hello this is a response to the many
requests I get to make a video about
statins but this isn't a video about how
statins work nor is an in-depth
exploration of all aspects of the topic
it's just my attempt to summarize the
most important facts in as short and as
accessible a video as possible so that
you will end hopefully feeling more able
to make an informed decision about
whether statins are right for you or a
loved one it's about understanding how
we think about things that work now
versus things that work over a long
period of time like years or decades
antibiotics opening a blocked artery
defibrillating a patient reattaching a
severed limb the effect of those things
is obvious for anybody to see but taking
a tablet now which doesn't make you feel
any better may make you feel worse for a
negative payoff I.E something doesn't
happen in the future hopefully
requires a completely different way of
thinking which is quite
counter-intuitive and frankly difficult
if a Statin does its job properly you'll
never feel any different
but cardiovascular disease causes a
third of all death it's the worldwide
number one killer so we should be
getting this right and not relying on
hot takes and opinionated pundits
I'm a cardiologist I work here in the UK
where I receive exactly the same salary
irrespective of what procedures I do or
drugs I prescribe and I receive no money
from the pharmaceutical industry at all
the only gain or loss to be made here is
to you not me I want to help anyone
viewing achieve their best possible
Health but my job is not to tell you nor
my real life patients what to do my
motivation for making this is because so
many videos about Saturns online that I
see both Pro and anti are either unclear
or confusing or just plain wrong a quick
tip actually about people with very
strong views that you'll find online
about anything health related just check
if they're selling something like a book
or a diet plan and then ask yourself if
they are truly neutral
this video is about statins for primary
prevention that's people who've been
told that they should take a Statin to
prevent the first instance of something
like a heart attack or a stroke so
they're otherwise healthy they've
they've not had a cardiovascular event
before so if you've been told by or your
loved ones have been told that they're
at risk and so should start a Statin
please keep watching this video is for
you it's not a video about secondary
prevention where you've already had a
heart attack or a stroke in which case
the evidence for a Statin preventing a
second event is overwhelming and even
the most vehement opponents of statins
do not suggest otherwise
so
maybe your doctor has suggested statins
you've heard them say it'll help you but
maybe in a kind of vague way but then
you've also heard other people say that
the benefit is negligible you've heard
about side effects and maybe you've
experienced them yourself maybe you've
tried a satin and then you've had to
stop there are many hours worth of
things to say about satids but if I had
to boil down the core message to the
simplest possible terms it goes
something like this
a newspaper article will state that
statins only offer a small extension in
life an average of seven months which in
the context of a lifetime I agree sounds
pretty unimpressive but that suggests
statins give everyone a small kind of
pointless benefit that it's evenly
spread across everybody who takes them
but that's not correct
let's imagine a thousand people and give
them all statins
700 of those people will die from
non-cardiovascular Death so statins
won't have any effect obviously if you
die from cancer the fact that you took a
Statin for 10 years beforehand is pretty
irrelevant
out of the 300 that do die of
cardiovascular disease 200 will probably
die around the same time that they would
have without a Statin
the remaining 100 so one-third of all
cardiovascular deaths will live on
average 70 months longer than they would
have without statins that's six extra
years of life or more depending on which
figures you look at but because it's
only a hundred out of that original 1000
we started with the overall average is
70 divided by 10 which comes out at that
seven months
so in other words for 10 people taking a
Statin nine won't really get any
significant benefit but one will get a
huge benefit
now having heard that you might say well
I don't think I want to take one and
that would be a reasonable position to
adopt but just ask yourself if you'd
enter Lottery with these odds in the UK
the national lottery has about a one in
14 billion chance of winning the jackpot
statins are a one in 10 chance of
winning six to ten extra years of life
which in my opinion is a windfall but
okay you may say entering the lottery
doesn't have side effects so let's
consider them a very elegant study was
published last year which had no funding
from industry and this demonstrated and
this is something that I have tried with
my patients having got the idea from the
internet actually in a slightly
different context something called an N
equals one study where you perform a
little mini study in a specific patient
in question rather than trying to apply
population-based figures to a single
person what the study did was give
patients who have already suffered side
effects to statins a Year's worth of
bottles for four months they took a
Statin for four months they took an
identical dummy tablet they didn't know
which was which and for four months they
took nothing so 444 one year and what
the study found was that there was no
significant difference between the side
effects experienced with the dummy
tablet versus the Statin but there was a
big difference between the months that
they were taking tablets versus the
months that they weren't in terms of
side effects
this is the nocebo effect genuine
unpleasant effects from taking tablets
even if the tablets are inactive
just like Venom is the Spider-Man or why
Luigi is to Luigi the nocebo is the
placebo effects evil twin the side
effects aren't caused by an inherent
property of the Statin molecule but by
taking tablets when you feel muscle
pains you're not making that up but the
results of this trial as well as dozens
of others looking at side effects show
that you can safely reintroduce statins
and with reassurance side effects mostly
go away which is what they observed in
the trial
so there are four pieces of information
to take on board here let's summarize
number one statins have a real
beneficial effect but is a it's a small
course correction that occurs over a
long period of time over a year the
reduction in Risk is small it's not a
particularly useful way to look at a
chronic disease but over 10 years over
20 years it can add up to a lot number
two statins save millions of lives when
applied to populations but if you ask me
if it will save your life I can't tell
you that and it's true to say that most
people who take statins won't derive a
benefit but number three
some people who take statins will derive
a huge benefit and number four side
effects are absolutely real but they're
not caused by any inherent property of
statins they're caused by taking tablets
the nocebo effect
the decision is of course yours you are
in charge of your health we as Medics
are here to help provide information
give advice but it's always your
decision if you were my patient and this
is pretty much exactly how I present the
information to my own patients my job
isn't to exert pressure on you but to
try to communicate your risk and let you
decide
in in conjunction if you have a genetic
predisposition to a high cholesterol a
significantly abnormal cholesterol blood
test your diabetic you've got a strong
family history of heart disease you're
already a healthy weight and you're
eating well and exercising I would say
that your risk profile is very high in
spite of your best efforts so your
benefit from a satin will
correspondingly be higher but if you're
a bit overweight sedentary eating junk
food and maybe have got a little bit of
high blood pressure I would say that
your risk is more moderate and if you
were not keen on starting a Statin
straight away there are several other
things we can address first which will
almost certainly benefit you more but
remember to present this as a dichotomy
is false which I see happen a lot just
because there are lifestyle factors to
address it doesn't mean that statins
shouldn't be taken or considered you can
add the benefit of both but if you want
to do one thing at a time that's okay
too
some people don't mind taking a Statin
and have the view that every little
helps some people try a Statin maybe
switch to a different one and they don't
agree with them and even after
reassurance they want to stop some
people say look doc I know it may help
me but I really like not being on
tablets I feel fine I'd rather not take
a Statin these are all fine
but as long as that decision is an
informed one based on correct
information not Facebook posts not
quacks Hawking books and not YouTube
videos and yes I realize the irony of
saying that don't unquestionally
unquestioningly accept any prescription
it's always a two-way discussion between
you and your doctor but equally don't
believe the Legion of people online who
say statins are poison and just tools to
make money for big Pharma knowledge is
power provided your sources are reliable
I hope this has helped
[Music]