I would not take statins myself this risk threshold, because the risk to benefit ratio is not as certain as the ‘experts’ say – and minimal for the individual.
For example, for an approximately 3% chance of benefit to me, assuming statins were 30% effective at preventing stroke and heart attack, I would have to make myself a patient, rather than a healthy 50-year-old.
I would have to take tablets every day, I would have to pay a minimum of £50 of my own money per year in prescription charges, have at least annual checks with my doctor and have a significant risk of side effects.
As a GP of 22 years’ experience, I find it almost impossible to believe the very low rates quoted by Collins et al[1] for side effects. At least 10% of my patients stop them for side effects, particularly muscle and joint pains, which clearly disappear on stopping the pills and restart on rechallenge.
I would rather get/stay slim and exercise regularly, which would be likely to produce similar long-term benefits, with added fitness self-confidence and enjoyment of life. If I smoked or drunk too much, I would be better being helped to reduce these than take pills.
Obviously the risk-benefit ratio improves as risks increase. I would consider treatment at 20% risk and do strongly recommend my patients consider it along with lifestyle changes.
Treatment of risk rather than illness means for many patients we are breaking the ‘above all do no harm’ instructions of Osler, replacing it with a more modern aphorism ‘don’t worry about harming individuals if there is net benefit to society’.
Dr Nick Chiappe is a GP partner in Plymouth Devon
1. Cholesterol Treatment Trialist Collaborators et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;380:581-90
