Although data supporting the use of statins to reduce cardiovascular risk are extensive, questions remain. Currently experts in cardiovascular health are in disagreement over the use of statins in low-risk patients, particularly patients with high cholesterol but no other cardiovascular risk factors.
While statin benefits are well established, real-world cohort studies have shown higher risks of complications and side-effects than seen in randomized-controlled trials. For every 100 otherwise healthy men men who take a statin for five years, one or two myocardial infarctions will be prevented but at least one patient will develop diabetes, and 20% or more will experience significant side effects.
One side of the argument states that in low-risk patients, clinicians should focus on lifestyle changes such as diet, exercise and smoking cessation. The use of statins in primary prevention is not a standard of care and the decision to initiate therapy should be based off a careful assessment of risk versus benefit.
Although previous meta-analyses have stressed that there is no mortality benefit with statins for primary prevention, a recent meta-analysis published in The Lancet showed that proportional reduction in major vascular events was as great in low risk patients as in high risk patients. Despite the author’s conclusion that statins are beneficial in low risk patients, clinicians remain divided over this issue.
References:
Redberg RF, Katz MH. Healthy men should not take statins. Journal of the American Medical Association 2012; 307(14):1491-3.
Mihaylova B, Emberson J, Blackwell L et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: a meta-analysis of individual data from 27 randomised trials. The Lancet 2012; DOI:10.1016/S0140-6736(12)60367-5
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