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December 11, 2013

Accumulating Evidence for Statins in Primary Prevention

Author Affiliations
  • 1Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
  • 2Department of Medicine, College of Public Health, University of Iowa, Iowa City
  • 3Prevention Intervention Center, College of Public Health, University of Iowa, Iowa City
JAMA. 2013;310(22):2405-2406. doi:10.1001/jama.2013.281355

Many voices in the public and the medical community argue strongly against the widespread use of statins for the primary prevention of atherosclerotic cardiovascular disease. Critics give several reasons to avoid statin therapy, including concerns about adverse effects, lack of a total mortality benefit, cost, and a philosophical aversion to drug therapy. However, the passage of time has allowed sufficient evidence to accumulate to refute each of these concerns.

Meta-analyses now provide extensive evidence that statins reduce cardiovascular events and total mortality in individuals at lower risk of cardiovascular events than has previously been appreciated, and do so with an excellent margin of safety.1-3 In this issue of JAMA, Taylor and colleagues4 provide a summary of the 2013 Cochrane2 meta-analysis (an updated version of the 2011 Cochrane meta-analysis on this topic3) of 18 primary prevention statin trials including 56 934 participants. The authors report that statins significantly reduce all-cause mortality (−14%), fatal and nonfatal cardiovascular disease (−22%), coronary heart disease (−27%), stroke (−22%), and coronary revascularization (−38%). These risk reduction benefits occurred in the absence of an increased risk of cancer, myalgia, rhabdomyolysis, liver enzyme elevation, renal dysfunction, or arthritis.