Pharmaceutical advertisements often highlight the benefits of a particular drug, including its ability to reduce the risk of various health conditions. However, the actual risk reduction these drugs provide may differ from what is portrayed in the advertisements. It is the opinion of the author that if cardiologists and other providers told their patients the absolute risk reduction of statins is 0.8% for all-cause mortality, 1.3% for myocardial infarction and 0.4% for stroke and the side effects of going on a statin include dementia, worsening dementia, confusion, muscle problems, such as aches, pains, weakness, muscle breakdown, falls, nausea, constipation, diarrhea, and increase the risk of type 2 diabetes, would you or anyone else ever agree to take a statin?
Understanding Risk Reduction
First, it is essential to understand the concept of risk reduction. Risk reduction is typically expressed as a relative risk reduction (RRR) or an absolute risk reduction (ARR) to distinguish between actual risk reduction and the risk reduction often seen in advertisements.
Relative Risk Reduction (RRR): RRR compares the risk of an event occurring in the treatment group to the risk in the control group. It is expressed as a percentage and sometimes misleading, as it does not provide information about the actual risk reduction.
Absolute Risk Reduction (ARR): ARR represents the actual difference in risk between the treatment group and the control group. It is also expressed as a percentage and provides a more accurate measure of the drug's effectiveness.
Statins and Cardiovascular Risk Reduction
Statins are a class of drugs commonly used to lower cholesterol levels and reduce the risk of cardiovascular disease (CVD). However, the actual risk reduction provided by statins may be smaller than often assumed. A meta-analysis of twenty-one randomized clinical trials involving 140,000 participants found that statins had an inconsistent and inconclusive impact on CVD outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. The researchers observed a relative risk reduction of 9% for all-cause mortality, 29% for MI, and 14% for stroke in those randomized to treatment with statins compared to the control group. However, the absolute risk reduction was only 0.8% for all-cause mortality, 1.3% for MI, and 0.4% for stroke.
The Difference Between Actual and Advertised Risk Reduction
Pharmaceutical advertisements often focus on the relative risk reduction of a drug, which can be misleading. A study published in the British Medical Journal found that people tend to overestimate the effect of an intervention when the results are expressed in relative terms. In the case of statins, the relative risk reduction may lead people to believe that the drug provides a larger benefit than it does. In contrast, the absolute risk reduction offers a more accurate measure of the drug's effectiveness. For example, a study published in the American Family Physician found that the absolute risk reduction for all-cause mortality with statin treatment was 0.6%, with a number needed to treat (NNT) of 167. This means that 167 patients would need to be treated with a statin for 4.1 years to prevent one death.
Dementia Risk and Statin Use
There's also an association between reduced dementia risk and statin use. Other side effects include but are not limited to, worsening dementia, confusion, and muscle problems, such as aches, pains, weakness, muscle breakdown, falls, nausea, constipation, diarrhea, and increased risk of type 2 diabetes.
Conclusion
Pharmaceutical advertisements often emphasize relative risk estimates, making drugs seem more effective than they might be. Understanding relative and absolute risk reduction is crucial for informed decision-making regarding statins and other medications.
