[How relevant is statin therapy for clinical practice?].
In the time of evidenced-based medicine results of randomised controlled trials with statins mostly are presented in terms of relative risk reduction and commonly declare this treatment to be "lifesaving". The way, how research data are presented, however, influences health care decisions and can greatly affect a physicians perception of treatment benefits and his willingness to prescribe. In addition, arguments for a lifesaving by statins are not supported by the underlying data, but show that in real terms the effect of the treatment is reduced to a relative short gain in lifetime depending also on age. E.g. the expected lifetime gain of a 45 year old high-risk patient due to therapy with statins is 2.3 years and only 0.7 years of a 70 year old patient. The lifetime gain is even much smaller in low risk patients (month only). From this point of view it is of note that lifelong treatment with statins must focus not only on risk reduction but also on the welfare of the patient in a comprehensive fashion. Therefore a small gain in lifespan may be sacrificed if the "price" gets too high (e.g. side effects of the drug, risks, troubles with compliance, reduced quality of life).
Bonelli
Johannes
J
Imabe-Institut für medizinische Anthropologie und Bioethik, Wien. bonelli@imabe.org
D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000401:mortality; D008136:Longevity / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D012306:Risk; D016019:Survival Analysis
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors