Are you over 60? Or younger but worried about your health? Then chances are you will be taking statins and/or aspirin. One in three people over 40 take statins, (up to seven million people in England), costing the NHS at least £450 million a year, and now NICE, the body that recommends what treatments are effective, is saying that that even more people should take them. 1
We all know the benefits, don’t we? – they reduce bad cholesterol and prevent heart attacks and strokes. So almost all of us over 40 should now “consider” taking them, say the experts (that means discuss it with your GP, of course – never mind the extra workload on a very hard pressed part of the NHS).
For those of us older people, like me, who do not want to take medication which may have side effects, all this media attention is making us feel that we really are missing a trick. Are we going to meet a premature death from a heart attack if we carry on putting our heads in the sand? So here are just a few little stories that put my mind at rest, at any rate. Recently a 61-year-old doctor, a leading public health specialist, wrote a letter to the BMJ 2 about this dilemma. He said that he knows that he is at least at moderate risk of heart attacks as he is of South Indian parentage and has a tendency towards diabetes, so he has researched all the recent papers thoroughly. He has come to the conclusion that he will not take statins – he does not think the benefits outweigh the harms. He says they don’t actually reduce the death rate from heart disease, and we need to treat around 67 people at this lower level of risk to prevent one person actually getting a non-fatal heart event. And the others get only the side effects, and the worry of taking tablets and worrying if they forget them. If he has made that decision, I feel a lot better about not taking them.
Then, what about the side effects? When I was in general practice, people certainly did complain of side effects, and some of the happiest patients I had were those in which I had stopped their statins! When you are treating at least 66 people who won’t benefit anyway from a drug, any side effect is reducing their quality of life. Statins have been linked to diabetes (in one out of a hundred patients) and dementia, though not conclusively, and they certainly did cause muscle pains, although I remember one patients whose muscle pains were put down to statins for months before the correct diagnosis – a form of rheumatism – was made, so it can confound the issue as well.
And there is the problem of medicalising people and illnesses. The psychological impact of going from some one who considers themselves healthy to someone who is ‘on medication’ can be large, the daily reminder of your own mortality when you take your morning pill. What of its effect on life insurance, and travel insurance? Also it now strays into philosophical realms. What do you want to die of? You do in fact have to die of something. Although heart disease in a young person is a tragedy, in a person in their nineties it is a ‘natural’ way to go, like pneumonia. Though not painless, it can be quick. Would you prefer cancer? Or a neurological condition such as Parkinson’s? What about dementia? Think carefully before you try to exclude a heart attack from the long list of things you can die of.
Lifestyle is far more important than tablets. Avoid tobacco and other pollutants and eat healthily. Of course you need to have chosen your parents wisely. I’ll tell you what I am going to do, for what it is worth. I am going to live as healthily as possible, eating plenty of fruit and veg, getting plenty of exercise and not too much alcohol. Then, if I do get a coronary event, I will start statins. Statistically if I am the one in 67 who does get a heart attack because I didn’t take a statin, it won’t kill me. After my “cardiac event” I will then take a statin knowing that the evidence proves conclusively that I do have a problem which statins will fix and by then I will be taking a whole lot of tablets anyway so one more won’t make any difference!

The other big story this year is aspirin. Millions of people take them, correctly, for angina and to prevent further heart attacks, and the dose is low so that only a few get serious side effects. Now, another academic paper 3 has shown that aspirin can help to prevent cancer too. Is this real? Should you take an aspirin a day even of you have no risk factors for cancer? I saw a lovely slide 4 illustrating this paper; of 100 patients taking aspirin, fewer than 2 will not get a cancer they would otherwise have got. So again 98 patients have to take a drug which is very well known to have side effects – indigestion and bleeding (very occasionally fatal) – when they won’t benefit. The study noted that everybody has to take aspirin for at least three years before any benefit is seen. And which cancers? They are mostly digestive tract cancers, and possibly lung, breast and prostate cancers. But your risk of lung cancer is small if you are a non-smoker, and being overweight increases the risk of breast cancer. Aspirin has no effect on other cancers – skin cancer, pancreatic, or brain cancers. Since this recent paper has come out, the number of people rushing to buy aspirin has increased by 10%. But such people think that aspirin will help to prevent all cancers and don’t understand the risks.
As for taking aspirin to prevent stroke, which is a very well established treatment for those at risk, only 1 in a hundred of those with no risk factors will benefit. Eating fresh fruit will help to prevent stroke5. Over the age of 70, the risk of a fatal bleed due to aspirin is so large that you shouldn’t take it anyway.
But newspapers have to run stories and people want to read them, and people get confused. They think – better safe than sorry. The only winners here are the pharmaceutical companies. Let’s get back to basics and live healthily and forget about all these health scares.

1. https://www.nice.org.uk/News/Article/wider-use-of-statins-could-cut-deaths-from-heart-disease
2. Raj S Bhopal BMJ 2014;349:g4980
3. .http://annonc.oxfordjournals.org/content/early/2014/07/30/annonc.mdu225.full Cuzic et al Estimates of benefits and harms of prophylactic use of aspirin in the general population Annals of Oncology10.1093/annonc/mdu225
4. http://annonc.oxfordjournals.org/content/early/2014/07/30/annonc.mdu225/F1.expansion.html
5. Fresh fruit meta-analysis American Health Association Dr Yan Qu