With pravastatin over 6,500 people were involved with trials going on for nearly four years on average. With simvastatin, just under 5,000 people were studied, but for over five years. The systematic review found no evidence for any increased risk in non-stroke mortality, nor any significant risk of cancer over control. Comment Many groups are seeking to produce guidance for clinicians on the use of statins. That guidance is best founded on solid evidence, and the best evidence comes from quality systematic reviews.
Key questions being asked include which patient and which statin.
Perhaps they ought to be driven by the weight of evidence as well - evidence which will change as more studies report, and as other evidence from audit and elsewhere becomes available. When it does, and if it changes the picture, then guidance can change with it. This always seem to be the bogeyman of cholesterol-lowering, whatever the intervention used. The problem is, as the authors tell us, is that while there is general agreement among the studies, there is high sensitivity to the assumptions used, especially in screening strategies. Pharmacological intervention is least cost-effective in the young and the elderly.