Statins, Primary Prevention, and Overall Mortality
Authors: Vinay Prasad
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions17 June 2014Statins, Primary Prevention, and Overall MortalityVinay Prasad, MDVinay Prasad, MDFrom National Cancer Institute, National Institutes of Health, Bethesda, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M13-2974 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In November 2013, the American College of Cardiology and the American Heart Association published an update to cholesterol guidelines that sparked lively debate about the role of statins in the primary prevention of cardiovascular disease. Statin therapy reduces illness (stroke and myocardial infarction) (1), but attendant harms have been underappreciated (2). One measure of efficacy that is universally considered important is the effect of therapy on overall mortality (1, 2). Only 1 trial (3) among dozens has shown strong evidence of a mortality benefit with statin therapy, and the study was criticized for early stopping (4). Small differences in all-cause ...References1. Robinson JG. Accumulating evidence for statins in primary prevention [Editorial]. JAMA. 2013;310:2405-6. [PMID: 24276744] CrossrefMedlineGoogle Scholar2. Redberg RF, Katz MH. Healthy men should not take statins. JAMA. 2012;307:1491-2. [PMID: 22496261] CrossrefMedlineGoogle Scholar3. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM, Kastelein JJ, et al; JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195-207. [PMID: 18997196] CrossrefMedlineGoogle Scholar4. Ray KK, Seshasai SR, Erqou S, Sever P, Jukema JW, Ford I, et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med. 2010;170:1024-31. [PMID: 20585067] CrossrefMedlineGoogle Scholar5. Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;1:CD004816. [PMID: 23440795] MedlineGoogle Scholar6. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301-7. [PMID: 7566020] CrossrefMedlineGoogle Scholar7. Ford I, Murray H, Packard CJ, Shepherd J, Macfarlane PW, Cobbe SM; West of Scotland Coronary Prevention Study Group. Long-term follow-up of the West of Scotland Coronary Prevention Study. N Engl J Med. 2007;357:1477-86. [PMID: 17928595] CrossrefMedlineGoogle Scholar8. Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, Barnes EH, et al; Cholesterol Treatment Trialists' (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380:581-90. [PMID: 22607822] CrossrefMedlineGoogle Scholar9. Newman DH, Saini V, Brody H, Brownlee S, Hoffman JR, Redberg RF, et al; Cholesterol Treatment Trialists' (CTT) Collaborators. Statins for people at low risk of cardiovascular disease [Letter]. Lancet. 2012;380:1814. [PMID: 23177692] CrossrefMedlineGoogle Scholar10. National Conference of State Legislatures. Automatic recount. Denver: National Conference of State Legislatures; 2010. Accessed at www.ncsl.org/research/elections-and-campaigns/automatic-recount-thresholds.aspx on 20 November 2013. Google Scholar Author, Article, and Disclosure InformationAffiliations: From National Cancer Institute, National Institutes of Health, Bethesda, Maryland.Disclaimer: The views and opinions of the author do not reflect those of the National Cancer Institute or National Institutes of Health.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2974.Corresponding Author: Vinay Prasad, MD, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 12N226, Bethesda, MD 20892; e-mail, vinayak.[email protected]gov.Author Contributions: Conception and design: V. Prasad.Analysis and interpretation of the data: V. Prasad.Drafting of the article: V. Prasad.Critical revision of the article for important intellectual content: V. Prasad.Final approval of the article: V. Prasad.Collection and assembly of data: V. Prasad. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByMeta-Analyses of Statin Therapy for Primary Prevention Do Not Answer Key Questions: An Empirical Appraisal of 5 Years of Statin Meta-AnalysesAccumulation of Cardiovascular and Diabetes Medication among Apparently Healthy Statin Initiators 17 June 2014Volume 160, Issue 12Page: 867-869KeywordsCardiovascular diseasesCardiovascular therapyCholesterolDeath ratesDietMuscular dystrophiesMyocardial infarctionStatins ePublished: 17 June 2014 Issue Published: 17 June 2014 PDF DownloadLoading ...