Statins. Photo: Getty
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Why the stats about statins don't tell the whole story

For those without the relevant risk factors, statins aren't the wonder-pill they've been sold as by the media.

Maggie came hot-foot from a “health check” where she’d had her cholesterol measured. “Six point two!” she told me. “The nurse said that’s high.” She sounded rather spooked. “I’d like you to give me a statin.”

I’ve known Maggie for years. She’s a sensible academic in her early fifties. She’d done enough googling to learn that a “high” cholesterol means you are “at risk” of cardiovascular disease (CVD) – heart attacks and strokes – and that statins lower cholesterol and reduce CVD risk by 25 per cent. Her request for treatment made perfect sense to her . . . except she had fallen for the same myth that leads to several million people in the UK swallowing a statin every day for no good reason at all.

Focus for a moment on that 25 per cent risk reduction. If you’re at high risk of something nasty, then lopping off a quarter of that risk makes sense. The people at greatest risk of heart attacks and strokes are those who have previously suffered one. Giving statins to these patients (secondary prevention) does convey modest benefits. If you take 100 heart attack survivors and get them to take a statin for five years, you’ll save one life, prevent two or three non-fatal heart attacks, and avert one stroke. That is worthwhile, even if the statins will fail to prevent at least 15 other heart attacks/strokes, and will cause two patients to develop diabetes, and provoke muscle weakness in ten others. Notice, though: 95 per cent of these highest-risk patients will derive absolutely no benefit from their five years of statin consumption.

Come back to Maggie. Using a statin on someone without existing CVD is termed primary prevention. Maggie has no other risk factors (high blood pressure, smoking, diabetes, and so on) and so her chance of developing heart disease is very low. In Maggie’s case, because her risk is so small to start with, a 25 per cent reduction is minuscule and meaningless. You’d have to treat hundreds of Maggies for years on end to hope to make a jot of positive difference to one of them, and the side effects from statins (we’re still discovering what these are) will far outweigh any putative benefit.

There are large numbers of people just like Maggie who are taking statins and who should come off the tablets. But what about individuals at greater risk – people with high blood pressure or obesity, or smokers? Is there a level of risk at which primary prevention is worthwhile? For some time the UK’s National Institute for Health and Clinical Excellence (NICE) has suggested a threshold of 20 per cent risk over ten years.

At first glance, the trial data does suggest a marginal impact at this sort of level: roughly two heart attacks/strokes are averted among 100 people treated for five years. But, crucially, death rates are not altered; no lives are saved by using statins. This probably reflects the harm also caused by statins, and how any small reduction in CVD is negated by disability and death from other causes.

Taking up regular exercise, or adopting a Mediterranean diet, reduces CVD risk by degrees comparable with statins – in the case of diet, substantially more so. If someone smokes, quitting is similarly helpful. What’s more, once one has adopted these lifestyle changes, statins become virtually redundant. Lifestyle modification is also cheap; there are very few harms besides. And, unlike with statins, these measures protect against other causes of death and disability, such as cancer and the frailties of advancing age. Oh, and they’re good for mental health, too.

This February, NICE initiated a consultation on halving its primary prevention threshold to 10 per cent risk. If achieved, this would add hugely to the six million people in the UK who take statins on prescription. Rather than exacerbate our statin fetish, NICE could design simple decision aids that would help doctors understand the more effective improvements that lifestyle changes can bring to health and well-being – and which would illustrate these benefits to patients.

Once we’d talked things through, Maggie resolved to start attending the university gym a few times a week. She decided to forget the statin prescription, too. As a nation, we’d do well to try the same. 

This article first appeared in the 26 February 2014 issue of the New Statesman, Scotland: a special issue

Artie Limmer/Texas Tech University
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Meet the evangelical Christian persuading believers that climate change is real

Katharine Hayhoe's Canadian missionary parents told her science and God were compatible. Then she moved to Texas. 

During Donald Trump’s presidential campaign, alarm rose with each mention of climate change. Denial, dismissal and repeated chants of “hoax” left no doubt as to his position.

Now President Trump’s withdrawal from the Paris Agreement has been seen as a seminal moment in the fight against climate change - one which many fear could lose the battle ahead of humanity.

But one scientist has been fighting a war of her own on the ground, against those who typically doubt the facts about global warming more than most - the evangelical Christian population of America.

And to make matters even more unusual, Katharine Hayhoe herself is an evangelical Christian who lives in the indisputably "bible belt" of Lubbock, Texas.

