Statins for Primary Prevention of Cardiovascular Disease
Authors: J. David Spence
Journal: Annals of Internal Medicine (2019)

Letters2 July 2019Statins for Primary Prevention of Cardiovascular DiseaseJ. David Spence, MDJ. David Spence, MDWestern University, London, Ontario, Canada (J.D.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0259 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their recent analysis of benefits and harms of statins, Yebyo and colleagues (1) accepted as harms many conditions reported in observational studies, which are subject to indication bias or reverse causality. Valid adverse effects are observed in large clinical trials and meta-analyses. Because of the 5-reference limit for comments published in Annals, many of the issues discussed here are referenced in a review (2).Statins do not cause hepatotoxicity; this is apparent from the GREACE (Greek Atorvastatin and Coronary Heart Disease Evaluation) trial, in which patients with liver enzyme abnormalities (probably due to nonalcoholic fatty liver ...References1. Yebyo HG, Aschmann HE, Puhan MA. Finding the balance between benefits and harms when using statins for primary prevention of cardiovascular disease: a modeling study. Ann Intern Med. 2019;170:1-10. [PMID: 30508425]. doi:10.7326/M18-1279 LinkGoogle Scholar2. Spence JD, Dresser GK. Overcoming challenges with statin therapy. J Am Heart Assoc. 2016;5. [PMID: 26819251] doi:10.1161/JAHA.115.002497 CrossrefMedlineGoogle Scholar3. Amarenco P, Goldstein LB, Szarek M, et al; SPARCL Investigators.. Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack: the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2007;38:3198-204. [PMID: 17962589] CrossrefMedlineGoogle Scholar4. Hackam DG, Woodward M, Newby LK, et al. Statins and intracerebral hemorrhage: collaborative systematic review and meta-analysis. Circulation. 2011;124:2233-42. [PMID: 22007076] doi:10.1161/CIRCULATIONAHA.111.055269 CrossrefMedlineGoogle Scholar5. McKinney JS, Kostis WJ. Statin therapy and the risk of intracerebral hemorrhage: a meta-analysis of 31 randomized controlled trials. Stroke. 2012;43:2149-56. [PMID: 22588266] doi:10.1161/STROKEAHA.112.655894 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Western University, London, Ontario, Canada (J.D.S.)Disclosures: The author has disclosed no conflicts of interest. His form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0259. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFinding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease Henock G. Yebyo , Hélène E. Aschmann , and Milo A. Puhan Statins for Primary Prevention of Cardiovascular Disease Zhen Zhou Statins for Primary Prevention of Cardiovascular Disease Benjamin Djulbegovic and Iztok Hozo Statins for Primary Prevention of Cardiovascular Disease Henock G. Yebyo , Hélène E. Aschmann , and Milo A. Puhan Statins for Primary Prevention of Cardiovascular Disease Paul C. Sorum Statins for Primary Prevention of Cardiovascular Disease Chester B. Good , Inmaculada Hernandez , and Natasha Parekh Metrics 2 July 2019Volume 171, Issue 1Page: 72-73KeywordsCataractsCholesterolLongitudinal studiesLow density lipoproteinMetabolitesNon-alcoholic fatty liver diseaseObservational studiesRhabdomyolysisStatinsStroke ePublished: 2 July 2019 Issue Published: 2 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...