This story by The Guardian highlights a new study in the journal “Circulation” that digs into the data of a 20-year study of cholesterol and heart disease in thousands of European men. The Guardian appears to lean heavily on an Imperial College press release that trumpets the benefits of taking statin drugs, which can lower LDL or “bad” cholesterol — and reduce the risk of deadly heart disease. It claims the study showed statins reduced the risk of death from heart disease by 28%.
But that’s a lopsided and potentially misleading way to present the data. When broken down into absolute numbers, the benefits are far less dramatic (see quantified benefits criterion, below). In that light, the advantages compared to the disadvantages of taking statins for many years — risk of muscle pain, liver damage, diabetes, and more — become less clear.
The story also misses a very big red flag when it comes to making clear that most of the authors have a financial relationship with the primary funder of the study: a drug company that makes statins.
Readers need accurate data to make informed healthcare decisions. Relative numbers sound good, but are only one half of the story. Readers also deserve to know any potential conflicts of interest, such as who paid for the study.
Costs were not discussed. However, statins cost between roughly $313 (generic) to $1,428 (name-brand) per patient per year in the US, according to a 2012 study in Pharmacoptherapy. The costs are much less in the UK: $164 (generic) and $509 (name-brand) per patient per year.
The story only told readers the relative risk improvements for taking a statin. It did not present the terms in absolute numbers. By the relative measure, taking statins seems very effective: 28% fewer men died from heart disease when taking statins compared to a placebo.
But the absolute risk is more sober and should always be presented along with relative numbers. Of the group taking statins, 6.69% of people with very high LDL died from cardiovascular heart disease within 20 years. Of the group taking a placebo (and it’s not immediately clear to us what their LDL status was), 9.03% died from heart disease.
No side effects of statins are mentioned, but they’re significant. Taken over many years, let alone decades, those risks become even more significant considerations. The most common side effect — 29% of people on statins report experience it — is damage to muscles and muscle pain (e.g. soreness, tiredness, and weakness), according to the Mayo Clinic. However, those on placebo report a similar rate of muscle pain and damage. Other, less common side effects (for which there’s also less evidence that statins may be responsible) include liver damage, increased blood sugar or type 2 diabetes, and memory loss/confusion.
The story lays out the basic results and methods (e.g. a randomized trial on 2,560 men with high cholesterol), though it doesn’t go much beyond that. What were the limitations?
We didn’t see any unwarranted language, though the potential is high for overtreatment when using a drug in healthy people.
The story doesn’t note how the study was funded through Sanofi, a company that makes, markets, and sells statins, Furthermore, most of the authors disclosed that they have accepted either grant money or fees from major pharmaceutical companies. In fact, five out of the the eight authors had or have a financial relationship with Sanofi.
This is not adequately explained. While a 20-year study sounds impressive, we’re not told about other similar treatments and lifestyle changes.
Statins are widely available drugs, and the story tacitly implies they’ve been available for about 20 years.
The story makes it clear that the length of the trial is what’s novel.
Quotes in this story directly match those from an Imperial College news release about the study, but there is no attribution given to the news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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