tag:theconversation.com,2011:/global/topics/abc-catalyst-7690/articlesABC Catalyst – The Conversation2016-11-04T05:31:14Ztag:theconversation.com,2011:article/681612016-11-04T05:31:14Z2016-11-04T05:31:14ZWhat the ABC’s new Catalyst could mean for science on TV<figure><img src="https://images.theconversation.com/files/144519/original/image-20161104-25353-bj7cgp.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Catalysts to move to a new format.</span> <span class="attribution"><span class="source">ABC/Screenshot</span></span></figcaption></figure><p>The ABC says the run of the popular science television show, <a href="http://www.abc.net.au/catalyst/">Catalyst</a>, has reached the end in its current format.</p>
<p>In its place, the <a href="http://about.abc.net.au/press-releases/abc-tv-announces-new-catalyst-format/">ABC has proposed</a> it will deliver a series of 17 one hour-long documentaries that will be aired later in the evening than the current half-hour science magazine style programming.</p>
<p>It would appear that most Catalyst staff will be let go from the new series as the ABC says “up to 9 ongoing staff members may be affected” although “some staff” will be offered other positions.</p>
<p>This change is despite Catalyst’s popularity and relatively inexpensive costs. Many documentary makers <a href="http://www.news.com.au/national/breaking-news/science-leaders-slam-changes-to-catalyst/news-story/14e1814befdb714e4876dd7d6b3d3642">are somewhat sceptical</a> of the ability of the ABC to follow through on the promise of the 17 documentaries independently produced from outside the ABC.</p>
<p>According to several film makers, one-hour programs take disproportionately greater resources and can have a production time running to years in order to get a good product. </p>
<p>This begs the question as to whether or not the ABC will be able to carry through with this replacement.</p>
<p>These changes also run in the face of a <a href="http://about.abc.net.au/wp-content/uploads/2016/04/ATTACHMENT-E-ABC-Science-Qualitative-Reseach.pdf">recent review for the ABC</a> that suggested short science programs shown early in the evening were more popular than longer programs shown later in the day.</p>
<p>So why is the ABC taking this dramatic turn with the popular and award-winning Catalyst?</p>
<h2>A convenient controversy?</h2>
<p>Catalyst has not been without its controversies over the past three years.</p>
<p>First there was the 2013 story <a href="http://www.abc.net.au/catalyst/heartofthematter/">on statins and heart disease</a> which was <a href="http://www.abc.net.au/news/2014-05-12/catalyst-program/5446620">found to breach</a> the <a href="https://www.theguardian.com/media/2014/may/12/abc-takes-down-catalyst-heart-disease-episodes-after-review-criticism">ABC’s editorial standards</a> on impartiality.</p>
<p>Then there was the July 2016 <a href="http://www.abc.net.au/catalyst/stories/4494933.htm">Wi-fried</a> episode which relied on a single study <a href="https://www.theguardian.com/society/2016/feb/17/abc-catalyst-program-linking-mobile-phones-to-brain-cancer-should-never-have-aired">to claim links</a> between Wi-Fi and mobile phone networks and brain cancer. </p>
<p>Wi-fried was criticised by several academics <a href="https://theconversation.com/do-wi-fi-and-mobile-phones-really-cause-cancer-experts-respond-54881">writing in The Conversation</a>. It was also described as “<a href="https://www.crikey.com.au/2016/02/17/mobiles-might-not-give-you-brain-cancer-but-catalyst-gives-scientists-a-headache/">scientifically bankrupt</a>” by a leading Australian cancer researcher.</p>
<p>The episode was again <a href="http://www.abc.net.au/news/2016-07-05/wi-fried/7569664">found to have breached</a> ABC’s impartiality guidelines. </p>
<p>The same reporter, Dr Maryanne Dimasi, was involved with both stories, and could be <a href="http://www.smh.com.au/entertainment/tv-and-radio/abc-saves-catalyst-but-staff-to-go-in-restructure-20161103-gsgzdf.html">one of those losing their job</a> in the axing of the old program format.</p>
<p>Is the failure of a few instances (as egregious as they appear to be) of investigative reporting not countered by the award-winning reporting of other Catalyst journalists? </p>
<h2>Public disinterest in science?</h2>
<p>Prime Minister Malcolm Turnbull has emphasised the critical importance of innovation and science to Australia’s future. And he is right. </p>
<p>Without an articulate and science savvy population, Australia runs at risk of falling behind in the globalisation stakes.</p>
