Should I take Statins?

Coronary heart disease, heart attacks, and ischemic stroke are examples of cardiovascular disease (CVD). CVD is the main cause of mortality in the world and researchers are constantly investigating ways to treat the underlying causes of this disease.

On 15 November, the US Preventive Services Task Force (USPSTF) released an updated recommendation for statin use for the prevention of cardiovascular disease in adults (JAMA. 2016;316(19):1997-2007). Statins are primarily used to lower total cholesterol, LDL-C (low-density lipoprotein cholesterol), and triglycerides. The USPSTF now recommends using a low- to moderate-dose of statins to prevent cardiovascular disease in at-risk individuals (individual with dyslipidemia, diabetes, hypertension, or smoking) that are 40 to 75. However, they stated that it is uncertain whether statins can help individuals that are over 75 and don’t have a history of stroke or heart attack. These recommendations are for the prevention of CVD and do not apply to people who already have high cholesterol, high LDL-C, or familial hypercholesterolemia.

Other bodies, National Institute for Health and Care Excellence (NICE), The American College of Cardiology/American Heart Association (ACC/AHA) guidelines, the European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS), and the Canadian Cardiovascular Society (CCS) also base recommendations for statin therapy on a calculated risk score (BMJ 2016;355:i6334). However, these bodies do not necessarily agree on how to calculate risk. This is a problem with the new recommendations, currently, no one can agree who is at risk. The American College of Cardiology and American Heart Association published recommendations to assess cardiovascular risk (Circulation. 2014 Jun 24;129(25 Suppl 2):S49-73). However, as this risk assessment has been shown to overestimate true risk. (JAMA2016;316:1997-2007, Circulation2014;129(suppl 2):S1-45)

While the USPSTF recommends using statins to lower CVD risk there are still researchers that doubt its efficacy. They believe that while there is an association between high cholesterol and CVD evidence supporting a causal link is lacking. Diamond and Ravnskov reviewed the literature in early 2015 and concluded that while statins do lower cholesterol they do not reduce cardiovascular disease. They believe that the results from prior studies use statistics to their advantage – presenting data in relative risk instead of absolute risk – to make it seem like there are substantial cardiovascular benefits. Diamond and Ravnskov acknowledge that there are cardiovascular benefits to taking statins but those benefits are minor and do not outweigh the potential adverse effects (Expert Review of Clinical Pharmacology, 8:2, 201-210).

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