Blog | Wednesday, February 23, 2011

QD: News Every Day--Statins rose tenfold as their use in primary prevention is questioned

The percentage of adults 45 years of age and over taking statins increased from 2% in 1988-1994 to 25% in 2005-2008, reports the chartbook "Health, United States 2010" released by the National Center for Health Statistics of the Centers for Disease Control and Prevention. In 2005–2008 nearly one-half of men 65 to 74 years of age took a statin drug in the past 30 days, compared with just over one-third of women in that age group.

Health, United States from the National Center for Health Statistics, Centers for Disease Control and Prevention.The chartbook reported a concurrent decline in the percentage of Americans with high serum total cholesterol (greater than or equal to 240 mg/dL), which may be attributable to increased use of cholesterol-lowering medications, especially statins.

Initial studies of statins' cholesterol lowering effects in the New England Journal of Medicine and the Journal of the American Medical Associationin patients at high-risk for heart disease contributed to widespread belief it would work in all patients.

But in the past year, using statins for primary prevention has come into question. A meta-analysis in the Archives of Internal Medicinecombined data from 11 randomized trials involving 65,229 participants followed for approximately 244,000 person-years. Researchers found no statistically significant benefit of statins on mortality, even in the highest risk group (risk ratio, 0.91; 95% confidence interval, 0.83-1.01).

And, a systematic review of the effects of statins reported in the Cochrane Database of Systematic Reviews suggests that the evidence is less clear for people without a past history of cardiovascular disease. Researchers conducted a systematic review of 14 randomized control trials (34,272 patients) dating from 1994 to 2006, all comparing statins with usual care or placebo. Duration of treatment was minimum one year and with follow up of a minimum of six months.

"Although reductions in all-cause mortality, composite endpoints and revascularizations were found with no excess of adverse events, there was evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease," the authors wrote. "Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life."