Reacción a "Statins cause almost none of the side effects listed in their package inserts, according to a meta-analysis"

A meta-analysis that includes individual patient data is an extraordinary collaboration that provides a higher quality of information than most meta-analyses, which use aggregated data from individual studies. In this regard, we are grateful to the Cholesterol Treatment Trialists' Collaboration, which has previously provided us with detailed information on the protective effects of statins in cardiovascular prevention and on some side effects (myopathy, diabetes mellitus), whose importance is far outweighed by the unquestionable benefits of lipid-lowering treatment in patients with high cardiovascular risk.

Several placebo-controlled studies report that most of the alterations attributed to statins are based on the “nocebo effect”, which is the mirror image of the placebo (subjective harm/benefit to the patient independent of the actual pharmacological effect of the treatment). In other words, the apparent discomfort or side effects of statins have no real pathophysiological or pharmacological basis. Paradoxically, the detailed description of possible side effects in the information contained on statin packaging (technical data sheet) potentially reinforces the “nocebo” effect. Who does not experience some discomfort over the years, whether or not they are taking medication?

Once it has been confirmed that there is no objective basis in clinical trials for many of the disorders attributed to statins, a note of caution should be added. Clinical trials are not real life; the use of statins is widespread, including in patients who are usually excluded from pivotal clinical trials: the elderly, ethnic minorities, patients with concomitant diseases and polypharmacy... Therefore, individual assessment of each patient with their doctor is essential.

Fortunately, we can reassure patients by pointing out that the primary (protective) and secondary (harmful) effects of statins have been extensively evaluated, and that hundreds of thousands of people currently take them and have taken them for decades with unquestionable cardiovascular protective effects.

If, after explaining all this, the patient considers that any of their discomfort is attributable to statins, we can agree with the patient to briefly suspend treatment (in most cases disproving the relationship with the drug) and, if the patient continues to consider that there are problems with the treatment, fortunately we have lipid-lowering treatments used specifically in statin-intolerant patients or with completely different mechanisms of action (ezetimibe, iPCK9), which have demonstrated cardiovascular benefits and can provide effective and safe alternatives for reducing cardiovascular complications by controlling hypercholesterolaemia.

Unfavourable press reports about statins are not irrelevant, as they are associated with a decline in their use and an increase in cardiovascular disease, so providing reassuring news has significant and undeniable public health value.