<p>As climate change intensifies, technology continues to escalate and human population busts, the need for greater understanding of science and its processes will determine whether we are able to seize opportunities or not. </p>
<p>The axing is presumably not because of audience disinterest. Audiences want more science, not less. In <a href="http://politicsir.cass.anu.edu.au/research/projects/electoral-surveys/anupoll/aussie-say-science-knocks-sport-six">a poll conducted by the ANU</a> in 2010, almost all of the 518 respondents reported an interest in science and related topics. </p>
<p>A national survey conducted on behalf of Inspiring Australia in 2014 similarly found <a href="http://diffusion.weblogs.anu.edu.au/files/2014/05/Searle-S.D.-2014.-How-do-Australians-engage-with-science.-April-2014.pdf">82% of respondents</a> engage with some form of science reporting at least fortnightly.</p>
<p>Most science itself isn’t a hard sell for media organisations operating on limited resources and highly competitive for market share.</p>
<p>It’s the critical examination of science in media that is hard to do, but worth trying (despite Catalyst’s lapses).</p>
<h2>The science investigators</h2>
<p>While scientists can be excellent communicators, they are not necessarily great investigative reporters. The ABC’s announcement suggests that a future science program could be in the scientist-led format.</p>
<p>If well-resourced, this could be a successful vehicle for some aspects of science with some audiences. But it will favour established science that lends itself to in-depth treatment.</p>
<p>Where will the up to date stories of Australian science be broadcast? Where will the audiences go who want to watch a bit of the latest Australian science content? </p>
<p>In a time when “innovation” is the catch-cry, we need a reliable source of information to promote the research being done and the discoveries being made.</p>
<p>Probably most important is the role of science journalists in telling us what science means, providing objective views in the face of unrelenting hype and wrangling the amazing scientific talent in Australia. </p>
<h2>Australia’s science stories</h2>
<p>Anyone can start a Facebook page or a YouTube channel, but where is the quality control? There are notable benchmarks of quality out there, such as <a href="https://www.youtube.com/user/1veritasium">Veritasium</a>, <a href="https://www.youtube.com/user/Vsauce">VSauce</a> and <a href="https://www.youtube.com/user/sciencealert">ScienceAlert</a> to name a few, but these exist online. </p>
<p>Within the traditional broadcast media context, it is difficult to identify a program that consistently delivers critical appraisals of science and its implications. </p>
<p>Sure, there exists <a href="https://theconversation.com/when-too-much-science-communication-is-barely-enough-38277">plenty of other options for science stories</a> to be told in the media and Australia oozes talent in science communication. This includes the <a href="http://www.celebrityspeakers.com.au/dr-jonica-newby/">award-winning Jonica Newby</a> of Catalyst who finds her future in question.</p>
<p>But all of this talent needs a vehicle.</p>
<p>Certainly there is a societal shift towards accessing content online, such as The Conversation, rather than via the traditional media. But the role of the traditional journalist – to convey information accurately, impartially and critically – is vital, whatever platform is used.</p>
<p>If even the best science journalists in the country are unable to retain positions that allow them to do that, then Australian science is either unrelentingly hyped, unquestioned, or at worst ignored. </p>
<p>It’s hard to be a clever country when you’re in the dark.</p><img src="https://counter.theconversation.com/content/68161/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Ove Hoegh-Guldberg undertakes research on coral reef ecosystems and their response to rapid environmental change, which is supported primarily by the Australian Research Council (Canberra), National Oceanic and Atmospheric Administration (Washington, D.C.), Catlin Group (London), and Great Barrier Reef Foundation (Brisbane). He not receive salary for writing this article.</span></em></p><p class="fine-print"><em><span>Professor Joan Leach undertakes research in science communication and is Director of the National Centre for Public Awareness of Science at the ANU. She is also President of Australian Science Communicators, the professional organisation for science communicators and science journalists. She receives research funding from the Australian Research Council, the NHMRC, and has worked with Inspiring Australia, the Australian National Strategy for science engagement.
