Nigel Hawkes, Health Editor
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People who take cholesterol-lowering drugs are protected from heart disease and premature death years after they stop taking them, a major study has shown.
New research into statins – the world’s biggest-selling medication – offers dramatic evidence of their long-lasting ability to halt and even reverse the progression of heart disease.
The study, involving 6,500 men, found that those who took statins were still showing benefits of the drugs ten years after they had finished taking them. The chances of suffering a fatal heart attack over the period dropped by more than 25 per cent, the scientists found, while there was no evidence of unexpected side-effects.
This remarkable result will increase pressure on GPs to prescribe statins to an even greater number of middle-aged people with raised cholesterol levels.
Professor Stuart Cobbe, of the University of Glasgow, the leading cardiologist on the study, said that he had been extremely surprised. “The benefit appeared to extend to at least ten years after the original trial,” he said.
The findings do not suggest that people on statins should give up; rather it is better to continue taking them. But even those who do give up continue to enjoy a benefit, Professor Cobbe said.
The results, published in The New England Journal of Medicine, come three months after a government adviser suggested statins should be offered to all men over 50 and women over 60 as an effective “shortcut” to prevent heart disease.
Statins are currently taken daily by an estimated three million Britons to tackle high chloresterol. Heart disease is Britain’s biggest killer, accounting for one in three deaths. The annual cost to the economy is about £26 billion a year, the bulk of which is treatment costs.
Professor Chris Packard, a co-author of the study, said: “The impact of the statin treatment appeared to persist long after the active phase of the trial. This suggests that the drugs have lasting beneficial effects on the artery wall, possibly by stabilising plaques that might be about to rupture and cause an heart attack.” Breakaway plaques can cause attacks by blocking the blood vessels and starving the heart of blood. Statins appear to stabi-lise the lining of the blood vessels, as well as damping down inflammation.
The original trial, the West of Scotland Coronary Prevention Study (Woscops), was launched between 1989 and 1991. More than 6,500 men aged between 45 and 64 who had not had a heart attack but had elevated cholesterol levels were recruited and divided into two groups. Half were given pravastatin and the other half a placebo. They were followed up for five years, until May 1995. The results showed that the risks of death from heart disease, or of suffering a heart attack, were significantly reduced in the statin users.
The new study follows up the same men for another ten years. It compares heart attack and death rates in the original statin group against the original placebo group. Since the trial, both groups have changed. The statin group have tended to give up taking the tablets, while many of those in the placebo group have started to take them.
No account was taken of these changes, and a simple comparison was made of the 15-year experience of the original statin group against the original placbo group.
Professor Ian Ford, lead author of the study, said: “Remarkably, five years of treatment with a statin resulted in 27 per cent fewer nonfatal heart attacks or deaths due to heart disease over the period of 15 years. There was a significant 12 per cent reduction in deaths over the entire period, with deaths due to heart disease reduced by 22 per cent.”
The gap between the groups narrowed after the trial ended, and their use of statins tended to converge. But up to the end of the 15-year period, the original statin group did better than the original placebo group, showing a persistence of the effect.
Professor Ford said: “The results of the follow-up provide strong support for the safety of five years of statin use.
“When fatal and nonfatal heart disease events were studied it was found that, despite the fact that most of the participants were not treated with a statin after the first five years of the trial, there was evidence of the group originally receiving the statin continuing to be at lower risk of having a heart disease event.”
Statin prescriptions have risen by 150 per cent in England in the past five years. The trial raises the question of whether they should be given to an even wider group, including younger people in whom heart disease has yet to get a start.
'Three years on statins and no plans to stop'
Jack Gordon, from Edinburgh, has been taking statins since he suffered what felt like a heart attack.
Mr Gordon, 57, was active and had a healthy lifestyle, spending a lot of time hill-walking, smoking only socially and eating what he felt was a healthy diet. But one morning he woke up with a pain in his stomach that got worse during the day.
When he phoned the emergency number, he was asked if the pains were also in his neck and wrist, and was told that he may have had a heart attack.
He was put on statins immediately and his cholesterol level fell from 5 mmol per litre to 3.5. Unlike many people prescribed statins, he is still taking them three years later and has no plan to stop.
He has also given up smoking and focused harder on what he eats. But with no further trouble from his heart he has returned to hill-walking.
