The presenter of today’s ESC Geoffrey Rose Lecture in Population Sciences is Professor Colin Baigent (University of Oxford - UK), whose main interests are in the design and conduct of large-scale randomised trials and the use of meta-analysis to assess the efficacy and safety of drugs for preventing and treating CVD.
“It might seem like an odd subject for a lecture on population sciences, but misinformation about the safety of statins is damaging public health. Reducing cholesterol is one of the most important tools available for reducing the risk of atherosclerosis, and statins are a cheap and effective means of achieving such benefits. But many people are reluctant to start a statin, or stop them prematurely, because of concerns about their safety. Much of this concern has been generated by non-randomised and non-blinded studies that are not reliable tools for detecting common adverse drug effects. Our recent meta-analysis, published in a series of three papers [1–3], sought to avoid the methodological limitations of previous studies by restricting attention to large double-blind randomised trials and then examining all adverse events recorded for individual patients in those trials.
In our first paper, we demonstrated that muscle symptoms were recorded very slightly more frequently in patients taking a statin, but that this very common symptom was almost always not attributable to statins [1]. Concern that muscle pain may be due to statins is one of the key reasons why patients stop or modify treatment, but the evidence shows clearly that statins are not usually responsible.
A second major concern has been that statins increase the rate of new onset diabetes. We were able to show that this effect is caused by a small increase in glycaemia, which precipitates a diagnosis of diabetes in those who are already pre-diabetic, but that the cardiovascular benefits far outweigh the consequences of this small change in plasma glucose [2].
Our third paper, rather than examining a specific adverse event, used an appropriate statistical strategy to examine the effects on the many adverse events that have putatively been associated with statins and have, as a consequence, been listed as potential undesirable effects in drug package inserts [3]. We found no evidence that statins increase the risk of any of the many disorders listed. This calls into question the reliability of the information that is routinely provided to patients about statins and which may influence decisions about whether they continue treatment.
A significant part of the potential benefit of statin therapy is currently being lost because of misinformation about their side effects. A major step to improving cardiovascular health would be to find effective ways to counter such misinformation.”
