Professor Bryan Williams separates fact from fiction about statins with Dr Mark Porter in the latest episode of Saga’s podcast, Experience is Everything: The Health Edition.
Why are statins so controversial? And are people right to be worried about their side effects? Those were the key questions that Saga’s latest health podcast set out to investigate – and the conclusions were eye-opening.
Dr Mark Porter’s guest on our podcast Experience is Everything: The Health Edition, was leading cardiovascular expert Professor Bryan Williams, the British Heart Foundation’s chief scientific and medical officer.
“It’s probably the most controversial drug,” he admits. “I’ve never quite understood it because there are many other treatments that we take on a regular basis – for blood pressure or some other drug to protect you against heart attacks and strokes – but for some reason, statins have always been in the firing line.”
Until recently, many assumed that the cholesterol-lowering drugs caused lots of side effects, including memory loss, depression, liver disease, sleep disturbance, weight gain, erectile problems and muscle pain.
However, major research earlier this year found there was little evidence for this. The research looked at data from 150,000 people in 23 clinical trials, most of which compared statins with a dummy drug or placebo.
In the review, led by Oxford Population Health and part-funded by the British Heart Foundation, of the 66 additional potential side effects examined, only four were found to have an association with statins, and only in a very small proportion of patients. They were: abnormal liver transaminases, other liver-function test abnormalities, changes in urine composition and oedema (swelling caused by fluid build-up).
Previous research by the same team had already examined the commonly held view that statins caused muscle pain and found that 14 out of 15 reports of muscle symptoms were not due to statins.
“Research like this plays such an important role because research is independent and statins can save lives,” says Professor Williams.
“Preventing cardiovascular disease has been one of the great successes of medicine over the last 50 years. The increase in life expectancy that we’ve seen in our population in my lifetime is 11 years. That is just extraordinary. Most of that has been due to effective cardiovascular disease prevention – and the cornerstone of that has been blood pressure lowering and cholesterol lowering. That’s indisputable.
“However, there is a lot of misinformation on social media and on the news - which always give higher prominence to misinformation than it does to trusted and existing sources.”
We take a look at the biggest myths surrounding statins and report Professor Williams’ expert take on each one.
It’s a commonly held view that as people reach their 70s and 80s they are less likely to benefit from taking statins. However, Professor Williams says there is no evidence for this. In fact, it’s the opposite.
“If your risk is high - and your risk gets higher as you get older - then the benefit, if anything, increases as you get older,” he explains. “Recently I was at a European Society of Cardiology meeting in Munich where they presented a very big study.
“People over the age of 70 starting statins for the first time [get the] same benefit – 30% reduction in the risk of heart attack, stroke, death or premature death. So, there’s no age threshold. If your life expectancy is still there ahead of you, and you want to avoid having a stroke and a heart attack during that time, the best way of doing it is to continue to take your statins.”
There had been fears that being on statins long-term could increase the risk of dementia and some cancers. However, recent research has found no evidence that statins increase dementia risk, while one recent study in people with type 2 diabetes found statin use was associated with a lower risk of dementia. Professor Williams believes the increase in these illnesses later in life is because people are living longer.
“In the early days of statins, people started to say things like, ‘People on statins tend to die more often of cancer.’ And of course, the reason for that was that cancer is a disease of ageing. And if you weren’t on a statin, you were dead. So, you didn’t get a chance to develop the cancer.
“In fact, there was also early controversy about whether statins increased the risk of dementia because people on statins were more likely to get dementia. The reason was that they were living longer.
“If you think about the common causes of death, they are cardiovascular disease, cancer and dementia. If you eliminate or massively reduce cardiovascular disease with statins and you reduce the risk of dementia, the one thing that’s left as you get older is cancer.
“So, I don’t think personally that the evidence is compelling that statins reduce the risk of cancer, but there’s no evidence at all that they increase it.”
In the podcast, Dr Porter reveals that both he and Professor Williams, 68, are on statins. They take atorvastatin, the most commonly prescribed drug in the UK, and they both feel very comfortable with their decision.
“If you were to talk to most doctors, they’re taking statins because they’ve looked at the data and the data is compelling that they will reduce your risk of heart disease and stroke,” Professor Williams points out.
“In this latest research we have hundreds of thousands of patients’ data, and you can look at the relationship between side effects in those who got a statin and those who got a placebo, a dummy drug. The important thing is that the patients in that trial didn’t know whether they got a statin or a dummy drug.
“You could work out what side effects are genuinely different between those who got the statin and those who got the dummy drug and the results are remarkable. If you look at the insert in a pack of statins, there were 68 or so potential side effects listed. What that study showed, published in the Lancet earlier this year, was that only four of those were seen in those who had taken statins.”
There are now dozens of plant-based products available that claim to reduce cholesterol without the need for medication. While Professor Williams believes these can help with your heart health, he doesn’t think they are a like-for-like replacement.
“They reduce the absorption of cholesterol from the diet and they will have a modest effect on cholesterol,” he says. “But nowhere near as potent as the effect of a statin in lowering cholesterol. It will be complementary to any statin.
“I haven’t seen any data that suggests just taking a plant-based strategy to reduce your cholesterol improves your survival. And I think it would be a very dangerous strategy to adopt as an alternative to a statin if you are high risk or you’d had a heart attack or a stroke.”
The best way to look at plant-based products like spreads, drinks and yogurts, he says, is as an additional top-up to a statin.
There are many different types. Earlier statins, like simvastatin and lovastatin, had to be taken before bedtime because our bodies make most of their cholesterol at night and in those days the effects of statins didn’t last long. “Your liver makes most of the cholesterol when you’re not eating, when you’re sleeping,” says Professor Williams. “So, if you only had a relatively short duration of action of the drug, you gave it at night.
“Atorvastatin came along after that and tended to have a longer duration of action. You can take [it] any time of the day because it works for the full 24 hours. It was also more potent than Simvastatin.”
However, many people on atorvastatin think they need to take it at night, he says.
There are many types of statins available, including:
Source: NHS
The big three, says Professor Williams are simvastatin, atorvastatin and the newest, rosuvastatin.
With more and more people trying weight loss jabs like Mounjaro and Wegovy, they are discovering that their blood pressure and cholesterol fall, along with their weight. That means their cardiovascular disease risk will be reduced, too.
So, will we even need statins in the future? Professor Williams says he will be interested to see what impact the jabs will have but we can’t just rely on them.
Of course, there’s the issue that most people who take the jabs currently pay for a private prescription. The NHS is planning for the jabs to be available to 220,000 people in 2028 – which represents only around 6% of the 2.8 million people eligible for the drug.
The rapid spread of the drugs – especially considering that they involve an injection – has taken many by surprise, including Professor Williams. “I’ve been surprised by the acceptance of a jab,” he says. “And of course, we now have daily tablets becoming available. The effects have been quite dramatic.
"Interestingly, not only does their weight come down, but their cholesterol comes down, their blood pressure comes down. Often if they were smoking, they smoked less. If they drank a lot of alcohol, they drink less. So, it looks like that centre in the brain that is involved in appetite regulation may also be involved in general craving regulation.”
However, he says that the most important thing is to have healthy lifestyle which will lower risk of cardiovascular disease.
“There’s really good evidence that if you can maintain a healthy lifestyle, it will maintain your health for as long as possible. Just doing some activity every day is really powerful at maintaining a healthy life expectancy.”
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