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Dr Daniel Jones , LE PRE SAINT GERVAIS, PARIS
I hate to contradict a professional but the claim that they are wholly reversible is wrong. Please read Dr Graveline at spacedoc.net. It is clear that some of the changes ARE NOT REVERSIBLE, such as neurological changes & muscle mitochondrial changes.
m. cawdery, Portadown, Co. UK, EU
I was athletic, healthy and content before taking a statin drug five years ago. I am now 35 lbs heavier, lethargic, my joints ache, my muscles have atrophied; my memory, once good, is now spotty; I have little staying power, and I KNOW the statins, which I have not taken for over a year, are to blame. In restricting the mevalonate pathway to decrease the production of cholesterol, statins affect other vital functions utilizing the mevalonate pathway, such as the synthesis of CoQ10, dolichol and selenoprotein, and normal Glyceryl-glyceryl phosphorylation. These processes are not simply necessary for health, they are necessary for life. This is not only a dangerous, but a potentially lethal medication.
John Brooks, Fort Worth, USA / TEXAS
I started with horriable knee pain within weeks of starting lipitor, NO doctor connected it to the drug. Then I got lumpy swelling on my feet that itched and burned (NOT TINGLED) as it spread. Then I started with the forgetfulness overnight. Confusion, indigestion, acid reflux, vertigo and a whole array of problems that my doctor was more than happy to give me another Rx to fix.. I got off and within days realized my head fog was gone, my memory inproved and guess what.. all the other symptoms went away too and I realized something else.. It had stolen ALL my energy and I didn't even realize it until I got it all back.
This article made me laugh. The statin drugs on commercials and web sights had a disclaimer on them that it has not been proven these drugs prevent heart attack or strokes.
Gram, Gonzales, USA
Three weeks before I had a heart attack a well-woman's clinic tested my cholesterol level and it was 3.4. I have been put on statins four times with drastic side effects from muscle pain to oedema and the worst being a day of menstruation despite the hysterectomy I had 23 years previously. Despite medical assurances that it was not the statin, I have never taken one since and have never had that problem before in 23 years nor since stopping statins.
Roz Venner, Cambridge, England
I just tried statin tendon as a search in google. Try it for yourself, Not for the sqeamish. Seems the truth is easier to find than when I first searched 2 years ago......
bob taylor, castelnau, France
To answer Mandy who writes "My fear is that the statin has permanently damaged me and limited my mobility"; this is not possible as all the adverse effects of statins (which would have eased off had you insisted with them) are completely reversible, no need to worry from that point of view. As for Paul's comments, effectively diet is not just not enough it's often largely a waste of time as you can observe from his comments about his childrens' cholesterol levels. Most cholesterol isn't dietary but metabolic; some people just make too much of it. Dr Daniel Jones
Dr Daniel Jones , LE PRE SAINT GERVAIS, PARIS
Fat meat, cheese , eggs, butter, full cream milk, cream, full fat yogart, chips cooked in beef dripping, fish, fruit and veg, steak&boiled potatoes, salads. = low cholestoral.ie-4.3
Eddie Ward, Llandrindod Wells, Radnor County
The second sentence of your article explains the real reason for the increased use of statins....ie.....'the world's biggest selling medication'. Pharmaceutical Companies are laughing all the way to the bank while using sophisticated selling methods to increase profits even further .
It is a little publicised fact that statins inhibit the body's production of the enzyme CoQ-10, which is essential in good heart function. Doctors in the USA now prescribe CoQ-10 as the standard supplement when the use of statins is required ...while my brother's doctor (UK) claimed she knew nothing about it when questioned!
It doesn't inspire me with great confidence!
Laura Crawford, Glasgow,
I am on statins myself, and while I do believe that it is beneficial, I am not very satisfied with the above article, since it forgets to mention that it is highly controversial that statins are beneficial for women, and also highly controversial that its benefical effect is effectuated through the lowering of cholesterol. That looks like just a side effect. Also I very much would like to see real numbers instead of percentages, the overall effect then usually is much less impressive.
The cholesterol-debate is just like the climate debate choked by some stalinist consensus which makes journalist to forget about reporting about opposing views. That stifles progress. Google Malcom Kendrick or Uffe Ravnskov for more info.
Theo Richel, Kapelle, The Netherlands
surely any long lasting effects could equally if not mostly be attributed to lifestyle changes in diet and exercise
jo, edinburgh,
I am amazed that there is so little said about the side effects of statins, both in the Times article and elsewhere. I was prescribed statins after developing angina but decided against taking them as a work colleague was at that time sufering from severe side effects including muscle pain and wasting of muscles and tendons in his arms and legs. He also had severe kidney problems which he was told was caused by muscle protein in his blood. These problems were due to statins. I chose to make lifestyle and nutritional changes which appear to have worked.
