Your Odds with Statins: 500 to 1?

Originally posted October 5, 2011.

If you are considering a drug such as a statin, do you and your family know about the “number needed to treat” (NNT)? I’ve been looking into NNT and found a Businessweek article from January 17, 2008 that explains the concept well. Basically, NNT is the number of patients who must be given a specific drug (by example, Lipitor) for a single person to benefit. The article provides a handy table that you’ll want to look at before you consider taking any prescription drug, not just Lipitor.
The NNT table indicates that for a single person who has already had a heart attack or has signs of heart disease to benefit from Lipitor, 16 to 23 patients have to be treated with the drug. Presumably the other 15 to 22 patients receive no benefit. The NNT for a patient taking Lipitor who does not yet have heart disease, but has a risk factor like high blood pressure, is 500 to 1. Sound like good odds to you?

Beyond such uncompelling odds, the associated risk factors that come with testing for heart disease—never mind the risk of staph infection on any visit to a hospital—are unattractive. Drug-resistant staph infection is no joke. If I were considering Lipitor, I would consider the potential benefits it offers that would be worth the wide array of risks. Is the treatment likely to extend my life? If so, by how much? I would want to see hard data from all recently available trials. Is lower cholesterol the target benefit? Were I a woman or an elderly male, I would comb the abundant literature that casts doubt on the value of lower cholesterol for these groups.

The more you study, the more questions you’ll want to ask. I have found that those with serious health issues almost always benefit from the assistance of an advocate who asks the hard questions and performs the most rigorous and demanding research. It is often difficult for a troubled person to proceed alone.

I suspect you’ll agree that NNT is compelling subject matter, certainly as it relates to the sticky wicket of statin drugs. Coming installments of Lifesaver will present another chapter in the quest for answers on the statin drug front. In the interim, remember that my goal here is to encourage thoughtful independent research and a rigorous approach to getting the answers you need to better your family’s quality of life—just the approach I use myself.