Statins have been featuring in the news fairly regularly of late. Last week they made the headlines again when a systematic review of side effects in placebo-controlled trials of statins was published in the European Journal of Preventive Cardiology.
“Statins ‘have no side effects’” read the front page of The Daily Telegraph. But as Jacqui Wise reports in a research news article on bmj.com, it is the number of side effects attributable to statins that this study calls into question, “as almost all side effects were reported just as often with a placebo.” An interesting finding and perhaps a demonstration of the nocebo effect at work? As Judith Finegold, one of the study’s authors, puts it: “Most people in the general population, if you repeatedly ask them a detailed questionnaire, will not feel perfectly well in every way on every day. Why should they suddenly feel well when taking a tablet after being warned of possible adverse effects?”
The authors also discuss how side effects are often incompletely reported in randomised controlled trials. Observational studies were outside the scope of the review, but are an important source of information regarding adverse effects (such as this population based cohort study on the unintended effects of statins in men and women in England and Wales).
The news article mentions that the findings are important in the context of recent draft guidance from NICE recommending lowering the risk threshold at which statins are offered for primary prevention of cardiovascular disease. Similarly in the US, the latest guidelines from the American College of Cardiology/American Heart Association also recommend wider prescribing of statins. These moves have been seen as controversial by some and ensured that statins are never very far from the headlines.
Here’s a round-up of recent coverage on bmj.com:
- Should people at low risk of cardiovascular disease take a statin? by John Abramson and colleagues (with accompanying rapid responses, including a letter from the authors of the Cochrane review of statins for primary prevention of cardiovascular disease)
- Statins: benefits and harms for low risk patients podcast
- Target cardiovascular risk rather than cholesterol concentration by Harlan Krumholz
Navjoyt Ladher is a clinical editor, BMJ.