medication pills elderly
© PA
A pensioner with her daily prescription drugs. A recent study recommended more over-75s should be staking statins.

More than six million people in the UK take statins, but the arguments continue over whether everyone should be on them.

Few drugs polarise the academic and medical world like statins - the most commonly prescribed medicine in the UK with at least six million people taking the cholesterol-lowering drugs. In recent days, the debate surrounding statins has seen daggers drawn once more with even the Health Secretary dragged into the latest war of words.

Earlier this month a "devastating investigation" in the Mail on Sunday claimed to unmask a group of high profile "statin deniers" who were spreading "deadly propaganda" about the drug. Dr Aseem Malhotra, an honourary NHS consultant cardiologist at Lister Hospital Foundation trust in Stevenage, Hertfordshire, and in private practice, Dr Zoe Harcombe, an academic whose research focuses on food and nutrition, and Dr Malcolm Kendrick, a GP from Cheshire, who says people are "being conned" over statins in his recent book on the subject, were the focus.

The article said the "noisy group of sceptics" are responsible for putting people off taking statins who would otherwise benefit from them. Matt Hancock was approached for comment - the only problem was he was not told the article would be attacking Dr Malhotra, who met the Health Secretary in Westminster at last month's All Party Parliamentary Group for Diabetes meeting, and Dr Harcombe.

Mr Hancock sent a direct message on Twitter to Dr Malhotra saying he had "no idea" the paper would link statins denial to the pair.

"I have never denied statins can be beneficial," Dr Malhotra told i. "The key point about the statins is: will the benefits outweigh the side effects of the drugs for the patient? And in many cases they don't. But most importantly is ensuring patients are fully aware of absolute benefits and risks so they can make an informed decision on whether to take or stop the drug. This is the ethical practice of true evidence based medicine."

During a recent TalkRadio interview with Eammon Holmes, Dr Malhotra said it is "completely false" to refer to him as a statins denier. "What I advocate is lack of transparency in their prescriptions. This is about patient choice, good science and the ethical practice of medicine," Dr Malhotra said.

The 59-year-old presenter revealed he had been taking statins for five years until recently. He said: "I woke up most days having taken my [statins] tablets and feel like crap. I feel fatigued. I continually forget things."

Having stopped taking statins two months ago, Holmes said he felt better "day by day", adding: "I feel like the old me."

'Distorted and defamatory'

The media war of words goes back further. Under the headline "Butter nonsense: the rise of the cholesterol deniers", a Guardian article in November targeted Dr Malhotra - a regular Guardian (and i) contributor - for his "strong views" of statins. For personal reasons Dr Malhotra was unable to respond at the time, but in a letter sent today to Guardian editor Kath Viner has called for a retraction calling the article "misleading, distorted, inaccurate and defamatory".

He wrote: "And unless it is fully retracted online I believe it will continue to cause significant damage to public health with a negative effect on millions of people."

Fiona Godlee, editor in chief of The BMJ, told i: "The debate about who should take statins is clearly still very much alive. The Guardian article seemed to be a blatant attempt to suppress that debate by attempting to discredit those who question the merits of statins in people at low risk of heart disease. The article was misleading and fell well short of the standards for accuracy or impartiality expected of a credible and trusted publication. I believe it needs at least very substantial correction."

Oxford University's Professor Rory Collins, who has published many papers on the benefits of statins, has accused Dr Malhotra and others of endangering lives by putting people off taking the drug.

In a 2016 review he carried out on statins analysing all the published trials on the drug over a 30-year period, published in the Lancet, Professor Collins said: "Our review shows that the numbers of people who avoid heart attacks and strokes by taking statin therapy are very much larger than the numbers who have side-effects with it."

The review concluded that lowering cholesterol over five years with a cheap daily statin would prevent 1,000 heart attacks, strokes and coronary artery bypasses among 10,000 people who had already had one. It would also prevent 500 in people who were at increased risk, for instance because of high blood pressure or diabetes.

Following accusations that previous statins trials "hid" data on adverse side effects, Professor Collins and a colleague have now requested every single adverse event in all the major studies and plan to publish the first analyses of these data later this year.

