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.
Cost-effectiveness improves when treatment is targeted at high risk individuals. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. DJ Cook, NL Greengold, AG Ellrodt, SR Weingarten. The relationship between systematic reviews and practice guidelines. S Morris, A McGuire, J Caro, D Pettitt.