The apparently uncritical promotion of statins by the medical profession without making clear the possible side effects should not be allowed to go unchallenged.
John Cruickshank, Aberdeen, Scotland
Grr! The headline is so misleading! The studies do not prove that people in general benefit from taking statins only men. Of the thousands of men tested in the trials, women were excluded. Is it any wonder that heart disease is the number one killer of women in this country for example, when their differing medical needs are so blatantly ignored by drug companies researching the subject? I speak from personal experience. When my sky high blood pressure was first diagnosed as part of a health check at a gym, the man taking it assumed I was on drugs. He later admitted that had I been a man he would have immediately called for an ambulance.
Anne, London, England
The absolute risk reduction (ARR) in WOSCOPS was 0.43%! The number of patients needed to treat (NNT) for one to benefit was 232 (NNT = 1/ARR). In the WHO's MONICA trial it was showed there's absolutely no relationship between a country's average cholesterol level and rate of coronary heart disease-related death.
Framingham's ARR = 0.13!
JApanese Lipid Intervention trial (J-LIT) showed an increase in death rate as LDL ("bad cholesterol") dropped from 120 towards and to 80.
PROSPER trial - NO all-cause mortality benefit!
ASCOT-LLA trial - Paltry 0.5% ARRin nonfatal MI in treatment group
PROVE-IT trial - ARR was 1% (all-cause mortality).
The very, very little benefit statins provie is likely due to proposed pleiotropic effects - increased nitric oxide release, decreased proliferation of smooth muscle cells and NF-Kappa B inhibition.
For me it's phytonutrients, raw garlic, fish oil and curcumin!
Scott, Tampa, USA
Why are these studies only done on men and why are the side effects, and their terrible severity in some people, continually ignored?
Thalia, London,
I was put on Simvastain and within a year it had caused me to have liver damage!! oh yes its a great drug!!
Deborah Panaghiston, Essex,
By the time Pfizer had to stop the trials of torcetrapib at the end of 2006 (because of too many deaths), they had been testing the drug for almost 2 years. For those not familiar with torcetrapib, it was designed to be used with Lipitor so producing a combined drug that not only decreased LDL (bad cholesterol) but increased HDL (good cholesterol). The ultimate panacea for heart disease in fact. Unfortunately when they examined the data they had collected they found that although the drug combination had produced the low LDL and high HDL as required, there had been no alteration to the patients heart disease progression (at least compared to Lipitor alone). The doctors now claim it produced the wrong HDL on top of the terrible side effects. I am always amazed at how tenacious the modern doctor is at protecting the cholesterol theory. So keep taking those statins. They cause terrible side effects and probably wonât stop you getting heart disease.
Paul, Tamworth,
Does this mean that they were aware that statins would cause serious harm to people? How many folk did they estimate would have memory problems where they would not be able to recall the names of their family members or even finish off a complete sentence without forgetting what they were saying and even start slurring when they talk?
How many people are left with muscular problems and fatigue that often stays after stopping the medication and in some cases becomes permanent? The side effects from statins are horrendous and while people keep saying that "STATINS ARE A WONDER DRUG" all I can say is you take them and see what happens to your body and mind.
Just google "statin side effects" and see what comes up!!!
By the way you can almost guarantee if you have problems with statins, that your Doctor wont believe that this medication is the culprit.
Allen Heatley, Blyth Northumberland, England
I agree with Mandy, the side affects of taking Statins can be
devastating and the medical profession are just not interested.
Casey
Jim Sidebottham, wigan,
Just tried a google search, statin tendon, it makes interesting reading. When I did this search 2 yrs ago not much was found. times have changed....
Bob Taylor, Castelanu, France
I have taken statins for a few years now and my cholesterol level is down to a reasonable level. With my Drs agreement, I stopped for 2 months as a trial to see what would happen. My diet consists mainly of salads and probiotic yoghurt in the morning. After 2 months without statins, my cholesterol level had increased to excessive levels and I was advised to re-start my statins again. Both my children, in their late 20's, have high cholesterol readings although they eat extremely healthily and are very active in sports. My father has had several heart attacks, the first being aged 53. Both his brothers died of heart attacks at an early age. I have also been diagnosed as having had a silent heart attack in my late 40's. I think that if there is a family history of heart disease and cholesterol loevels are high at an early age, statins should be prescribed. Prevention is better than cure. Once you have furred up arteries, there is NO going back. Diet is NOT the whole story.
