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August 15, 2012

Use of Statins in Healthy Men

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (jbeckman@partners.org).

JAMA. 2012;308(7):666-667. doi:10.1001/jama.2012.8729

To the Editor: The Viewpoint by Drs Redberg and Katz1 advocated against the use of statins in otherwise healthy middle-aged men with elevated total cholesterol. I believe the authors misrepresent the data in a number of the studies cited in support of their points.

The authors reported that “healthy but high-risk men and women showed no reduction in mortality associated with treatment with statins” and cited 2 meta-analyses. However, both meta-analyses showed a reduction in mortality. The study by Ray et al2 chose a random-effects model for their meta-analysis, which assumes study heterogeneity. When using a fixed-effects model (appropriate given the absence of statistical heterogeneity among the trials), the risk reduction was 0.93 (95% CI, 0.86-1.00). The other cited meta-analysis demonstrated a similar significant reduction in all-cause mortality as well.