The findings
- Correct – no mortality benefit associated with treatment of people with a less than 20% risk of developing cardiovascular disease over the next 10 years.
- Incorrect – statin side effects occur in 18-20% of patients
In October last year, The British Medical Journal (BMJ) published an article by John Abramson and colleagues that questioned the evidence behind new proposals to extend the routine use of statins to people at low risk of cardiovascular disease.
The authors re-analysed data from the Cholesterol Treatment Trialists’ (CTT) Collaboration. This showed no mortality benefit associated with treatment of people with a less than 20% risk of developing cardiovascular disease over the next 10 years. This analysis has not been challenged.
However, the authors also cited data from a separate uncontrolled observational study and incorrectly concluded that statin side effects occur in 18-20% of patients. This incorrect statement was repeated in another article published in the same week in The BMJ by Aseem Malhotra – and is the statement the authors have now withdrawn.
An editorial by Editor-in-Chief of the BMJ, Dr Fiona Godlee, alerted readers, the media, and the public to the withdrawal of these statements “so that patients who could benefit from statins are not wrongly deterred from starting or continuing treatment because of exaggerated concerns over side effects.”
The BMJ was alerted to the error by Rory Collins, professor of medicine and epidemiology at Oxford University and head of the CTT Collaboration whose data were re-analysed by Abramson and colleagues.
Professor Collins has requested retraction of both articles, but Dr Godlee questions whether the error is sufficient for retraction, “given that the incorrect statements were in each case secondary to the article’s primary focus.”
Considering that the primary focus was an analysis of the data and that Abramson and co raised very valid questions regarding routine use of statins for people at low risk of cardiovascular disease, then the hope is that their findings will not be lost or diminished by the error made in reporting the percentage of side effects.
In reality, although they got the percentage wrong, people do experience side effects from statins and it is good to question their use on a mass scale, while acknowledging that there are some people with specific conditions who do benefit from the use of statins.
Meanwhile, back at the BMJ, Godlee asserts that: “The BMJ will continue to debate the important questions raised in both these articles: whether the use of statins should be extended to a vastly wider population of people at low risk of cardiovascular disease; and the role of saturated fat in heart disease.
This is welcome as the whole issue of statins is a debate that is far from over.
Health Aware 