Statin Therapy: Rethinking Benefits and Risks

A recent 30-page manuscript provides an exhaustive review of the evidence for the efficacy and safety of statin therapy.

The authors of this excellent review provide some context for the relative value of statins.

The note that putting 10000 individuals with a history of a vascular event on a statin drug for 5 years would prevent 1,000 subsequent events. This is an example of secondary prevention--preventing another adverse outcome in those already experiencing an adverse event.

But the statin drugs also appear very powerful in primary prevention-preventing a first event in those at high risk for vascular disease. They estimate putting 10,000 individuals at high risk for vascular events on statins would result in prevention of 500 vascular events over five years.

This review provides an up-to-date review of the safety of statins and generally supports the therapy as very low risk.

One proposed adverse event of statin therapy is concern about memory and cognition. However, the authors note that well-designed studies of statin therapy in older individuals find no evidence of adverse cognitive effects compared to placebo.

They argue that:

"..given the weight of evidence against adverse effects of statin therapy on memory or other adverse effects of cognition, it would now be appropriate for regulatory authorities to consider removal from the lists of potential adverse effects on the drug labels so that patients are not inappropriately deterred from using statin therapy." (emphasis mine).

The authors go on to emphasize the potential adverse public health consequences of misleading claims regarding the safety of the statin drug class.

This excellent review is likely to lead to further discussion about extending the indications for statin use in the general population.

This review also supports discussion between individuals and their physicans on the appropriateness of statin therapy as part of a disease prevention progra.

Readers with more interest in this topic can access the full free-text manuscript by clicking on the link in the citation below.

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Collins R, Reith C, Emberson J et al.  (2016). Interpretation of the evidence for the efficacy and safety of statin therapy Lancet : http://dx.doi.org/10.1016/S0140-6736(16)31357-5