</span></em></p><p class="fine-print"><em><span>Merryn McKinnon lectures and researches at the National Centre for the Public Awareness of Science at the ANU. She is a member of the Australian Science Communicators, the professional organisation for science communicators and science journalists. </span></em></p>Changes to the ABC’s science show Catalyst follow recent criticism of some of its journalism. But will the new format still give a voice to Australian science, or will some issues lose out?Ove Hoegh-Guldberg, Director, Global Change Institute, The University of QueenslandJoan Leach, Professor, Australian National UniversityMerryn McKinnon, Lecturer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/431772015-06-14T20:11:42Z2015-06-14T20:11:42ZABC’s 2013 Catalyst program may contribute to up to 2,900 heart attacks and strokes<figure><img src="https://images.theconversation.com/files/84781/original/image-20150612-11427-x654u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Half a million fewer statins were dispensed to patients in the eight months following the Catalyst broadcasts.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-193018853/stock-photo-watching-tv-and-using-remote-controller.html?src=JrVLkbYZnyUXjQkh-cXN_g-1-1">Concept Photo/Shutterstock</a></span></figcaption></figure><p>Media coverage of health issues, via advertising campaigns or in the form of news and current affairs coverage, can powerfully influence community understanding of disease, health risks and notions of who is responsible for doing something about these problems.</p>
<p>Often the impact of this coverage happens in “slow burn” fashion. Public understanding and access to emerging new information – and the debates accompanying it – gradually translate into personal relevance, concern, behaviour change and support for legislative or regulatory action.</p>
<p>But there have also been many casebook examples of how media coverage of health issues can have dramatic, rapid and sometimes sustained effects on health-related behaviours, both positive and negative.</p>
<p>News of Kylie Minogue’s breast cancer diagnosis in 2005, for example, was followed by an unprecedented <a href="https://www.mja.com.au/journal/2005/183/5/impact-news-celebrity-illness-breast-cancer-screening-kylie-minogues-breast">101% increase</a> in the number of women aged 40 to 69 booking in for their first mammogram.</p>
<p>There was also a concerning <a href="http://www.ncbi.nlm.nih.gov/pubmed/18515324">20% increase</a> in younger women, at very low risk for breast cancer, who underwent mammographic screening.</p>
<p>Similarly, widespread news coverage in 2002 about serious negative risks of using hormone replacement therapy (HRT), was associated with an <a href="http://www.ncbi.nlm.nih.gov/pubmed/14757616">18% fall in HRT</a> use in California.</p>
<p>But sometimes even very limited, small-scale news coverage can also trigger widespread effects.</p>
<p>In 2005, the ABC-TV Catalyst program ran a single item – <a href="http://her.oxfordjournals.org/content/23/3/543.long">seen by</a> a quarter of Australian households – on the importance of iodine in the diet to prevent iodine deficiency disease.</p>
<p>This was followed by an immediate <a href="http://her.oxfordjournals.org/content/23/3/543.long">5.2% jump</a> in national sales of iodised salt. Table salt has never been advertised, discounted or commercially promoted in Australia, so the increase was hard to explain by anything other than the Catalyst program.</p>
<p>Today, researchers from the University of Sydney and the Australian National University report on the impact of another Catalyst program. In October 2013, Catalyst broadcast a segment highly critical of statins, a class of drug used for lowering cholesterol.</p>
<p>The program questioned the link between cholesterol and heart disease, and suggested the benefit of statins in preventing cardiovascular disease was exaggerated.</p>
<p>There was extensive criticism of the program, including from the ABC’s own <a href="http://www.smh.com.au/entertainment/tv-and-radio/abc-report-could-cause-death-says-abc-health-specialist-20131104-2wx3n.html">Norman Swan</a> and the ABC later removed the episodes from the Catalyst website after an <a href="http://about.abc.net.au/wp-content/uploads/2014/05/Catalyst-Heart-of-the-Matter-ACA-Investigation-Report.pdf">internal review</a> found that the episodes had breached its impartiality standards.</p>
<p>The <a href="https://www.mja.com.au/journal/2015/202/11/crux-matter-did-abcs-catalyst-program-change-statin-use-australia">new report</a> in the Medical Journal of Australia used Pharmaceutical Benefits Scheme data of 191,000 people and found an immediate fall of some half a million fewer statins dispensed to patients in the eight months following the Catalyst broadcasts.</p>
<p>The authors wrote:</p>
<blockquote>
<p>This translated to an estimated 60,897 fewer people taking statins over the eight months examined. If patients continue to avoid statins over the next five years, this could result in between 1,522 and 2,900 preventable, and potentially fatal, heart attacks and strokes.</p>
