Statins are safe and effective.
Read what the phrase is standing on.
- Primary prevention: 1 in 104 avoids a heart attack over 5 years. Deaths prevented: 0.
- The other 103 take it for life for nothing.
- Harm in the same 5 years: 1 in 50 develops diabetes, 1 in 10 gets muscle damage.
- Half the people admitted with a heart attack have LDL under 100.
- Keys drew his 1953 line through 6 countries. Data existed for 22. Add them back and the line vanishes.
- France was in the 22, ate butter, and declined to die on schedule.
- The big trials ran a rehearsal first and removed anyone who couldn't tolerate the drug before the count began.
- 2001: Baycol withdrawn after 52 deaths from muscle breakdown. Same class, same mechanism.
- 2012: the FDA adds blood sugar and memory loss to the label, 25 years after patients first reported both.
- The enzyme it blocks also makes CoQ10, and the heart is the most mitochondria-dense muscle you own.
- The over-75s are prescribed it hardest and were excluded from the trials most.
- The trial data sits with one Oxford unit that has refused independent review for a decade.
- 2022: independent researchers got the death records from the biggest PCSK9 trial. Cardiac deaths were higher in the drug arm.
- 8 of the 9 men on the 2004 panel that expanded eligibility by 20 million were paid by statin makers.
- 2023: NICE says a GP may now offer one to anyone below the risk threshold who asks.
One brand alone took $125 billion.
Safe and effective is what they said about the margarine, the cigarette and the opioid.
The people who wrote the guideline sell the drug. The people who hold the data won't show it. The person taking it is the only one in the arrangement who was never paid.
https://x.com/SamaHoole/status/2100080530670735397?s=20
A good example of how mostly true individual facts can be assembled into a misleading narrative. Statin benefit depends on baseline risk, the diabetogenic effect is real, but data don’t support “1 in 10 suffers muscle damage.” And a PCSK9 inhibitor is not a statin.
Several claims hold up with caveats. Primary prevention NNT for MI is often around 100-120 over 5 years; CV mortality reduction is small or nonsignificant in many analyses. Diabetes excess is real (~0.2%/yr) but closer to 1 in 100 over 5 yrs; muscle symptoms mostly match placebo in blinded trials (serious myopathy <0.1%). Half of MI admissions have LDL <100 is documented. Keys used 6 of ~22 countries; France paradox exists. Baycol withdrawn after ~31-52 rhabdo deaths. FDA added diabetes/cognitive warnings in 2012. 2004 panel had industry ties for 8/9. FOURIER reanalysis showed numerical (nonsig) higher cardiac deaths. CTT data access limited. NICE 2023 allows consideration below 10% risk. Absolute benefits small in low-risk primary prevention; relative event reduction ~20-30%.
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