6 September 2018

Latest statins study comes under fire

Cardio Research

Australian experts have slammed new research claiming statins are generally useless in healthy older people, calling the evidence for the conclusion “weak”.

In contrast to guidelines recommending widespread statin use in primary prevention for older and very old individuals, the authors of a Spanish primary care database analysis said statins did not reduce heart disease and stroke in this population, although the treatments did appear to be effective in patients with type 2 diabetes.

But cardiologist Associate Professor David Colquhoun attacked the study, saying the authors’ statements were wrong and that the paper did not add anything to the literature.

“It is difficult to understand how a respected medical journal such as The BMJ could publish poor research and allow unsubstantiated statements to be made which are incorrect and which have important consequences regarding cardiovascular health,” the Associate Professor of Medicine at the University of Queensland said.

Professor Colquhoun warned that media coverage of this could echo the infamous statins story that ABC science program Catalyst ran, which he said caused an additional 1,500 to 3,000 heart attacks or strokes after patients stopped taking their medication.

Rather than being a clinical trial of the medication, the European study authors sifted through one of Spain’s primary care databases which included almost 50,000 patients aged 75 or older. They compared those who had type 2 diabetes and those that didn’t, as well as those who didn’t use statins and those who began during the study period.

Using linked hospital and prescription data, the authors said patients with diabetes had a significantly lower chance of cardiovascular disease and all cause mortality if they were started on statins, but the rates were unchanged in patients without diabetes. The protective effect for diabetes patients also appeared to drop off after the age of 85 years.

But Professor Colquhoun said linking prescription and database data was the “weakest form of research” and that it was impossible to know who took their drugs and whether their lipid levels were affected.

Professor Garry Jennings AO echoed these reservations, saying definitive conclusions couldn’t be drawn from a retrospective cohort study such as this.

Because the study failed to include a valid control group, the fact that patients on statins had similar health outcomes as those not on the drugs could instead be a sign of the drugs doing their job in well-targeted patients, the Executive Director of Sydney Health Partners said.

While guidelines recommend some patients aged 75 or older should have statins as primary prevention, Professor Jennings reiterated that research was under way to better clear up their value for those aged 85 or older.

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3 Comments on "Latest statins study comes under fire"

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Dr Ross Baillie
9 months 9 days ago

PS res ipsa loquitur

9 months 11 days ago

Thanks for the story, Ruby. It is interesting though, that the Australian medical media picked up on Prof Colquhoun’s responses without any mention of his extensive and longstanding conflicts of interest with the pharmaceutical industry.
It would have been nice to get an independent viewpoint rather than his very predictable one.

Dr Ross Baillie
9 months 12 days ago

GP colleagues will be interested in a short interview between a prominent Sydney cardiologist Dr Ross Walker and Dr Maryanne Demasi earlier this year. A search will find it fairly quickly. Please dont be put off by any adds that may come before the interview posting (depending on which site it is located). Paul Smith (now Editor of a competing weekly medical publication) also raised similar issues of substance in a past ‘Journal Talk’ Editorial in his magazine.