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Tuesday, July 23, 2013

Statins and their risk/benefit

  • A recent large Meta-analysis (a study which combined the results of 135 randomized trials) has shown that statins did not significantly increase risk for myalgia (muscle pain), myopathy (muscle weakness), rhabdomyolysis (muscle breakdown) or cancer as compared with control treatment. There was a slight increase in the risk of diabetes. 

    I remain a strong believer in the benefit of statin therapy to reduce heart attack, strokes and death in patients with known heart disease and in those at intermediate-to-high risk for heart disease. See my prior blog posting explaining my rationale. I have also previously written about ways I help my patients assess their risk of heart disease. 

    Below is an excellent editorial based on the recent trial I cited above which I wanted to share with you:

    "At a time when the major trials continue to support substantial benefit from statin use, especially in patients with known atherosclerotic vascular disease, this study provides important information that the risks of long-term therapy with statins is relatively low.

    But, like all medications, there are benefits and there are risks. We are not at a point at which statins should be placed in the water. We need to be careful that when we recommend statin therapy for primary prevention of CVD we do so with the knowledge that the patients for whom the therapy is recommended should be at increased risk and have their risk identified as a guide to therapy. In the future we will see increasing emphasis placed on the risk-benefit of statin therapy for patients in primary prevention who have not yet experienced an event. There is no doubt that with secondary prevention the benefits of statin therapy far outweigh the risks. From this very interesting study of almost a quarter million patients, we can see that those risks are quite small.

    Recently, the FDA warned that simvastatin at high doses should not be used in most settings. Across the board, we are learning that the problems with statin side effects tend to occur with higher doses. It is important to be careful that we still have a good way of assessing risk and identifying those who will truly benefit from long-term therapy with statins.

    • Sidney C. Smith Jr., MD, FACC, FAHA, FESC
    • Professor of Medicine, University of North Carolina, Chapel Hill
      Past President, AHA
      Previous Chair of the ACC/AHA guidelines committee"

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