</blockquote>
<p>One of the study authors, Associate Professor Sallie Pearson, Scientific Director of the Centre of Research Excellence in Medicines and Ageing at the University of Sydney, said:</p>
<blockquote>
<p>What is particularly concerning is that this drop in use was seen in people who were at high risk of cardiovascular disease – for example, those who were also taking medications for diabetes. Heart attacks and strokes are the main killers of people with diabetes.</p>
<p>Statins are recommended for people at high risk of cardiovascular disease because they have been shown to be effective. Like all medications, they have risks and benefits and should only be used as recommended.</p>
</blockquote>
<p>The study authors wrote:</p>
<blockquote>
<p>Even though the observed effect was relatively small, the prevalence of statin use in Australia and their established efficacy means that a large number of people are affected, and may suffer unnecessary consequences.</p>
</blockquote><img src="https://counter.theconversation.com/content/43177/count.gif" alt="The Conversation" width="1" height="1" />
In October 2013, Catalyst broadcast a segment highly critical of statins, a class of drug used for lowering cholesterol.Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/198772013-11-07T19:40:25Z2013-11-07T19:40:25ZWorried about taking statins? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/34647/original/np7yfhgt-1383800656.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who are questioning whether to continue taking statins should talk to a doctor.</span> <span class="attribution"><span class="source">Hilke Kurzke</span></span></figcaption></figure><p>After last week’s <a href="http://www.abc.net.au/catalyst/heartofthematter/default.htm">controversial Catalyst program</a> on the ABC, some people may be wondering whether they should stop taking statins to lower their cholesterol. But before making such a decision, read this article and discuss your risk of heart disease or stroke with a doctor.</p>
<p>About <a href="http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2012-07/review-of-statin-therapies">2.6 million Australians</a> take statins. And a recent analysis of <a href="http://www.racgp.org.au/afp/2012/october/prioritising-cvd-prevention-therapy/">Australian data</a> found that over-treatment of people at low risk is more common than under-treatment of people at high risk. </p>
<p>This is problematic but it doesn’t reflect a problem with the statins. Rather, it shows that people may not be appropriately informed about who benefits from taking this medicine.</p>
<h2>What the trials say</h2>
<p>While Catalyst highlighted that most of the major trials for statins have been funded by the pharmaceutical industry, it didn’t explain their overall results. </p>
<p>A collaboration funded by the UK Medical Research Council, British Heart Foundation and Cancer Research UK (the <a href="http://www.ctsu.ox.ac.uk/research/meta-trials/ctt/ctt-website">Cholesterol Treatment Triallists Collaboration</a>), brought together data from 26 trials involving 170,000 patients, to better understand what the trials found. </p>
<p>What they discovered was the results are remarkably consistent: they show statins reduce the risk of heart attack or stroke by about 20%. This is true whether you’ve had a heart attack or stroke in the past or not. </p>
<p>There were fewer women in the trials, so the numbers for women are less precise but they’re approximately the same as the overall numbers. </p>
<p>If your risk of having a heart attack or stroke over the next five years is 30%, taking statins will reduce it to 24%. If it’s 10%, your risk is reduced to 8%. Obviously, the benefit is greater if your initial risk is higher (we’ll come back to how to work this out later).</p>
<p>Heart attacks and strokes are serious events that most people want to avoid, and there’s clear, solid evidence that statins reduce the chance of having one.</p>
<p>But like all drugs, statins also have side effects and the Catalyst program was correct in pointing out that these were probably underestimated in the trials. There are good reasons for this.</p>
<p>Trials often exclude people with early side effects, the elderly and people with other conditions, such as kidney disease. It would be unethical to continue giving a new drug to someone if they are experiencing side effects and do not wish to continue, so participants can withdraw from the trial at any time. </p>
<p>The age group and medical conditions for clinical trials are specified so it can identify the effect of the drug on the target group for treatment. But the side effects of statins have been investigated in many other studies and populations outside of those trials, and <a href="http://www.tga.gov.au/safety/alerts-medicines-statins-120302.htm">continue to be monitored</a>. </p>
<p>The most common side effects are fatigue, exercise intolerance, cataracts, and sometimes, memory loss. On the other hand, statins may protect people from small strokes that could <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874131/">cause dementia</a>. This is why the decision to take statins has to be a balance between their benefits and risks.</p>
