Are statins overprescribed for cardiovascular disease prevention?
05 December, 2018
For millions of people who take statins to prevent the onset of cardiovascular disease, the potential harms of the cholesterol-lowering medication may outweigh the benefits.
So concludes a recent modeling study from the University of Zurich in Switzerland that questions whether statins are "significantly overprescribed."
The research, which features in the Annals of Internal Medicine, concerns the use of statins for the "primary prevention" of cardiovascular disease in people with no history of the disease.
A primary prevention measure is one that intervenes to prevent a condition before it can impact health. Vaccinations, for example, are primary prevention measures.
Statins are some of the most prescribed classes of drugs worldwide. They work by blocking an enzyme called HMG-CoA reductase that helps the liver to make cholesterol.
Most medical guidelines recommend the use of statins for people with no history of symptoms when their expected risk of developing cardiovascular disease over the next 10 years is 7.5–10 percent.
Such a 10-year risk threshold places around 3 out of every 10 adults worldwide as eligible for treatment.
However, the authors note that "whether and how guideline developers weighed harms against benefits is often unclear."
Statins for primary prevention
In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) updated the recommendations that guide doctors in the treatment of cholesterol and use of statins.
One reason for the update was the argument that high blood cholesterol is one of the "most prevalent" of alterable cardiovascular risk factors.
Another argument was that there is evidence that treating cholesterol reduces numbers of people who develop cardiovascular diseases and who die of them.
The update caused controversy. This was mainly because it lowered the thresholds that doctors should use to help them decide whether to prescribe statins for primary cardiovascular disease prevention.
This recommended that doctors should consider adults with no history of heart problems as eligible for primary prevention if their risk of developing cardiovascular disease in the next 10 years is 7.5 percent or higher.
Also, the revision expanded the target of prevention to include not just coronary heart disease, but also atherosclerosis, stroke, and peripheral arterial disease.
Experts predicted at the time that full implementation of the guidelines would identify around 13 million people in the United States as "newly eligible for consideration" for treatment with statins.
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