Which would you prefer: An apple a day or a statin a day to keep the doctor away? Let’s look at this comparative proverb to see whether lifestyle changes are preferable to using pharmaceuticals for prevention…  

Since the 19th Century, we’ve been hearing the proverb “an apple a day keeps the doctor away.”  Indeed, every time you eat apples, this might come to mind. It is a health promotion message that has had lasting effects, at least in our minds.

But a paper in the British Medical Journal (BMJ) recently compared this well-known apple proverb with the concept of taking a statin, in order to keep the doctor away. Specifically, they modeled the effect on vascular mortality of being prescribed either a statin or an apple a day. 

Primary Prevention

Prevention of vascular disease typically begins with lifestyle changes – increasing exercise and improving nutrition. But more and more, we see the use of drugs getting thrown into the prevention picture. For a while in the US, there was even a discussion of adding statins to the water supply. Even if they aren’t in our water (yet!), statins are the only drug class in the UK recommended for primary prevention at a population level for those at >20% risk. This has led to considerable statin use for those over 50. So how does the use of statins for disease prevention compare with a lifestyle change such as eating an apple a day?

Intervention

The BMJ paper looked at the concept of giving everyone over 50 in the UK either a statin a day or an apple a day. As part of the model, they assumed 70% compliance (based on study data) and no change in calorie consumption. 

Methods

The scientists used a comparative risk assessment model, looking at the reduction in death from vascular disease, adverse events, and cost. The datasets came from meta-analysis studies from the UK. Further details are given in the paper

Results

Assuming 70% compliance, the results showed:

Table comparing apple a day vs statin a day from CALMERme.com

 

Study conclusions

The authors conclude that prescribing either an apple a day or a statin a day to everyone over 50 years old is likely to have a similar effect on population vascular mortality. Both “approaches to primary prevention of vascular disease have the potential to have a significant effect on population mortality.”

While apples came out costing more than statins, those costs are based on apples as an NHS prescription! If purchased through general food stores, the general NHS and pharmacy costs would be greatly reduced.  

But the key difference is that choosing apples over statins might avoid more than a thousand cases of myopathy and more than 12,000 excess diabetes diagnoses. And the cost of dealing with those adverse events of statins was not taken into consideration in the number above.

Take home message

This paper highlights that implementing lifestyle changes can have considerable effects on prevention of chronic diseases. We don’t need to resort to pills. They just hide one set of symptoms, only to give us a whole new set of symptoms. 

Let’s focus our disease prevention efforts and wellness on lifestyle changes. It’s all about optimizing health and well-being. We don’t need pharmaceuticals for that. We need a healthy lifestyle. Yes, it might take us longer to eat an apple a day than to swallow a statin – all that chewing and swallowing, etc! I think I can deal with that. What about you?

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