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2017 ; 83
(5
): 938-941
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Statins and mortality: the untold story
#MMPMID27921324
Kostapanos MS
; Elisaf MS
Br J Clin Pharmacol
2017[May]; 83
(5
): 938-941
PMID27921324
show ga
Statins are first-line evidence-based drugs for the management of dyslipidaemias
and to reduce the risk of cardiovascular events. However, statin clinical trials
have shown marginally significant benefits on mortality, especially in the
primary prevention setting. A major limitation of those trials is their
relatively short follow-up. A reduced number of fatal events within a 5-year
follow-up make mortality benefits unlikely to arise. This is particularly
relevant for the primary prevention trials, where the risk of cardiovascular
death is low. The short follow-up is a limitation for safety assessments too.
However, extended major statin trials failed to detect any major safety concerns.
Safety and efficacy assessments are even more complicated considering the
differences of cardiovascular risk status in primary prevention individuals, and
also given some potential ethnic and inter-individual genetic variations in
response to statin treatment. Considerable evidence suggests a favourable
risk-benefit balance for statin treatment. It can be assumed that statins reduce
mortality in the long term by preventing cardiovascular events with complications
that reduce lifespan. Unfortunately, this hypothesis cannot be proven as there is
no current ethical basis on designing long-term placebo-controlled statin trials.
Nevertheless, by effectively reducing disabilities related to cardiovascular
events, statins have major benefits for public health. Therefore, clinicians
should not withhold statin treatment awaiting proof of mortality benefits, as
this may remain an 'untold story'.
|Cardiovascular Diseases/etiology/mortality/*prevention & control
[MESH]
|Dyslipidemias/complications/*drug therapy
[MESH]
|Humans
[MESH]
|Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse
effects/pharmacology/*therapeutic use
[MESH]
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