Statins

The primary prevention of cardiovascular disease consists of treating patients with elevated lipids before a heart attack or stroke. This might seem obvious at first glance, but the evidence that lowering cholesterol will actually prevent a heart attack is inconsistent. Patients with the greatest risk are the ones most likely to benefit from medication and statins are the medications that have the most convincing data.

Pharmaceutical companies have devoted great resources to the development and study of medications to lower cholesterol. It is disappointing that a critical analysis of these studies has failed to show the superiority of statin therapy over life-style changes and aspirin; there is no difference between statins and placebo in all-cause mortality. No particular statin has been shown to be superior at preventing coronary heart disease and at equivalent doses all statins substantially reduce LDL cholesterol (the ‘bad’ cholesterol). Guidelines in the United States, the United Kingdom and Canada agree that lowering LDL l should be the primary target of therapy.

Some patients will still have low levels of HDL cholesterol (the ‘good’ cholesterol) or high level of triglycerides even after meeting their LDL target. There is no good evidence that treating these secondary lipid abnormalities with additional medications will prevent a first heart attack.

Statins will not reduce mortality in patients with peripheral artery disease but will increase maximal walking distance by 499 feet and pain-free walking distance by 295 feet. The rate of expansion of abdominal aortic aneurysms does not change with statin therapy but patients who are taking statins at the time of rupture are more likely to survive.

The bottom line is unchanged: eat a low-fat diet, exercise regularly and stay at a healthy weight. Most importantly: Don’t smoke.

More information: Medicines for Lowering Cholesterol