I am a 60-year-old woman and I read in Plus that taking a daily cholesterol-lowering drug has a 30 percent lower chance of having a stroke. In the same issue I read that someone who does not take his cholesterol pills for three weeks runs hardly any extra risk. What’s up? I have high cholesterol but get a lot of muscle pain from those pills.
Christa
Joris Bartstra, journalist with medical diploma
The main difference is between relative and absolute risk reduction.
The thing is, a cholesterol-lowering statin reduces the risk of a heart attack or stroke in everyone by about 30 percent. This ‘relative risk reduction’ is an impressive figure, but what you really gain from it is determined by your personal chance of one of those, say, disasters. In medical guidelines, the use of cholesterol-lowering drugs is considered worthwhile from an ‘absolute’ (personal) risk of about 2 percent per year. If you deduct 30 percent from that, your absolute risk reduction is 0.6 percent per year: you are left with 1.4 percent. Then you might say: that’s not what I do it for! But over the years it tends to add up, and especially at an age above 75 your risk becomes higher than that 2 percent, so the profit is greater. But if you don’t take that pill for a small part of a year, you only run a small part of that 0.6 percent extra risk.
If you have to have muscle pain every day for that little bit of risk reduction, then I would say: it’s not worth it. Fortunately, there are other ways to prevent heart attacks and strokes: eating healthy, exercising, not smoking, you know them. This reduces your absolute risk and therefore also the benefit you can get from a statin.
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