statines

Should Anyone Not Take a Statin?

In a meta-analysis, benefits of statins outweighed risks, even in the healthiest patients.
Meta-analyses have shown that statins safely lower the incidence of major vascular events (MVEs, including nonfatal myocardial infarction or coronary death, any stroke, or coronary revascularization) by about 20% for every 40 mg/dL reduction in LDL cholesterol level. But the net benefit of statin therapy in patients at low vascular risk has been unclear.
In a new meta-analysis of patient-level data from 27 randomized trials of statins versus control treatments or high- versus low-dose statins, researchers stratified 170,000 participants by their pretrial 5-year risk for MVEs (from <5% to 30%). Overall, statins lowered 5-year relative risk for MVEs by 21% per 40 mg/dL reduction in LDL cholesterol level, and risk reductions were more pronounced in the lowest risk categories (as much as 38% per 40 mg/dL reduction in LDL cholesterol level for participants with 5-year vascular risk <5%). Similar relative risk reductions occurred when patients with prior vascular disease, diabetes, or chronic kidney disease were excluded. Statins lowered 5-year relative risk for vascular death by at least 12% and did not raise risk for nonvascular death in patients with or without histories of vascular disease.
Comment: Among patients with 5-year MVE risk of <10%, statins lowered the absolute 5-year MVE risk by about 11 events per 1000 patients for each 40 mg/dL of reduction in LDL cholesterol level. This benefit substantially outweighs any known risk of statin therapy. The authors and editorialists suggest that current guidelines, which generally do not recommend statin therapy for low-risk patients, should be reevaluated. However, lingering questions include the following: In the general population, are statins tolerated as well as was reported in the randomized trials? Among the lowest-risk patients in real-life practice, is the long-term balance of benefits and harms as favorable as predicted from the trials? And, if low-risk patients choose to take statins, what are the appropriate ages to start and stop?
— Bruce Soloway, MD
Published in Journal Watch General Medicine June 12, 2012

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