Between 2006 and 2016 statins prescriptions increased 68.6 per cent, due in part to the substantial growth of generic prescribing as more drugs became available for cheaper on the NHS. Dr Malhotra said he has prescribed statins and managed "thousands of patients" on the drug over the course of his career so has a first hand experience of their effects.

"I know what they're absolute benefits are," he said. "If you have a low risk of heart disease, or are otherwise relatively healthy... statins will not prolong your life by one day. And most of the people in the world taking statins are in this category."
What are statins?

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol - so called "bad cholesterol" - in the blood. Statins reduce the production of LDL inside the liver.

Having a high level of LDL is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD), a general term that describes a disease of the heart or blood vessels. CVD is the most common cause of death in the UK and kills about 150,000 people in the UK each year.

The main types of CVD are coronary heart disease, angina, heart attacks and stroke. Your doctor may recommend taking statins if either you have been diagnosed with a form of CVD, or your personal and family medical history suggests you are likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk.

The NHS says that the risks of any side effects, such as such as diarrhoea, headache, fatigue or feeling sick, also have to be balanced against the benefits of preventing serious problems. A review of scientific studies into the effectiveness of statins found that around 1 in every 50 people who take the medication for five years will avoid a serious event, such as a heart attack or stroke, as a result.

The NHS also says your doctor should discuss the risks and benefits of taking statins if they are offered to you. Doctors should also recommend lifestyle changes - such as changes to diet, exercise or reducing alcohol intake - to reduce the risk of developing CVD before they suggest that taking statins.

Comment: It's important to note that the above description is the mainstream line on cholesterol and heart disease and does not necessarily reflect the truth. The subject is controversial and much more complex than the simple "good cholesterol/bad cholesterol" narrative implies. See:

In 2014, the National Institute for Health and Care Excellence (NICE) recommended that preventative treatment for cardiovascular disease (CVD) should be halved from a 20 per cent risk of developing the disease over 10 years to a 10 per cent risk. A BMJ article in 2017 said that almost all men over 60 and all women over 75 in England - 12 million people - qualify for statin prescriptions under the updated guidelines.

Comment: And none of these "experts" seem to see a problem with an entire segment of the population being medicated as a result of their risk assessment.

Almost 20 articles have been written about statins across national print and web in the last week alone as research into the drug continues apace. An international study published this month said a new type of drug - called bempedoic acid - could offer another weapon in the fight against bad cholesterol. It suggested the pill lowers cholesterol in people who continue to have high levels despite taking other drugs such statins.

And scientists suggest the new therapy may also work as an alternative for people who are unable to take statins because of side-effects. Researchers, who published their findings in the New England Journal of Medicine, say they have asked UK and US drug regulators to consider whether to approve the pill.

Responding to the research Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: "Research has shown a clear link between cholesterol and heart disease. People with high cholesterol levels may need to combine medication along with a healthy lifestyle to bring these levels down.

"On the whole statins do a great job of lowering cholesterol. However, this new drug could provide real benefit for the few people who can't take them or require additional treatments to get it to the right level. The research suggests that it has the potential to reduce risk of heart attacks and strokes without major side effects."

Row rumbles on

What is certain is that the great statins debate shows no signs of going away.

Sir Richard Thompson, past president of the Royal College of Physicians, said: "Attacking doctors who genuinely hold opposite views , such as labelling them 'cholesterol or statin deniers', should be no part of this healthy debate; rather we must all try to move towards a scientific consensus for the benefit of patients."

Professor Samani said: "While there may be some debate to be had about the level of risk a person should reach before being prescribed statins, there is overwhelming evidence to suggest that statins save lives of those at a relatively high risk of heart attack or stroke, especially people who have already suffered one of these events.

"There is a natural interest in statins as they are one of the most widely prescribed drugs in the UK. Although their benefit is largely invisible to the people taking them, there is a wealth of evidence that proves they save lives by reducing a person's risk of a deadly or disabling heart attack or stroke.

"We know that negative and conflicting reports in the media can stop people from taking their prescribed statins. While recent headlines might lead people to question their statins prescription, the reality is the benefits of taking statins far outweigh any risks, especially in patients who have had a previous heart attack or suffer with coronary artery diseases.

"If you are taking statins and have any concerns, consult your doctor who will base their advice on objective interpretation of the best evidence available."