The simple answer to this question is yes, however, the deeper more philosophical answer would be “yes, in the same way that the Atlantic Ocean level drops when one person gets out of it.” The better question is how much does the risk really drop when you take a statin drug. The results may surprise you.
In order to understand how the medical industry misleads you and your doctor into believing that these medications actually make a significant difference to your health, you will need to understand some very basic statistic terms. I realize that this may make you want to stop reading, but please continue, I promise that they are very easy to grasp and will only require 60 seconds of your time. Here they are:
Relative Risk (RR) – This is almost always the number that will be reported by the press and the drug companies because it makes the tiniest of difference sound quite impressive. Relative risk is best described by giving an example. If a study is looking to find out if a medication decreases the risk of death in a giving period and the results demonstrate that the medication decreased the death rate from 4 per 1000 to 2 per thousand then the Relative Risk reduction is 50%. It sounds quite impressive that a medication decreased the risk of death by 50%.
Absolute Risk (AR) – This number is the more meaningful of the two statistical numbers and will almost never be presented to the public unless they are discussing the side effect risk. An example of absolute risk reduction can be demonstrated by the above example. If the medication decreases the risk of death from 4 per 1000 patients to 2 per 1000 patients then the absolute risk reduction is a measly 0.2%. As you can see, this number is not as impressive as a 50% reduction.
Number Needed to Treat (NNT) – This value is an interesting representation of the data and can be quite useful in evaluating the significance of risk reduction. This value basically tells you how many people need to take the medication before one benefit is realized. If death is the endpoint, NNT means how many people you will need to give the medication to before one life is saved.
Now that you have a fundamental understanding of basic statistics, let us evaluate some of the research literature. Please note, we are not choosing obscure studies in order to prove our point, we are evaluating the very same studies presented by the drug companies and published in peer reviewed journals.
EXCEL Study – The EXCEL study used lovastatin and was a short duration of only 1 year. Unfortunately for the drug company, there was an increased relative risk of death of 150% and an absolute increased risk of 0.3%. This means that the lovastatin increased the risk of death. The NNT for this study was 333 which means that you had to treat 333 people to kill one person.
AFCAPS Study – Again lovastatin was the medication used in the study. This time the study continued for 5.2 years and again resulted in an increased risk of death, although lower than the previous study. RR was a 3.9% increased risk of death, 0.09% increased absolute risk and you would need to treat 5000 people with lovastatin to kill one person.
4S Study – This study used simvastatin and followed people for 5.4 years. At study’s end the subjects who took the simvastatin apparently enjoyed a 29% decreased relative risk. The absolute risk reduction was a miniscule 3.3% decrease which means you will need to treat 167 people in order to save one life.
HPS Study – This study used simvastatin and followed subjects for 5 years. At the study’s end the simvastatin group had a 12% relative risk reduction which translates to an absolute risk reduction of 1.8% which means you will have to treat 278 people in order to save one life.
WOSCOPS Study – This study used pravastatin and followed people for 4.4 years. In this study there was a 22% decreased relative risk reduction which amounted to less than a 1% absolute risk reduction. This means that you will need to treat 500 people in order to save one life.
PROSPER Study – This study used pravastatin for 3 years and had a relative risk reduction just under 2% which was an absolute reduction of just 0.2%. This means that in order to save 1 life 1429 people would need to be treated.
ASCOT Study – This study used medicines most powerful statin, atorvastatin. The relative risk reduction was just 12% after 3 years and the absolute risk reduction was just 0.15%. This means that you will have to give 667 people to save one life.
As you can see, it is in the advantage of the drug company to report the relative risk which is an inflated statistical value that is not the actual or absolute risk. When absolute risk is taken into account, the medication still appears to lower risk of death it is just a lot less than the relative risk would have you believe. In my book I am only interested in the absolute number of deaths, this way I can make a truly informed decision about my course of action. I am not interested in using a medication that only helps 1 in 300 people and subjects the remaining people to needless side effects such as liver damage, nerve damage, memory loss, muscle pain and increased cancer risk.