The risks and benefits of statins.
An interesting if impenetrable paper this year looked at the risk/benefit profile of statins in different age groups and for four different statins.
The paper itself was scarcely readable unless you are familiar with advanced statistics and biomedical jargon but the conclusions bear discussion.
First, some explanation.
Statins reduce cholesterol levels but also have some anti-inflammation effects that also reduce the risk of heart attacks, which is why some people with normal cholesterol levels are offered statins, particularly people with diabetes and previous heart attacks.
Treatment with a statin after a heart attack is called secondary prevention, treatment prior to a heart attack, in the hope of preventing an event, is called primary prevention.
When deciding whether a statin would be of benefit in primary prevention, we use a scoring system called Qrisk3. This inputs factors such as age sex, height, weight, smoking status and other health issues that can increase heart disease risk. It uses these figures to calculate the average risk of one experiencing a heart attack or angina within the next 10 years and expresses it as a percentage. Current guidance from NICE is that patients should be offered a statin for primary prevention when their 10 year heart disease risk exceeds 10% (a one in ten risk of a cardiac event in a period of ten years) and in America statins are offered at even lower risk levels (all those who have had a heart attack are automatically offered a statin)
In this paper, they measured the risks and benefits of statins and worked out the probability of a patient benefiting from treatment. Essentially, they produced two useful tables. The first recorded the probability of benefit exceeding risk for different age groups with different risk profiles for ischaemic heart disease, that is the type of heart disease caused by furring of arteries. The second compared four different statins.
The first table showed that men aged 40-44 benefited from statins when their heart disease risk over 10 years exceeded 14%. At the other end of the age range patients aged 70-75 did not benefit until they reached a 10 year heart disease risk of 21%. The age groups in between followed a line between these two risk figures, 55-59 year olds for instance benefited at Qrisk3 of 15%
The second table showed that Atorvastatin had the best risk/benefit profile, Rosuvastatin the next best and Simvastatin the third best profile, last was Pravastatin. So Atorvastatin benefited people at a lower risk level and so was the most effective/safe.
This may result in a change in thinking from NICE and other bodies, should these data be proved reliable and accurate. We may be offering statins to people dependant on age as well as risk profile and be offering them less frequently than we currently do.
Calculate your qrisk her;
https://qrisk.org/three
Find the paper by pasting this into google;
Finding the Balance Between Benefits and Harms When Using Statins
for Primary Prevention of Cardiovascular Disease
A Modeling Study
Henock G. Yebyo, MSc; He´ le`ne E. Aschmann, MSc; and Milo A. Puhan, MD, PhD
Recent Comments