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The American Journal of Cardiology
Volume 97, Issue 8, Supplement 1 , 17 April 2006, Pages S95-S97
Benefit versus Risk in Statin Treatment
John R. Guyton MD,
Duke University Medical Center, Durham, North Carolina, USA.
The Statin Safety Assessment Conference of the National Lipid
Association (NLA), reported in this supplement to The American
Journal of Cardiology, provides a comprehensive evaluation of
old and new experience on adverse events associated with the 3-hydroxy-3-methylglutaryl
coenzyme A (HMG-CoA) reductase inhibitors, or statins. To place
these in context, one can express both the risk of side effects
and the benefits for cardiovascular disease in terms of events
per person-year of statin treatment. The mortality risk from fatal
rhabdomyolysis is approximately 0.3 per 100,000 person-years,
and the risks of nonfatal rhabdomyolysis and of putative statin-attributable
peripheral
neuropathy are approximately 3 and 12 events, respectively,
per 100,000 person-years. Reports of acute liver failure and acute
or chronic kidney disease give lower rate estimates that, even
when corrected for underreporting, are approximately equal to
the background rates of these conditions in the general population,
lending scant support for statin-attributable etiology. In contrast,
the benefit of statin use is to avert several hundred deaths and
several hundred cases each of heart and brain infarction per 100,000
person-years in appropriately treated high-risk patients. Although
population estimates such as these are useful, they must be translated
repeatedly to individual patient-provider encounters, where clinical
skill and art must combine with scientific evidence. The continued
publication of individual case reports and small randomized trials
among groups of patients with potential side effects should be
encouraged. Statins should not be used in situations where minimal
benefit is expected, as safety data and risk–benefit analysis
must be meshed with guidelines that help the clinician decide
whom to treat and how aggressively to treat.
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Related: A
German study on the cost-effectiveness of statins concluded
that statins were cost effective in preventing first heart attacks
(primary prevention) and less so in secondary prevention.
Related: the
economics of statins
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Statin Answers
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