Statin Therapy in Primary CVD Prevention Remains a Hot-button Topic for Some

Abstract

SOME MEDICAL RESEARCHERS AND practitioners continue to question the use of statins to treat abnormal lipid levels in asymptomatic patients for the purpose of preventing cardiovascular disease. That reluctance leaves most cardiology researchers shaking their heads. The latter cite the many studies showing benefits of statin therapy in the primary prevention setting, such as reduced risk for nonfatal myocardial infarction, nonfatal stroke, revascularization, and cardiovascular death. They also suggest, although the evidence is not as robust, that statin therapy in asymptomatic individuals may reduce all-cause mortality risk. But even if it does not affect all-cause mortality, reducing a person’s risk of stroke or myocardial infarction is a good goal for using statins, said Christopher P. Cannon, MD, an associate professor of medicine at Harvard Medical School in Boston and editor in chief of the Science and Quality section of the American College of Cardiology’s CardioSource Web site. “So why would you not give the therapy?” he said. The “why,” say skeptical cardiology and primary care researchers, is that the claims of benefit attributed to statin therapy in the primary prevention setting tend to be inferred from less-thanrobust subset analyses or metaanalyses of clinical trials. These skeptics argue that using statins in asymptomatic patients leads to a costly lifetime drug regimen that may cause adverse effects and does not lengthen life. Lee A. Green, MD, MPH, a professor of family medicine at the University of Michigan Health System in Ann Arbor, said the only group of asymptomatic patients for whom statin treatment is appropriate is middle-aged men who are at high risk of myocardial infarction or death from cardiovascular