The online home for the primary care professionals managing patients with cardiovascular disease, diabetes and related diseases.

Major review allows informed decisions on statin use

Major review allows informed decisions on statin use

Publication date: Thursday, 27 October 2016
Contributor(s): Jeremy Bray

The benefits of statin therapy have been repeatedly underestimated, and the harms exaggerated, due to misinterpretation of the evidence, according to the authors of a major review published in The Lancet recently.

The review considered the generic strengths and limitations of randomised trials and observational studies for assessing the effects of treatment, and then considered all the specific evidence available on the efficacy and safety of statin therapy. It concluded by considering the public health implications of the failure to recognise the full benefits of using statin therapy and of the exaggerated claims that have been made about the rates of side-effects.

The review highlighted that observational epidemiological studies have been extremely valuable for identifying associations of risk factors with disease (e.g. smoking with lung cancer; blood pressure and cholesterol with cardiovascular disease), but their value for the assessment of the effects of treatment is more limited. However, randomised controlled trials are able to determine cause and effect

Professor Rory Collins (Clinical Trial Service Unit, University of Oxford) said, “Our review shows that the numbers of people who avoid heart attacks and strokes by taking statin therapy are very much larger than the numbers who have side-effects with it. In addition, whereas most of the side-effects can be reversed with no residual effects by stopping the statin, the effects of a heart attack or stroke not being prevented are irreversible and can be devastating. Consequently there is a serious cost to public health from making misleading claims about high side-effect rates that inappropriately dissuade people from taking statin therapy despite the proven benefits.”

Overall conclusions

The study authors concluded that lowering cholesterol by 2 mmol/L with an effective low-cost statin therapy (e.g. atorvastatin 40 mg daily, approx. £2 per month in the UK) for 5 years in 10,000 patients would: 

  • Prevent major cardiovascular events (heart attacks, ischaemic strokes and coronary artery bypasses) in 1000 people with pre-existing vascular disease (secondary prevention), and in 500 people who are at increased risk (e.g. due to their age or having hypertension or diabetes) but have not yet had a vascular event (primary prevention).
  • Cause 5 cases of myopathy (one of which might progress to the more severe condition of rhabdomyolysis, if the statin is not stopped), 5-10 haemorrhagic strokes, 50-100 new cases of diabetes and up to 50-100 cases of symptomatic adverse events (such as muscle pain).

ACTION

The study provides an evidence-based defence of the effectiveness of statins in the light of negative coverage in the media. The review of randomised trials and analysis of the limitations of other types of studies allows to doctors and patients to make informed decisions about the use of statins.

Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016, published 8 Sept www.thelancet.com/journals/lancet/article/PIIS140-6736(16)31357-5/abstract

Topics covered:
Category: Evidence in Practice
Edition: Volume 1 Number 10 PCCJ Online 2016
Contributor(s): Jeremy Bray

Article search and filter