The question of whether or not to give more healthy patients statin drugs is one of considerable interest to the public and much debate in both the medical community and the lay press.
In Nov. 12, 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) released their long-awaited new guideline on the treatment of blood cholesterol to reduce the risk of adult atherosclerosis.
This guideline, among other recommendations, guided physicians to expand the number of patients being treated with statin drugs. This ACC/AHA guideline was greeted with many objections in both the medical community and the lay press. Most notable was a Nov. 14 New York Times Op Ed by two respected experts, Dr. John Abramson and Dr. Rita Redberg, entitled "Don’t Give More Patients Statins."
Other New York Times articles by Gina Kolata on Nov. 18 and 26 (citing Dr. Paul Ridker, Dr. Nancy Cook, and others) expressed similar reservations about the ACC/AHA guideline recommendation to broaden statin administration. Thus, this guideline and its recommendations are controversial and of great interest and importance to physicians and the public.
The Op Ed by Dr. Abramson and Dr. Redberg makes the case that the recent ACC/AHA cholesterol guideline is incorrect to advocate expansion of statin usage to more patients because such expansion "will benefit the pharmaceutical industry more than anyone else." They state that the guideline’s authors were not "free of conflicts of interest." In addition, they claim that "18% or more" of statin recipients "experience side effects" and that the increase in statin administration will largely be in "healthy people" who do not benefit and who would be better served by an improved diet and lifestyle.
While the latter is true for everyone, Dr. Abramson and Dr. Redberg convey the wrong message. Statins are the miracle drug of our era. They have proven repeatedly and dramatically to lower the disabling and common consequences of arteriosclerosis – most prominently heart attacks, strokes, and deaths in patients at risk. Statins avoid these vascular catastrophes not only by lowering bad blood lipids but also by a number of other beneficial effects that stabilize arterial plaques.
They have minimal side effects, most of which are benign. In several controlled studies, the patients who did not receive statins had an incidence of "side effects" equal to those who received them. Serious side effects are rare and manageable. Moreover, healthy patients are healthy only until they get sick. Many individuals over 40 take a daily aspirin. Statins are far more effective than aspirin in preventing heart attacks and strokes which often occur unexpectedly in previously "healthy people."
Clearly it would be worthwhile for such healthy people to take a daily statin pill with few side effects if it would lower their risk of such vascular catastrophes and premature death. In contrast to what is implied in the Abramson–Redberg Op Ed, these drugs are an easy way for people to live longer and live better, and statins cannot be replaced with a healthy life style and diet – although combining the latter with statins is a good thing.
Lastly, regarding the comments about the pharmaceutical industry benefitting and guideline authors’ conflicts of interest, both are less important than patient benefit, which has been demonstrated dramatically and consistently in many controlled statin trials. Moreover, most statins are now generic so the cost for obtaining these miraculous drugs need not be prohibitive, and the guideline’s authors are experts who are eminently qualified to write them.
More patients should be on statin medication.
Dr. Veith is professor of vascular surgery, Langone New York University Medical Center and The Cleveland Clinic. He is an associate medical editor for VASCULAR SPECIALIST. He has no financial conflicts of interest.
The ideas and opinions expressed in VASCULAR SPECIALIST do not necessarily reflect those of the Society or Publisher.