Questioning the “beatification” of statins

Abstract

Statins have been described as miracle drugs, but such “beatification" is not justified. Changes in lifestyle should be considered the cornerstone in cardiovascular prevention. However, trends in mortality from coronary heart disease have not effectively changed since statins were approved in the United States, while obesity has risen significantly. Have these drugs contributed to a deterioration in lifestyle among those who believe a pill will protect them? Adherence to healthful lifestyle has been shown to be associated with reductions in the rates of coronary disease, diabetes in women, and mortality in elderly. Patients with major lifestyle problems enrolled in recent statin trials were given only drugs, and no statin has ever been compared with a nonatherogenic lifestyle and shown to be superior or additive. Furthermore, there is no evidence for a total mortality benefit in women and elderly persons from dyslipidemia therapy. Side effects are often presented as relative, not absolute risk, and are suggested to be low. However, there is reason to believe that their numbers are much larger in clinical practice where the drugs may be given to most patients usually excluded in randomised trials. Statin-related side effects may be considered as a complication to the primary disease. However, these complaints may be statin therapy related. Finally, the relationship between long-standing statin therapy and cancerogenesis is not fully understood. Investigators should carefully resist the natural tendency to highlight the most positive findings in their studies while minimising harm, especially when commercially sponsored.