From Clinical Endocrinology News, June 2012, is mention of a publication in Lancet 2012 May 16, that reviews results from a meta-analysis of more than 170,000 participants showing a “clear, positive, overall effect from statin treatment in all types of adults, even those with relatively low baseline risk for major vascular events.” Among those with a 5-year risk of major cardiovascular events lower than 10%, each 39mg% reduction of LDL resulted in an absolute risk reduction of 11 events per 1000 people treated. Their conclusion is that even in people at low risk, the benefits “greatly outweigh the risks.” They also concluded that the increase in the incidence of hemorrhagic strokes and diabetes are not sufficiently large enough to outweigh the benefits.
Drs. Shah Ebrahim and Juan Casas then express their views on the findings, stating that the results look encouraging and give assurance that higher dose statin doses needed to achieve this 39mg% reduction apparently are not associated with any potential serious adverse events. The results from this meta-analysis are contrary to one performed by AHRQ, which used specific inclusion criteria for their analysis, and stated that for every 1000 people treated with intensive-dose therapy there would be an additional four cardiovascular deaths prevented (10 MIs & 6 strokes), but would result in an additional thirty-three additional adverse events (21 requiring discontinuation of the drug). So for every cardiovascular event prevented there would be eight ADEs of any type with five being potentially serious. This can be found at a previous post at http://elderdrugs.com/2012/06/adverse-events-associated-with-intensive-dose-statin-therapy-minimize-use/
Drs. Ebrahim and Casas save their credibility, in my opinion, by suggesting treating low-risk individuals may take the eye off those at higher risk; it may be difficult to treat those with no evidence of cardiovascular disease; and suggest “an even better solution would be more aggressive dietary measures to lower LDL cholesterol”, although they suggest to achieve this on a national level would be difficult. They then conclude that “treating all those over 50 years old” would be the best solution since most people over 50 are at greater than 10% risk for cardiovascular disease, thereby backtracking on the recommendation to achieve LDL reductions through diet. I’m afraid the number needed to treat, barriers to adherence, drug interactions and adverse effects would pose a problem with that approach. With all the data on adverse effects from statins I tend to believe a individualized approach is most appropriate, and isn’t that what we should be doing in all instances? One meta analysis, with limitations, should not drive new prescriptive habits.
FYI Several authors of the meta-analysis disclosed they received reimbursement from the pharmaceutical industry, and two authors received honoraria from Solvay for lectures related to the meta-analysis.