In this war over statins, how can patients win?

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The statin Lipitor. A study found that statins may also be warranted for people at intermediate risk of heart disease.

There is an academic war brewing that could help determine how many millions of statins will be prescribed to try to prevent heart disease.  Two prestigious medical journals, the Lancet and the British Medical Journal, are the battlegrounds.

On one side: the doctors who have performed clinical trials proving that statins will lower the chance of having a heart attack.  In a recent article published in the Lancet,  researchers have suggested that almost everyone will benefit from taking a statin, even if they have never had a heart problem.  The conclusion:  statins are so safe that they are essentially no different from placebo.  

On the other side: A British Medical Journal article suggesting side effects of statins are very common, perhaps suffered by as many as 20 percent of people taking cholesterol-lowering medication.  The authors of this BMJ publication call for new medications to help lower cholesterol in people who cannot tolerate statins.

Lancet has accused the BMJ of fabricating results to make statins look bad, and have called for a retraction of the BMJ article.  Asking for a retraction is a big deal in the academic world -- it can easily ruin the career of the authors of the retracted article.  Estimating that as many as 200,000 people may have stopped their medications because of fear of statins after the press reported the BMJ article, the editor of the Lancet has called for a complete halt to any future studies examining alternatives to statins.

Further complicating this battle: Researchers on both sides are saddled with conflicts of interest.

The Lancet does not mention that many authors of their article did research into statins funded by the pharma companies that make the cholesterol-lowering drugs Zocor, Lipitor, and Crestor. The research was done several years ago, before generic versions were available,  and the companies funding the studies have made a lot of money based on these results.  Until earlier this year, one month of Crestor cost over $200; as a generic it may only cost $10. 

BMJ has its own dirty little secret.  Among the members of this group, who argue that some people just cannot take statins, are physicians promoting new medications such as Praluent and Repatha.  These new injectable medications can lower cholesterol in patients who cannot tolerate statins, without as many side-effects.  Many of these authors have a stake in seeing these medications become successful. Let’s not forget they are very expensive, costing as much as $16,000 per year.

Here is the problem that both sides are missing:  They assume that more and more people will need to take medication for high cholesterol in the future.  The controversy sends the not-so-subtle signal that cholesterol-lowering drugs may prevent heart problems, and other interventions are not as important.  No need to exercise, lose weight or watch what you eat if you can take a pill or receive an injection.

In order for there to be a real winner in the statin war, our focus has to move from picking the right drug, and toward personalized medicine where each individual’s risk is determined, lifestyle improvement promoted, and medications used only as a last resort.


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