For those who don’t know me, my claim to fame is that I’m “the Pharmacist who Gave Up Drugs”. One of my standard talks is “Die Young at a VERY OLD AGE. ” I was chatting to Clyde of Coffee Bank Roastery (my fantastic local coffee shop in East Finchley that coffee drinkers live longer we hatched the idea of a coffee-related talk

Now I know, this sounds absurd, but we need to ask the one question that matters most:

Did fewer people die?

This is where the statin conversation becomes more nuanced than the slogans suggest. All-cause mortality means death from any cause.
Not LDL.
Not “risk factor improvement”.
Not even non-fatal heart attacks.

Primary prevention means treating people who’ve not had a heart attack, stroke, stent, bypass, angina or any other form of established cardiovascular disease.

That is entirely different from secondary prevention, where baseline risk is higher and the case for statins is stronger.

Two numbers everyone should understand:

NNT = number needed to treat.
How many people need to be treated for justt one person to benefit?

NNH = number needed to harm.
How many people need treatment for one extra person to be harmed?

So what happens in primary prevention?
Statins lower LDL and reduce some cardiovascular events.
But the all-cause mortality benefit is tiny, and heavily dependent on which trials are included.

One major evidence review estimated roughly:
💊 1 fewer death per 286 people treated over about 5 years
Other stricter primary-prevention analyses have found no clear all-cause mortality reduction.

IN OTHER WORDS NO EFFECT ON DEATH

Now lets compare coffee: Moderate coffee intake is repeatedly associated, in observational studies, with lower all-cause mortality.

☕ Around 1 fewer death per 100 people over long follow-up
(Important caveat: Coffee evidence is mostly observational. Statin evidence includes randomised trials. So this is not a like-for-like comparison)

Now I’m not suggesting anyone swaps their daily statin for an espresso.
But the comparison exposes how poorly health claims are framed.

Relative risk makes benefits sound huge.
Absolute risk tells patients what the benefit actually means to them

And of course harms matter too: Statins are not biologically neutral. Muscle symptoms, liver enzyme abnormalities, increased diabetes risk are not imaginary especially in a population already struggling with insulin resistance, fatty liver and visceral fat.

The informed-consent conversation between patient and prescriber should not be:

“Your cholesterol is high. Take this.”

It should be:

What is your absolute risk?
Is this primary or secondary prevention?
Are we preventing death or mainly non-fatal events?
What is the NNT?
What is the NNH?
Have we addressed metabolic health first?

Coffee is not medicine, but it is a useful contrast. Because for all-cause mortality (your risk of death) in primary prevention, coffee seems to work better than statins.

That is not anti-statin, its an ethical principal. “Patients deserve numbers, not marketing”