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Contempo 1999
November 24, 1999

Gauging the Impact of Statins Using Number Needed to Treat

Author Affiliations

Author Affiliations: Departments of Medicine (Drs Kumana and Cheung) and Statistics (Dr Lauder), University of Hong Kong, Hong Kong.


Edited by Thomas C. Jefferson, MD, Contributing Editor.

JAMA. 1999;282(20):1899-1901. doi:10.1001/jama.282.20.1899

The first evidence-based guidelines to treat coronary heart disease (CHD) with lipid-lowering drug therapy1-7 were largely based on findings from the Scandinavian Simvastatin Survival Study (4S),8 which involved secondary prevention in patients with CHD. Thus, intervention was indicated only in patients with (1) hypercholesterolemia and (2) increased risk of CHD. Conventionally, this entailed dietary manipulation followed, if necessary, by treatment with a statin drug. However, mounting evidence from several subsequently published, large-scale, randomized clinical trials involving long-term use of statins has important additional implications on clinical practice. Thus, the cardiovascular benefits of long-term intervention with statins have now been amply demonstrated in: (1) men with hyperlipidemia but no known CHD,9 (2) patients with CHD but without hyperlipidemia,10,11 and (3) men and women with average total and low-density lipoprotein plasma cholesterol levels and no known CHD.12 In summary, statins have been confirmed to confer such benefit in persons with and without CHD, and with and without hyperlipidemia. Choosing the least expensive alternative from among many "me too" statins might represent a narrow short-term view of cost-effectiveness. Though important, the vagaries of such selections will not be discussed here, as the prices of individual drugs vary from time to time, and from place to place. The broader strategic view of their usefulness is the focus of this article, and requires an understanding of how much benefit is likely to accrue under different circumstances over given periods of time.