Paul, Norwich, Norfolk
I too experienced intensely painful and stiff joints with oedema whilst taking statins. I left them off and though I'm still in pain months later, things are better and I'm more mobile. My fear is that the statin has permanently damaged me and limited my mobility. Why isn't anyone keeping up with people who react badly to these drugs ?
Mandy, London, UK
I have been taking it for five years and the results haven been outstanding. my cholesterol levels have been much lower and I feel quite well.
George, New York, USA
It is a shame that people even need to take statins because lower cholesterol can be achieved with a healthy diet. Some of the comments here stated that cholesterol lowering does no good and that high cholesterol results in longevity⦠however this is not the case. There is absolutely NO EVIDENCE whatsoever that increasing someones cholesterol while itâs declining with age or not, will extend longevity. This is complete nonsense. For those that need statins please do what your doctor says and take them.
Matthew, Cardiff, Wales
Whilst my husband's colestrol was only slightly over what the doctor thought was the norm for a person with heart desease he had been on Provastatin for many years. But sadly this did not stop him from haveing a masive heart attack when he had a minor operation and then another massive heart attack three weeks later that he died from. This was 10 months ago. The statins did not help him!
I am on 40 mg of the same drug and I am by most standards now 'normal' colestrol wise. I ask myself is it worth it?
Hazel Dennis, Rossendale, Lancs, England
How easy is it to hoodwink the medical journalist.
Many recent studies (including Framingham) are now finding in favour of cholesterols protective role in longevity.
Stop taking a statin and live longer is the real message.
Pharmaceutical reps. tell jokes at the expense of medical journalists.
Statins cause 'mevalonate inhibition' in everyone and we bichemists know that road literally leads to madness.
G Wainwright, Leeds, UK
We were at our local village, new year dance and it was midnight, everyone was very happy. Then our neighbour fell down, his achilles tendon had snapped. Over the next three months his othe achilles tendon snapped and despite a repair the original snapped again. All this was due to a Statin. Our neighbour can now only walk with difficulty. Attacks on the tendons is a known but well hidden side effect of these drugs. Beware.....
bob taylor, castelnau, France
Within a month of starting Lipitor I suffered badly from oedema in my lower limbs and hands. "Utter rubbish" said my doctor , "none of my other patients are so affected". Reluctantly he agreed that I could stop taking them. Result, after 2/3 weeks, ankles, legs and hands were back to normal.
GMF, Poperinge, Belgium
My husband's decade annivesary with Lipitor adverse effects will occur in two months. A healthy and successful 50 year old corporate CEO when he took his first Lipitor pill, 10 mg over 4 years. The muscle pain started within three weeks. The Lipitor left him disabled with muscle damage, muscle wasting, peripheral neuropathy, memory loss to below the 1 percentile, chronic debilitating pain, multiple epsodes of transient global amnesia, aphasia, mitochondrial damage, chronic fatigue and pancreatitis leading to diabetes. All were adverse effects of the Lipitor, and all other potential causes have been eliminated. Today he remains disabled and in pain, a decade after that first Lipitor pill. An 85 page Frequently Asked Questions publicaiton lists published medical journal articles confirming every one of the adverse effect he continues to suffer these 10 long years.
Sharon Hope, Covina, California
Jeff (Bedfordshire) -- Beautifully expressed refute--no more needs to be added to it.
F. Durrer
F. Durrer, Alexandria, VA/ USA
Statins are not the panacea claimed for them. They are highly toxic preparations that lower cholesterol. They act early on within the mevalonate metabolic pathway and prevent the synthesis of cholesterol. They also prevent the synthesis of several vital products of this particular pathway... Heme A, Dolichols, Ubiquinone and Prenylated Proteins.
Cholesterol is found in every cell that respires. It is not the bad guy here and people who have a lower cholesterol tend to die earier than people with a high cholesterol, essentially because the body's bio-chemical process have been profoundly perturbed by statins.
The evidence is published and the medical profession and the pharmaceutical companies are not listening. I challenge any medic or biochemist to prove that cholesterol values are a predictor of heart disease. This meme has been circulating since the junk science of Ancel Keys & Framingham, where even the director admitted that after years of research there was no causal link.
Jeff Cable, Leighton Buzzard, Bedfordshire