A conversation with my doctor

How many statins does it take to prevent a heart attack?

I have been following the recent reports from Australia that a government minister thinks Novak Djokovic’s presence in the country is “a risk to the health, safety or good order of the Australian community.” Somewhat tenuously, it has reminded me of a conversation with my GP, back in the days when we sat face-to-face and only one of us knew what a coronavirus was.

"Hearts all a Flickr" by Neal

My cholesterol count was (and is) a little higher than he would like. He had put me on statins, as doctors do these days. Unfortunately, I am one of the minority who experiences side effects. In my case, they made me really uncomfortable.

Without statins, I feel well and would definitely not wish to have a coronary incident. But, with them, I feel they are just saving me in order that I can be miserable. I thought it better to stop taking them and he agreed that it seemed sensible. “But first”, he said, “let’s just take a look at the numbers.”

He fed my medical characteristics into QRISK and came back with an assessment of the risk that I might suffer an adverse event. With my cholesterol at the level that it is without statins, the risk was more than 10%, which is the trigger level for the NHS to recommend statins. Then he repeated the calculation, but this time with the lower cholesterol level reached when I was taking statins. The risk dropped by four percentage points.  

He started to explain to me:

These figures suggest that, for every 100 people like you, there would be four fewer heart attacks or strokes in the next ten years if they all took statins.

He petered out about halfway through the sentence. I think he had remembered that I used to be an actuary. Or maybe, back in those mask-free days, the expression on my face conveyed that I was someone who understood the maths and lacked the consideration or the patience to let the doctor finish his sentence. I was quick to volunteer my own take on the figures:

If it’s going to take 25 of us on statins to save one person, and the pills make me feel utterly terrible, I think it’s pretty clear where we go from here.

He agreed. My online medical history records the conclusion we reached (without mentioning either my statistical acumen or my lack of tact).

But, here’s a thought. In these days of Covid, we have all become used to the idea that we don’t just wear masks or have vaccinations in order to protect ourselves. We take steps to help others too. So, if it takes 25 people like me on statins to save one man from a heart attack, what has happened to that man’s chances now that only 24 of us are taking the pills?

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