Comment: Are Lipid-Lowering Guidelines Evidence-Based

Abramson J, Wright J. Comment: Are Lipid-Lowering Guidelines Evidence-Based? The Lancet 20 January 2007 369:169. 

COMMENTS: According to the authors, the answer to the question posed by the title is: in many cases, no. They cite that the 2001 National Cholesterol Education Program recommended that those who do not have evidence of but are thought to be at risk of coronary heart disease should use statin therapy. There were 7 RCTs cited for women and 9 for people over age 65 years. The authors state that none of these trials indicated a need for statin therapy for these populations. Therefore, there are no studies showing benefit for the three-quarters of those whom they recommend for statin therapy. It is lucrative for the Pharmas. The authors found most of the studies included both those with occlusive heart disease and those without so it was difficult to separate the two populations. Combining the two groups does have an effect on the statistics and inflates any benefits of statin therapy. Of two studies with both populations that the authors studied, total mortality and serous adverse events were not reduced by statins. The reduction of risk of cardiovascular by statins appears from the studies to be 1.5%. There was no reduction in women or people over aged 65 years.The data has been extrapolated from secondary prevention groups (those with heart disease or other risk factors) to primary prevention groups. The authors state that this assumption is false. “Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years. High-risk men aged 30-69 years should be advised that about 50 patients need to be treated for 5 years to prevent one event. In our experience, many men presented with this evidence do not choose to take a statin, especially when informed of the potential benefits of lifestyle modification on cardiovascular risk and overall health.”