<h2>Who should take statins</h2>
<p>In Australia, the National Heart Foundation, Kidney Health Australia, Diabetes Australia, and the National Stroke Foundation (<a href="http://www.cvdcheck.org.au/index.php?option=com_content&view=article&id=47&Itemid=27">the National Vascular Disease Prevention Alliance</a>) have weighed up the benefits and risks of drugs to lower cholesterol. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/34648/original/xg5mz9nm-1383800808.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The decision to take statins should not be based on someone’s cholesterol level alone unless it’s unusually high.</span>
<span class="attribution"><span class="source">Divine Harvester/Flickr</span></span>
</figcaption>
</figure>
<p>They recommend medication for people who have a high absolute risk, which is more than a 15% chance of having a heart attack or stroke over the next five years. </p>
<p>The absolute risk of heart attack or stroke is calculated by using all the major factors that predict risk – age (it gets more likely as you get older), sex (males are at higher risk), blood pressure, and cholesterol. Whether someone smokes or has diabetes also strongly impacts their risk profile.</p>
<p>Medication may also be considered for people at moderate risk (10% to 15%), who haven’t been able to reduce their risk with diet and exercise. Or if they have a strong family history of heart disease.</p>
<p>The decision to take statins should not be based on someone’s cholesterol level alone unless it’s unusually high. If you are between 35 and 74 years of age, and know your blood pressure and cholesterol level, you can <a href="http://www.cvdcheck.org.au">calculate your own risk here</a>.</p>
<p>The advantage of this approach (using absolute risk as the guide) is that people at high risk of heart attack or stroke who have normal cholesterol levels can still reduce their risk by taking statins. </p>
<p>At the same time, people with mildly elevated cholesterol levels who have no other risk factors (and are therefore unlikely to benefit) don’t need to take them.</p>
<h2>The balancing game</h2>
<p>Regular exercise and a <a href="https://theconversation.com/what-is-the-mediterranean-diet-and-why-is-it-good-for-you-12656">Mediterranean-style</a> diet also lower the risk of heart attack and stroke, and are <a href="http://www.healthyactive.gov.au/internet/healthyactive/publishing.nsf/Content/recommendations-guidelines">recommended for everyone</a>, whether they have low, medium, or high risk. But for some people, this is not going to be enough.</p>
<p>The number of deaths from heart disease has <a href="http://www.aihw.gov.au/cardiovascular-health/trends/">fallen dramatically</a> since its peak in the late 1960s and early 1970s. This is partly because of overall improvement of diet, efforts to stop smoking and control blood pressure. </p>
<p>But reducing cholesterol levels through drugs, such as statins, has also played an important role.</p>
<p>People on statins who are now questioning whether to continue take them should talk to a doctor about their absolute risk of heart attack or stroke. This calculation needs to be based on levels of cholesterol and blood pressure <em>before</em> starting medication. </p>
<p>If substantial lifestyle changes have recently been made, it may be appropriate to consider a trial period off statins.</p>
<p>Statins are no magic bullet and people who take them may still have a heart attack or stroke, even though their chance of having one is reduced. And the truth is that if a person has been taking statins and doesn’t have a heart attack or stroke, we can’t tell if that’s because of statins or because they were never going to have one.</p>
<p>The best we can do is use data from trials and other studies to estimate the benefits and risks. Like all medications, statins are not inherently good or bad - whether they help someone depends on whether their likely benefit outweighs their side effects for an individual.</p><img src="https://counter.theconversation.com/content/19877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carissa Bonner receives funding from an Australian Postgraduate Award and the National Heart Foundation of Australia.</span></em></p><p class="fine-print"><em><span>Jenny Doust receives funding from National Health and Medical Research Council. She was previously a member of the Pharmaceutical Benefits Advisory Committee which considered the effectiveness and cost-effectiveness of statins.</span></em></p>After last week’s controversial Catalyst program on the ABC, some people may be wondering whether they should stop taking statins to lower their cholesterol. But before making such a decision, read this…Carissa Bonner, Research Coordinator and PhD Candidate in Public Health, University of SydneyJenny Doust, Professor of Clinical Epidemiology, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/196552013-10-31T03:39:48Z2013-10-31T03:39:48ZSome things you should know about statins and heart disease<figure><img src="https://images.theconversation.com/files/34142/original/58h636fk-1383181140.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Statins have improved the quality of life for many people who would have otherwise suffered debilitating cardiovascular disease.</span> <span class="attribution"><span class="source">Mykl Roventine</span></span></figcaption></figure><p>Cardiovascular disease (heart attack and stroke) causes the most deaths in Western countries overall and the vast majority of premature deaths. Drugs known as statins have been the cornerstone of how we treat people at risk of such deaths, and they’ve made a huge difference to survival rates.</p>
