The Stats on Statins: Should Healthy Adults Over 50 Take Them?

[xchrom]

http://www.scientificamerican.com/article.cfm?id=statins-should-healthy-adults-over-50-take-them


Everyone over 50 should take statins to lower their cholesterol, an editorial argued last week in The Lancet. The piece based its recommendation on a meta-analysis of 27 clinical trials published in the same issue that concluded statins significantly reduce the risk of heart attacks and other cardiovascular events in healthy people without posing substantial risks. Subsequent articles heralding the meta-analysis's findings were published in the Guardian, Forbes and the U.K. Telegraph. But based on the numbers, many experts still aren't convinced that the drugs' benefits outweigh their risks.

There's no question that statins save lives when they are prescribed to people with cardiovascular disease. But whether the drugs should also be given to healthy people who do not have high cholesterol or other cardiovascular risk factors has been a long-standing and controversial question. One large clinical trial known as JUPITER reported in 2008 that rosuvastatin (Crestor) lowers the risk of heart attacks and other events by 44 percent in healthy subjects but experts have since raised questions about its methodology in part because the trial was stopped early, which might have created the effect of overestimating the drug's benefits. The current meta-analysis was designed to help put the issue to rest. "Our aim was to bring together all the available evidence," explains co-author Colin Baigent, an epidemiologist at the University of Oxford in England.

After pooling the results of 27 trials involving 165,149 people, the meta-analysis reported that people are 21 percent less likely to suffer a serious vascular event such as a heart attack, stroke or bypass surgery after their cholesterol drops by the amount that might be expected after taking statins for a year than are similar people who do not take the pills. But such outcomes are rare in healthy individuals anyway, so the risk reduction actually translated to a small clinical benefit—reducing the overall risk from 4.04 percent to 3.27 percent per year, a difference of 0.77 percent.

[Warpy]

1. I think two different ways about this one

While some lives lost to cardiovascular disease would likely be saved, these are powerful drugs that would cost other lives through rhabdomyolysis, a rare but statistically significant side effect in people who take them.

Medicine is a risk versus benefit proposition and I have to wonder if the risk outweighs the benefit in this case.

[BadgerKid]

2. IIRC, high LDL still remains of concern.

Some radio blurb this morning was saying, if I recall correctly, that a high HDL level in and of itself wasn't sufficient to reduce risk of heart problems and that there were still risks correlated with high LDLs.

FWIW, I once visited a health nutritionist who claimed she had high total cholesterol but it was due to high HDL.

[Ron Obvious]

3. This may be a stupid question,

And I apologise if it is, but has a causal link truly been established between high cholesterol and heart disease? Is high cholesterol symptomatic of heart disease or causally implicated? I ask because there are plenty of populations on earth who eat a high-cholesterol diet, but who nevertheless do not suffer high rates of heart disease. I daresay statins aren't the only lifestyle change people with heart disease are prescribed.

I get very nervous when people want to prescribe blanket drug-taking. I've even heard some physicians say it should be added to drinking water. Considering the side effects of these drugs, that would make me nervous indeed.

[Warpy]

4. There are people who are genetically predisposed to having

very high cholesterol. They tend to have heart disease and strokes starting in their thirties and their lives have been prolonged using statin drugs. I think the causal relationship is well established, as is the effectiveness of the drugs in people with dangerously high cholesterol. People whose parents and grandparents didn't make it to 40 are now in their 70s.

Most people can take these drugs and suffer no side effects at all. However, for a minority, the side effects can be life threatening. Overprescribing them would be just as deadly as underprescribing them.