Statinertia

A recent review provides the basis for updated USPSTF guidelines on statins for primary prevention of cardiovascular disease (CVD). The bottom line is that in adults at increased CVD risk but without a prior event, statins were associated with reduced risk of clinical outcomes based on 22 randomized trials with 6 months to 6 years of follow-up. What requires our consideration though is the fact that ALL BUT 3 studies were funded by statin manufacturers. These are companies accountable to their shareholders and hungry for favorable outcomes. They use tactics like recruiting on-average younger study participants, and using shorter study durations if things start looking ugly. Second, this review measured adverse effects leading a patient to withdraw from a study, but not adverse effects themselves. Additionally the study that used high-intensity statins (JUPITER) found that among patients with risk factors for diabetes, there were 54 additional cases of diabetes for every 134 CV events prevented. This is despite the study being funded by Astra-Zeneca, maker of rosuvastatin. Third and most important, these trials compare a statin to a placebo. Nowhere to be found in this review is a trial comparing a statin to a simple lifestyle change like walking around the neighborhood or reducing red meat. Historically, pharmaceutical companies have avoided such studies because they are smart. So let’s consider all the available data but put it in context. The current system is failing people with chronic disease. By counseling patients on plant-based nutrition, we might just change their lives. https://jamanetwork.com/journals/jama/fullarticle/2795521