<p>Statins are the most widely prescribed medication in Australia, <a href="http://www.heartfoundation.org.au/information-for-professionals/data-and-statistics/Pages/default.aspx">where 45,600 people</a> (31% of all deaths) died of heart attacks and strokes in 2011. In 2010-11, statins were taken by an estimated <a href="http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/2012-07/reviews">2.6 million Australians</a> (mean age 67 years, with mean age for starting treatment 58 years). </p>
<p>Risk factors for heart disease include age, being male, smoking cigarettes, high blood cholesterol, diabetes, and high blood pressure. Rates of cardiovascular disease have fallen with improved control of these risk factors through dietary changes and drug treatment, including statins; <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454952">between 1991 and 2002</a>, deaths from cardiovascular disease fell by 36% in men and 34% in women.</p>
<h2>Heart health and cholesterol</h2>
<p>Statins work by lowering blood cholesterol levels, especially the levels of low-density lipoprotein (LDL). </p>
<p>A small amount of low-density lipoprotein is essential for life as it delivers cholesterol to tissues, which use it to maintain cell membrane structure, to synthesise hormones, and to allow cells to proliferate. But too much of it is bad because it promotes the formation of plaques in coronary arteries. </p>
<p>Indeed, high blood levels of LDL cholesterol <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/abstract">are directly correlated</a> with increased rates of coronary disease (heart attack, angina, heart failure, and sudden death) and stroke.</p>
<p>When LDL cholesterol accumulates inside the walls of the arteries to the heart and brain, it forms plaques and results in atherosclerosis (narrowing from plaque formation). Atherosclerotic plaques gradually enlarge and narrow the artery. If they rupture, blood flow to the heart or brain can suddenly be blocked, resulting in heart attack or stroke.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/34143/original/fy6ddntq-1383181207.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Plaques form when LDL cholesterol accumulates inside the walls of the arteries to the heart and brain.</span>
<span class="attribution"><span class="source">Leo Reynolds</span></span>
</figcaption>
</figure>
<p>High levels of LDL allow cholesterol accumulation inside cells, starting (or continuing) the process of plaque build up. Statins reduce the risk of cardiovascular disease by reducing LDL levels and improve survival for people at high risk of cardiovascular disease. </p>
<p>They reduce the liver’s synthesis of cholesterol, and in response, the liver up-regulates its LDL receptors, restoring cholesterol levels in the liver, and reducing blood levels of LDL.</p>
<h2>Enter statins</h2>
<p>Many things can affect blood LDL cholesterol levels, including genetic disorders. <a href="http://www.genome.gov/25520184">Familial hypercholesterolaemia</a>, for instance, results in reduced LDL receptor function and high levels of LDL cholesterol. This, in turn, increases the rate of coronary disease.</p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/18840879">2008 UK study found</a> the death rate in people with familial hypercholesterolaemia was 37% times higher before statins were available. </p>
<p>Statins were originally used to treat people with genetically high LDL cholesterol levels and were <a href="http://www.ncbi.nlm.nih.gov/pubmed/23461430">found to be more effective</a> than previous drugs. They also had <a href="http://www.ncbi.nlm.nih.gov/pubmed/16456497">fewer side effects</a>.</p>
<p>They are now used to treat people at high risk of heart attacks and strokes based on the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/abstract">results of many clinical trials</a> showing reduced risk with statin treatment. </p>
<p>The benefits of statins include fewer heart attacks and strokes, and improved survival for people at highest cardiovascular risk.</p>
<p>A <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/abstract">2012 study of 27 randomised control trials</a> for statins showed a 24% reduction in relative risk per unit of LDL (the difference in rates of cardiovascular disease between groups receiving statins and control groups). </p>
