Many people wonder how effective statins are for preventing a heart attack in healthy people with high cholesterol. Even more important, do statins save lives in this population? There are few more controversial questions in medicine. That’s because tens of millions of people have been prescribed statins to lengthen their lives.
Statins Save Lives for Secondary Prevention:
Let’s make one thing absolutely clear. We are talking about PRIMARY PREVENTION, not secondary prevention. What’s the difference between these two situations?
If someone has experienced a heart attack or has diagnosed cardiovascular disease, we think a good case can be made for statins in what doctors call secondary prevention. That’s because people who have clearly defined heart disease or have had heart attacks or strokes appear to benefit from drugs like atorvastatin, simvastatin or rosuvastatin. The goal is to prevent a secondary event.
This article is not about that. We are reporting on people who are otherwise healthy but might have elevated cholesterol levels. Guidelines often encourage doctors to prescribe statins to older people just because of their age. Even if their cholesterol levels are good and their blood pressure is under control, they may be prescribed statins “just in case.” This is called primary prevention.
New Research Asks Whether Statins Save Lives:
A new meta-analysis published in JAMA Internal Medicine (Nov. 16, 2020) shows that if 100 healthy people between 50 and 75 years of age take a statin for 2.5 years, there will be one less cardiovascular event among that group. The data do not show that statins save lives.
This research focused on people over 55 years of age. They located eight randomized controlled trials involving 65,383 adults. Subjects were followed on average for 2 to 6 years.
Drilling Down on the Data:
The authors were looking for two major outcomes: A Major Adverse Cardiovascular Event (known to cardiologists as MACE) and mortality. Did statins save lives? Here is what they found:
“In this meta-analysis, only 1 of 8 randomized trials found that statins decreased all-cause mortality when used for primary prevention. We found that 100 adults aged 50 to 75 years would need to be treated for 2.5 years to avoid 1 MACE. This result suggests that statin treatment is most appropriate for adults aged 50-75 years with a life expectancy of greater than 2.5 years. For those with a life expectancy of less than 2.5 years, the harms of statins may outweigh the benefits. These results reinforce the importance of individualizing statin treatment decisions by incorporating each patient’s values and preferences.”
OK, that’s pretty technical. But the authors make it relatively simple. They state unequivocally in their conclusions:
“There is no evidence of a mortality benefit.”
That means that for primary prevention there is little, if any, evidence that statins save lives. The drugs will prevent 1 MACE [major adverse cardiovascular event] such as a heart attack out of 100 adults. It will take about 2.5 years for this benefit to show up. Another way of saying that is that 99 adults out of 100 will not avoid a MACE by taking a statin.
This finding will aggravate many health professionals. Please do not shoot the messenger. This is not our opinion. This is the conclusion of a meta-analysis published in a highly reputable publication, JAMA Internal Medicine (Nov. 16, 2020). You may want to print the abstract and show it to your prescriber. Better yet, suggest that she read the full article herself.
Do Statins Cause Side Effects?
There is also a growing effort to convince physicians and patients that statins do not cause side effects. This is not the first time. An article in the European Journal of Preventive Cardiology (March 12, 2014) concluded:
“Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo.”
You can read more about why doctors hate stories of statin side effects at this link.
If you would like to read more about statins you might find our book, Top Screwups, of interest. Do you know someone who might find this article of interest. Please click on the email, Facebook or Twitter links at the top of the page. Thank you for supporting our work. And if you would like to share your story in the comment section below we would love to read it.