Adapted from Statins: the risks and statistics by George Winter, Freelance writer and Fellow of the Institute of Biomedical Science. British Journal of Nursing 2023 Vol 32 No 20.
In a randomised trial of 3000 participants, Carling et al in 2009 concluded that when presented with the benefits of taking statins as a relative risk reduction, participants were more likely to accept treatment compared to when the absolute risk was given.
In a meta-analysis of 21 randomised controlled trials, Byrne et al in 2022 found reductions in AR of 0.8% for all cause mortality, 1.3% for myocardial infarction, 0.4% for stroke in those randomised for treatments with statins compared with control. The RR reduction for these were 9%, 29% and 14% respectively.
Diamond and Leaverton in 2023 consider that undue emphasis on RR reduction compared to AR reduction has led healthcare providers and the public to overestimate concerns about high cholesterol and to be misled as to the magnitude of the benefits of cholesterol lowering therapy.
Diamond and Leaverton re-evaluated the JUPITER trial of rosuvastatin. There were 18 thousand participants and there was a reported RR of 54% for fatal myocardial infarction. In absolute terms, the incidence of fatal MIs was 0.76% in the control group and 0.35% in the rosuvastatin treated group.
It would seem reasonable and good practice for both RR and AR to be discussed with patients when it comes to initiating treatments such as statins.
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I agree, absolute risk should also be discussed. All too often the absolute risk is minuscule but all we’re told is how large the relative risk reduction is.
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It is just ridiculous that we are forced to discuss this issue. Of course Statins are appropriate. Using statistics to make one thing look like another is a scourge.
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I think that the problem Rick, is that statins are certainly appropriate if someone has had a heart attack or stroke but more problematic if they haven’t, particularly in women.
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