Yup statins again - primary prevention

Ask your doc is this lipex for primary or secondary prevention?

Primary prevention

• If cardiovascular (SAEs) serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3 to 5 years to prevent one myocardial infarction or stroke.

• This cardiovascular benefit is not reflected in 2 measures of overall health impact, total mortality and total serious adverse events.

• Therefore, statins have not been shown to provide an overall health benefit in primary prevention trials.

Secondary prevention

These 4 trials reconfirm the benefit of statins for patients with elevated cholesterol and coronary disease and expand the benefit to patients with clinically evident occlusive coronary, cerebral or peripheral vascular disease and a total cholesterol >3.5 mM. Despite the lack of reporting of total SAEs in these trials, one measure of overall health benefit, total mortality, was reduced, pooled RR 0.84 [0.79–0.88], ARR 2.1%, NNT 48 for 3 to 5 years.

Note the lack of reporting of SAEs! Why not? Makes me suspicious.

Note that most of these studies take place only over a few years - notoriously the harms take years to surface.

Statins have been promoted as having few side effects - we shall see. Here's a place keeping tabs on side effects. This site doesn't mention the risk of cancer in the elderly.

In 70 and above year olds without heart disease statin therapy did not reduce risk of stroke or heart attack. It did increase their risk of cancer. By the fourth year there is one extra cancer for every 100 elderly people taking statin per year.

So 48 people have to keep taking the pill for 3-5 years for one person to benefit! Probably worth doing.

But what about diet and exercise?
What about women?
What about the elderly?