Statin Guidelines Continue to Perplex

By Joe Elia

Edited by Susan Sadoughi, MD

An analysis of guideline-driven indications for statin use concludes that the drugs — especially when used for primary prevention in low-risk patients — may constitute low-value care.

Researchers writing in The BMJ examined changes in eligibility for guideline-directed statin use between 1987 and 2016. They found that the proportion of people older than 50 in Ireland eligible for statin treatment rose from 8% to 61% over that period. As a result, the number needed to treat with statins to prevent one major cardiovascular event rose tenfold, from 40 to 400.

Although "there are clear benefits for high risk groups," the authors remind readers that statins' net benefits depend on the individual patient's baseline risks — for example, age, smoking status, and cholesterol status. With wide confidence intervals around measures of relative risk among patients at low baseline risk, they warn, the drug's effects also encompass the possibility of harm.