<p>The absolute risk reduction (difference in absolute rate of cardiovascular disease between the statin and control groups) is, naturally, greater in those at higher baseline risk. You’ll recall that the baseline risk is affected by such factors as age, gender, smoking habits, blood pressure, cholesterol levels and whether you have diabetes.</p>
<p>Statins <a href="http://www.cardioscience.ox.ac.uk/news-events/beneficial-effects-of-statins-therapy-in-people-at-low-risk-of-vascular-disease">also reduce the risk</a> of cardiovascular disease in people at very low risk (less than 10%). But even though they may benefit from statins, whether these low-risk people should take them is a matter for health economists and ethicists to consider. </p>
<p>Statin prescriptions in Australia <a href="http://www.nps.org.au/publications/health-professional/nps-radar/2007/february-2007/pbs-lmd-criteria">are usually reimbursed</a> for those at highest cardiovascular risk, independent of blood cholesterol levels. People at intermediate risk are reimbursed depending on their blood cholesterol levels. </p>
<h2>Statins’ side effects</h2>
<p>All medicines have potential side effects and statins are no exception. That’s why there are <a href="http://www.nhlbi.nih.gov/guidelines/cholesterol/statins.pdf">guidelines for statin use</a>.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/34144/original/wbm7d4tc-1383181680.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Whether these low-risk people should take statins is a matter for health economists and ethicists to consider.</span>
<span class="attribution"><span class="source">AJ Cann</span></span>
</figcaption>
</figure>
<p>One significant side effect of statins is the risk of developing diabetes, especially if you are overweight. In the approximately 250,000 people treated with the drugs in 135 randomised trials, there was a <a href="http://www.ncbi.nlm.nih.gov/pubmed/23838105">9% increased risk</a> of developing diabetes compared to the rest of the population.</p>
<p>But this <a href="http://www.uamshealth.com/healthlibrary/newsdetail.aspx?id=6758&siteid=1&contentid=678114&contenttypeid=6&request=breakingdetail">increased risk is outweighed</a> by the benefits statins have for heart health in high-risk people.</p>
<p>The authors of a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/abstract">meta-analysis of 27 clinical trials</a> of statins found the risk of cancer was not increased. They also found that statins were well tolerated, with no evidence of increased muscle side effects, and only a slight increase in liver enzymes (transminases) that can indicate it’s damaged. </p>
<p>These data differ from the “real world” experience, as <a href="http://www.ncbi.nlm.nih.gov/pubmed/16453090">a study 7,924 people</a> treated with high dose statins showed. In this study, 10.5% of people taking statins complained of muscle symptoms (pain, aches, stiffness, weakness, fatigue, cramping and tenderness), usually within a month after starting to take the drugs. </p>
<p>These symptoms were severe enough to prevent moderate exercise in 38% of the people in the study, and 4% were unable to work, or were confined to bed. </p>
<p>Risk factors for developing muscle symptoms included a history of muscle pain with other similar therapy (ten times more likely), unexplained cramps (four times more likely), a family history of muscle symptoms (twice as likely), and low thyroid activity (70% more likely).</p>
<p>People at most risk of side effects are the elderly (aged over 75 years) because they metabolise the drug less efficiently, so there’s a higher level of statins in their blood, predisposing them to muscle toxicity. People with lean muscle mass, and risk factors for muscle symptoms outlined above are also more likely to suffer these side effects.</p>
<p>Other people also at risk are those taking drugs that may raise blood levels of certain statins, liver or kidney disease, taking high-dose statins, and those undertaking high levels of physical exercise (because it predisposes them to getting the muscle symptoms). </p>
<p>For these people, lower doses of statins with close monitoring may be the best way to proceed, or they may need to try alternative therapies.</p>
<p>Statins have made a big difference to evidence-based preventative medicine. And they have improved the quality of life for many people who would have otherwise suffered debilitating cardiovascular disease.</p><img src="https://counter.theconversation.com/content/19655/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton-Craig is a current member of Lipid Advisory Boards for Merck, Sharp & Dohme ( for ezetimibe, a non-statin cholesterol absorption inhibitor), Abbott (for fenofibrate, a non-statin fibrate) and Amgen (for AMG-145, a non-statin PCSK9 inhibitor).</span></em></p>Cardiovascular disease (heart attack and stroke) causes the most deaths in Western countries overall and the vast majority of premature deaths. Drugs known as statins have been the cornerstone of how we…Ian Hamilton-Craig, Professor of Preventative Cardiology, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.