Are Statins Helping?
In the realm of cardiovascular health, statin therapy is often the first step in the prevention and management of heart disease. But the real question is: Is it working? Let's take a look at a few articles and opinions that help clarify the decision.
In the medical community, statins are generally accepted as effective and safe
Published in The New England Journal of Medicine, the study led by Collins et al. in 2016 this article aimed to assess the efficacy of statin therapy in the primary prevention of cardiovascular disease. This was a rigorous analysis of data from multiple randomized controlled trials involving thousands of participants, the researchers concluded that statin therapy significantly reduced the risk of major cardiovascular events, including heart attacks and strokes, in individuals without a history of cardiovascular disease. This study provided evidence supporting the use of statins as a primary prevention strategy, particularly in high-risk populations.
Why there is debate...
Studies like the one first mention reduced risk of 20% to as high as 60%. In contrast, the study conducted by Byrne et al. and published in JAMA Internal Medicine in 2022 offers a nuanced perspective on statin therapy. They explained that when you look at the absolute risk reduction as opposed to relative risk reduction those values that look promising drop to 1.3% or less for heart attack or stroke. For example, if 2/100 will have a heart attack and then those 100 people take a statin and then they see that number drop to 1/100, that would half as many people that had a heart attack! That would be a 50% risk reduction! Sounds great on paper. However since only one less out of the 100 saw improvement the absolute risk reduction would be 1/100 or 1%. Much less sensational of a headline. This brings into question the actual value added to the individual. Was the risk worth it for those other 98 individuals?
Cardiovascular disease is still the leading cause of death worldwide.
Even the first article acknowledges that cardiovascular disease is the leading cause of death worldwide. If statins are so helpful, safe and widely prescribed, a basic question would be, why is the problem not going away and in many areas, particularly the US, getting worse.
Could chronic inflammation be the real driver?
A thought-provoking article authored by Mauro Vaccarezza and Francesco Maria Galassi, bring up a possible missing link. They discuss the pivotal role of inflammation in cardiovascular disease risk in their article titles "Inflammation Beats Cholesterol: A Comment on the Unequivocal Driver of Cardiovascular Disease Risk" challenging the conventional wisdom.
Their opinion piece highlights the emerging body of evidence implicating inflammation as a key determinant of cardiovascular risk. From inflammatory markers like C-reactive protein (CRP) to the role of immune cells in plaque formation and rupture, the authors underscore the multifaceted nature of inflammation in driving the development and progression of cardiovascular disease. By shifting the focus from cholesterol-centric approaches to inflammation-targeted strategies, the commentary advocates for a paradigm shift in cardiovascular risk assessment and management. Maybe then we can start to make a dent in the epidemic.
At Renew, our goal is not to tell you what to do but put you in the driver seat to make informed decisions about your health. Everything in the body is connected and it is silly to try to address one facet and not the others.
- Byrne P, Demasi M, Jones M, Smith SM, O’Brien KK, DuBroff R. Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis. JAMA Intern Med. 2022;182(5):474–481. doi:10.1001/jamainternmed.2022.0134
- "Statin Therapy for Primary Prevention of Cardiovascular Disease." Collins R, Reith C, Emberson J, et al. The New England Journal of Medicine, 2016. DOI: 10.1056/NEJMoa1605086.
