advantages. From a risk perspective, breast cancer discovery appears to be flukes. All studies summarise, “There was no association between statin use and the risk of cancer.” Regarding muscle problems, risk estimates range from about 1,000 to nearly 1/50.
If all of these numbers are blurred together, Mayo Clinic has developed a great visualization tool that shows it at 4:39 in my video.
For people at average risk, 10 out of 100 people who are not taking statins could have a heart attack over the next 10 years. However, if all 100 people take statins every day for 10 years, eight still suffer from a heart attack, but two are spared. So there’s about one person who takes drugs to help avoid a heart attack over the next 10 years. What are the drawbacks? The cost and inconvenience of taking the pill daily can cause gastrointestinal side effects, muscle pain, about 5% stiffness, 2% reversible liver inflammation, and perhaps more serious damage in one of 20,000 patients.
Yes, note that the two happy faces in the lower left row of the statin chart represent a heart attack that was avoided, not something saved. If you don’t know your heart disease, the chances of a few years of statins actually saving your life is about 1 in 250 people.
If you want a more personalized approach, Mayo Clinic has an interactive tool that allows you to calculate the risks of a decade. You can reach it directly by going to bit.ly/statindecision.
