Absolute Vs Relative Risk—How the Game is Played

Larry A. Law

The Cholesterol Lie was how the pharmaceutical industry made cholesterol the bad guy in the fight against heart disease. Cholesterol is actually a good guy. In reality, the accumulation of calcium plaque (calcification of the arteries) is the bad guy. The brain represents only 2-3% of our total body weight, but it has 25% of the cholesterol in our body. The cells in our body produce 2,000 milligrams (2 grams) of cholesterol every day, because our bodies require it to function properly. Cholesterol is absolutely essential to the health of human brains, hearts, and nearly every cell in the body.

Relative Risk Reduction

Akira Endo was the Japanese biochemist who discovered statins from mold. Merck ultimately took his discovery and made the first statin drug, Lovastatin, which was approved by the Food and Drug Administration (FDA) in 1987. In 2004, statin sales were estimated to be around $19 billion annually, and between 2002 and 2018, the average annual cost of statins was $24.5 billion. The global statins market was valued at $15 billion in 2021 and is expected to reach $22 billion by 2032. It is Big Pharma's number one money maker of all time. Because statin drugs lowered cholesterol, it was necessary to keep up the myth that cholesterol was responsible for heart disease. How did they make their statistical studies show benefit?

The pharmaceutical industry is notorious for over-stating the benefits of drugs and vaccines. A statistical analysis model called relatative risk reduction is often employed to demonstrate drug/vaccine efficacy. This model is very misleading. It's a way of hyping benefits and hiding the real story. Suppose there are two groups of 100 people, with the first group taking an experimental pill purporting to prevent heart attacks and the second group is taking a placebo (image shown above). During a trial time of two years, the first group experienced one heart attack, while the second group—also of one hundred participants—there were two heart attacks.

Statistically, the experimental pill appears to be insignificant in its cardiovascular protection (one out of 100). But when relative risk reduction is utilized, all of a sudden, the pill shows a 50% improvement (efficacy) in decreasing heart disease compared to placebo, given that there was one fewer heart attack in the treated group. 

Pfizer's Statin Drug—Atorvastatin

The inflation of data attracts raving reviews from mainstream media. The New York Times noted the results of a large 2008 study on AstraZeneca's rosuvastatin (Crestor), stating that the risk of heart attack was "more than cut in half" by statins. Sounds impressive until you see the actual (absolute) reduction. 

Another study, which is often cited to showcase "statins' robust protective effects," is a large trial on Pfizer's atorvastatin (Lipitor), called ASCOT-LLA. In this case (see image below), statins were 36% more protective than the placebo. But the absolute risk reduction (98.1% in drug versus 97% in placebo) represents only 1% reduction, which is way less impressive. As opposed to relative risk reduction, assessing the efficacy of a drug is more accurately interpreted by using absolute risk reduction. 

Playing the Game

In a 2022 investigative report published in JAMA Internal Medicine, researchers from different countries reviewed 21 clinical studies on statins. They averaged a relative risk factor reduction of all-cause mortality by 9% and for heart attacks by 29%. The absolute risk reduction was a mere 0.8% and 1.3%, respectively. The researchers commented that the absolute benefits of statins were extremely "modest" and "should be communicated to patients as part of informed clinical decision-making." There is a big difference between these two types of data and the public has a right to know. But this is the game pharmaceutical companies play in drug trials. Unfortunately, they get away with even worse lies in vaccine trials.