The atmospheric scientist has been named one of Time magazine's 100 most influential people and one of Politico’s 50 thinkers transforming American politics. Now she is using her considerable heft to speak to those who are hardest to convince that there is a manmade problem that threatens the Earth’s future.

I meet her at the science and music festival Starmus in Trondheim, Norway, where she is to address the attendees on Thursday in a talk entitled "Climate Change: Facts and Fictions".

Hayhoe was born in Canada, to missionary parents. Her father, a former science educator, showed her that there was no conflict between the ideas of God and science. However, it was something of a surprise to her when she discovered her pastor husband, whom she married in 2000, did not feel the same about climate change. It took her two years to convince him.

What started as a conversation became an organised project when she moved to America's South in the mid 2000s. 

“Moving to Lubbock was a culture shock," she tells me. "When I moved there I wasn’t doing much outreach, but it moved me in that direction.

“Lubbock is very conservative. It’s small and isolated.

“I would say the majority of people in Lubbock are either dismissive or doubtful about climate change. I was surrounded by people - neighbours, parents of friends, people at church, colleagues down the hall in the university - who weren’t convinced.”

So Hayhoe, who works as an associate professor and director of the Climate Science Centre at Texas Tech University, set to work. She began to collect the responses she was seeing to the climate change discussion and prepare her counter-argument.

“When I talk to people who are doubtful, I try to connect with the values they already have," she says. “The greatest myth is the myth of complacency - that ‘it doesn’t really matter to me’.

"But I would say that the second most insidious myth is that you only care about this issue if you’re a certain type of person. If you’re a green person, or a liberal person, or a granola person."

The stereotypes mean that people outside that demographic feel "I can't be that kind of person because that's not who I am", as she puts it.

Hayhoe convinced her husband using data, but rather than repeating a formula, she tries to find out what will resonate with different people: "For many groups, faith is a core value that people share.”

Whether she’s speaking to city planners, water company managers, school kids or Bible believers, Hayhoe says her hook is not the facts, but the feelings.

“I recently talked to arborists," she says. "For them, trees and plants are important, so I connect with them on that, and say ‘because we care about trees, or because we care about water or what the Bible says then let me share with you from the heart why I can about these issues because it affects something that you already care about’.

“My angle is to show people that they don’t need to be a different person at all - exactly who they already are is the kind of person who can care about climate change.”

Hayhoe came to public attention in the United States after appearing in a Showtime series on climate change. She has appeared on panels with Barack Obama and Leonardo DiCaprio, and launched a web series. As well as plaudits, this level of fame has also earned her daily threats and online abuse. 

“My critics think they’re coming from a position of religion, but they aren’t," she says. "They’re actually coming from a very specific political ideology which believes that the government should not have control over people’s lives in any way shape or form - very libertarian, free market, free economy, Tea Party."

She believes that in the United States, faith and politics has been conflated to the point "people can no longer tell the difference". 

“Now it’s conservatism that informs religion," she elaborates. "If the two are in conflict - like the Bible says God has given us responsibility over everything on this earth - then people say ‘oh, we can’t affect something as big as this Earth, God will take care of it anyway’."

Around half of those who attack her on social media identify themselves as Christians, she notes, but almost all call themselves conservatives. 

As a scientist, she’s been preparing data herself - naturally - on her online attackers, with depressingly familiar results.

“As soon as you stick your head out of the trench, you get it. There have been papers published showing that white men disproportionately form up that small group of dismissives. They’re almost all men. When I track my social media comments, I would say that 99.5 per cent of them are white men.

“Out of 1,000 negative comments, I have maybe five from women.”

After the climate change argument moved up a gear - following the Paris withdrawal - Hayhoe admits that she and her fellow scientists are concerned, although she pays tribute to the businesses, cities and states from the US that have committed to following the Paris agreement themselves.

On the subject of the chief white male denier, Trump himself, Hayhoe says she has a discussion point which she feels may convince him to think carefully about his role in the fight against global warming’s impact on humanity.

“I would attempt to connect with the values that he has and show him how acting on this would be in his best interests," she says.

“One guess would be ‘what do you want your legacy to be? What do you want to be known as, the man who destroyed the world, or the man who saved it?’”

Katharine Hayhoe is speaking at Starmus on Thursday June 22. For more details, visit Starmus.

Kirstie McCrum is a freelance journalist. Follow her @kirstiemccrum.

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