Benefits of Statins Outweigh Risks

Summary and Comment |
September 14, 2016

Benefits of Statins Outweigh Risks

  1. Karol E. Watson, MD, PhD, FACC

But exaggerated claims of harm may dissuade appropriate patients from taking them.

  1. Karol E. Watson, MD, PhD, FACC

To address the current perceptions and misperceptions of statin effects, as often portrayed in the lay literature, these authors comprehensively present randomized, controlled data on the benefits and risks of statin therapy from the Cholesterol Treatment Trialists' Collaboration (NEJM JW Cardiol Feb 2011 and Lancet 2010; 376:1658). Many of the authors have disclosed financial ties to makers of statins.

The authors found that each mmol/L (39 mg/dL) of LDL-cholesterol reduction with statins is associated with a 20% reduction in the rate of major vascular events and a 12% reduction in vascular mortality. Compared with the benefits of statin therapy, the risks “remain small”; the authors conclude that the only serious adverse effects of long-term statin treatment are myopathy, new-onset diabetes, and, probably, hemorrhagic stroke. Treating 10,000 patients for 5 years with standard statin therapies would result in 5 myopathy cases, 50 to 100 diabetes cases, 5 to 10 hemorrhagic strokes, and 50 to 100 symptomatic adverse events like muscle pain.

Hoping to help clinicians and patients decide about statin treatment, the authors note “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.” They observe that these claims sidestep an examination of the limitations of less rigorous and reliable sources of evidence.

Comment

For many different patient populations, including appropriate primary-prevention patients, the benefits of statins outweigh the risks. Too often media coverage focuses on rare, minor, or readily reversible adverse effects; exaggerated or misleading claims of harm may dissuade appropriate patients from taking statins. Despite this impressive compendium of data, we continue to need information on people who have not yet been studied well, such as very elderly and minority populations.

Editor Disclosures at Time of Publication

  • Disclosures for Karol E. Watson, MD, PhD, FACC at time of publication Consultant / Advisory board: Amgen; GlaxoSmithKline; Merck; Quest Editorial boards: Reviews in Cardiovascular Medicine; Circulation Quality Outcomes; Circulation

Citation(s):

Reader Comments (4)

Sheila Mouser Medical Student, Unspecified

As patients become more aware of medical conditions and treatments via technologies now readily available, it would seem reasonable to plan for inclusion of more detailed data when speaking with patients, specifically regarding the anti-inflammatory, carcinogenic and immunological data. While myopathies, cerebrovascular events and new-onset diabetes are certainly adverse effects to carefully consider, the additional emerging data on statins is proving to seemingly more than even the score, dependent, of course, upon specificity of particular patient medical history, past and current diagnoses, comorbidities (present or of hereditary probability) and patient tolerance of statin therapy.

Randy Minion MD Physician, Family Medicine/General Practice, United States

why did you report benefits as relative reductions, and harms as absolute risk increases. Isn't it better to compare like terms. For every 10,000 patients I treat with statins in primary prevention, how may deaths will I prevent? thanks

James Recht, MD Physician

Agree with Dr. Allan's comment above. For example, according to whom are the risks of harm "exaggerated"? The many authors with financial ties to makers of statins?

CHRISTIAN ALLAN Physician, Unspecified, Michigan

Statin Benefit Vs Risk discussion is an important one, and sadly not reasonably addressed in this comment or the article.

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