The guideline-recommended risk thresholds for initiating statins for primary prevention of cardiovascular disease may be too low, a modeling study in the Annals of Internal Medicine suggests.
Researchers performed a network meta-analysis of studies comparing four low- or moderate-dose statins with no statins in patients aged 40 to 75 with no CVD history. They balanced statins' potential benefit of CVD event prevention with potential harms, like myopathy, hepatic or renal dysfunction, cataracts, hemorrhagic stroke, type 2 diabetes, and cancer.
Most current guidelines recommend statin initiation when a person's 10-year CVD risk is 7.5%–10%. In this study, the benefits only began to outweigh the risks when CVD risk was 14% for men aged 40 to 49. For men 70 to 75 years, the threshold was 21%. For women, thresholds ranged from 17% to 22%.
The authors conclude: "Our results suggest that guidelines should use higher 10-year risk thresholds when recommending statins for primary prevention of CVD and should consider different recommendations based on sex, age group, and statin type."
Of note, guidelines released last month by the American College of Cardiology and American Heart Association consider a 10-year risk score of 7.5%–19.9% to denote "intermediate risk."
Finally, a study that supports reining in the blanket use of statin drugs. This meta-analysis reflects views held by much of the holistic health community for decades. Don’t hold your breath for any changes from the American College of Cardiology or the American Heart Association. Their views reflect the interests of Big Pharm.
Most patients taking statin drugs have never even heard of cardiac myopathy. That’s the heart muscle damage that occurs in 10% of patients taking statin drugs. Physicians are required to explain all the possible risks associated with prescribing a drug. However, the risks of statin drug use are rarely related to patients. More typically, they develop myopathy in the legs and stop the medication because their legs are weak and painful.
Statin drug use should be restricted to those patients with a high risk of CVD rather than used as a panacea for everyone over the age of 40. Think of it like aspirin, not to be used for primary prevention because the side effects are too great, but often used after a cardiac event as now the risks are greater than the side effects.
Source: December 4, 2018 New England Journal of Medicine
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