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Comment & Response
December 26, 2019

Questioning the Benefit of Statins for Low-Risk Populations—Medical Misinformation or Scientific Evidence?—Reply

Author Affiliations
  • 1Duke Clinical Research Institute, Durham, North Carolina
  • 2Associate Editor, JAMA Cardiology
JAMA Cardiol. 2020;5(2):233-234. doi:10.1001/jamacardio.2019.5123

In Reply Abramson et al and I differ on our interpretation of evidence regarding statins in primary prevention. In addition to preventing cardiovascular events in those with established disease, statins also prevent atherosclerosis, which can precede a cardiovascular event by many years. The high number needed to treat quoted by the authors at 5 years and the lack of mortality benefit in lower-risk adults is a reflection of the atherosclerotic timeline, not a repudiation of statins. An emerging body of literature supports a “nocebo effect” for statins,1 where fear of an adverse effect drives perceived intolerance and misattribution of unrelated muscle symptoms. Most patients who report statin “side effects” can tolerate statins if given a blinded rechallenge.2 Statin randomized clinical trials that have systematically collected muscle symptoms found little to no difference in myalgia between statin and placebo.3 Many iterations of independent guideline committees concur that statins are safe and effective in primary prevention.4

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