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1/9 How often are statins actually to blame for their side effects?
A fascinating new research paper sheds some light on this
Here's a short Twitter thread for anyone interested in statins
#MedTwitter #Tweetorial
Here's the trial
https://www.nejm.org/doi/full/10.1056/NEJMc2031173
@mgtmccartney
A fascinating new research paper sheds some light on this
Here's a short Twitter thread for anyone interested in statins
#MedTwitter #Tweetorial
Here's the trial
https://www.nejm.org/doi/full/10.1056/NEJMc2031173
@mgtmccartney
2/9 The trial:
Seems to be well conducted by Imperial College, London
Funded by @TheBHF
60 patients recruited (
+
mostly >50yrs) who had previously had side effects to statins WITHIN 2 WEEKS OF STARTING THEM (interesting)
Some (but not all) had a history of heart disease
Seems to be well conducted by Imperial College, London
Funded by @TheBHF
60 patients recruited (
+mostly >50yrs) who had previously had side effects to statins WITHIN 2 WEEKS OF STARTING THEM (interesting)Some (but not all) had a history of heart disease
3/9 Here's the clever bit... they were given 12 pill bottles to take over a year. Each month they were told to take the contents of a specific bottle, picked at random
Bottles were:
4 bottles of atorvastatin 20mg
4 of placebo (looked identical to atorvastatin)
4 empty bottles
Bottles were:
4 bottles of atorvastatin 20mg
4 of placebo (looked identical to atorvastatin)
4 empty bottles
4/9 More details:
Which bottle to take was randomly generated each month
Participants told via an app
Participants blind to whether on placebo or statin
Participants aware (obvs) when on empty bottle month
Symptoms were self-reported via the app + scored 0 (none) to 100 (worst)
Which bottle to take was randomly generated each month
Participants told via an app
Participants blind to whether on placebo or statin
Participants aware (obvs) when on empty bottle month
Symptoms were self-reported via the app + scored 0 (none) to 100 (worst)
5/9 Results:
49/60 ppl completed the year
Mean symptom scores were:
Empty bottle months = 8.0
Placebo months = 15.4
Statin months = 16.3
The "side effects" on statin and placebo were very similar (placebo had 90% of the side effects of the statin)
49/60 ppl completed the year
Mean symptom scores were:
Empty bottle months = 8.0
Placebo months = 15.4
Statin months = 16.3
The "side effects" on statin and placebo were very similar (placebo had 90% of the side effects of the statin)
6/9 30 out of 60 ppl (ie 50%) were able to restart a statin 6 months after the end of the trial
The authors conclude:
"In patients who'd discontinued statin therapy because of side effects, 90% of the symptom burden elicited by a statin challenge was also elicited by placebo"
The authors conclude:
"In patients who'd discontinued statin therapy because of side effects, 90% of the symptom burden elicited by a statin challenge was also elicited by placebo"
7/9 Difference between placebo and nocebo is in the response to the inert therapy
A beneficial response to an inert substance = PLACEBO response
A side effect to an inert substance = NOCEBO response
The "nocebo ratio" came out at roughly 90% in this trial
The nocebo ratio is
A beneficial response to an inert substance = PLACEBO response
A side effect to an inert substance = NOCEBO response
The "nocebo ratio" came out at roughly 90% in this trial
The nocebo ratio is
8/9 Lots of interesting questions arise from this study like:
If we use the placebo effect for benefit, does the nocebo effect matter every bit as much? Symptoms are real to those that get them
If we warn people about side effects, are we just
ing the risk of nocebo effect?
If we use the placebo effect for benefit, does the nocebo effect matter every bit as much?
Symptoms are real to those that get themIf we warn people about side effects, are we just
ing the risk of nocebo effect?
9/9 Can I point out:
I've no conflicts of interest to declare, see http://www.whopaysthisdoctor.org
I'm paid only by the NHS
I have never received money from a drug company
Lastly, thanks to @JulianTreadwel1 for his critique of this paper + @rcgp Overdiagnosis Group for their views
I've no conflicts of interest to declare, see http://www.whopaysthisdoctor.org
I'm paid only by the NHS
I have never received money from a drug company
Lastly, thanks to @JulianTreadwel1 for his critique of this paper + @rcgp Overdiagnosis Group for their views
