title: Clinical and public health assessment of benefits and risks of statins in primary prevention of coronary events: resolved and unresolved issues.
abstract: Peer-reviewed, evidence-based recommendations for statin use in primary prevention of cardiovascular events are limited. A narrative review of published randomized controlled trials and meta-analyses was conducted to critically appraise the benefits and risks of statins in primary prevention. Statins effectively reduce plasma concentrations of low-density lipoprotein cholesterol, and reduce the risk of cardiovascular events and death. The greatest benefits are observed in high-risk subjects, such as patients with diabetes or hypertension. Serious cardiovascular events should not be included among serious adverse events because they are efficacy outcomes and are dependent on the baseline risk of patients. Rates of specific serious adverse events, such as cancer and rhabdomyolysis, seem to be similar between the statin and control arms of the clinical trials examined. Thus, the benefits of statins in primary prevention outweigh the risks, particularly among high-risk patients. However, the benefit-risk ratio would likely be optimized through interventions designed to increase persistence and adherence in a real-life setting.
authors.affiliation: Faculty of Pharmacy, Université de Montreal, Montréal, Quebec. yola.moride@umontreal.ca
authors.forename: Yola
authors.initials: Y
authors.lastname: Moride
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hegele
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
authors.forename: Ruth
authors.initials: R
authors.lastname: McPherson
authors.forename: David B
authors.initials: DB
authors.lastname: Miller
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D011634:Public Health; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors