Dublin—Do the statin prescriptions pharmacists fill every day have as much benefit as assumed? A new study raises that question and offers a surprising answer.

The report in the Journal of the American Medical Association Internal Medicine suggests the link between high low-density lipoprotein cholesterol (LDL-C) levels and undesirable cardiac outcomes might not be completely clear.

The Royal College of Surgeons in Ireland (RCSI)–led researchers pointed out that about one-third of Irish adults aged over 50 years take statins. In the United States, the CDC advises that the percentage of adults prescribed statins ranges from 17% of those aged 40 to 59 years to 48% of those aged 75 years and older.

The study, which involved researchers from the University of New Mexico as well participation from academic institutions in Denmark and Australia, found that lowering LDL-C using statins had an inconsistent and inconclusive impact on cardiovascular disease (CVD) outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. It added that the overall benefit of taking statins appears to be small and is very dependent on an individual's risk factors.

"The message has long been that lowering your cholesterol will reduce your risk of heart disease and that statins help to achieve this. However, our research indicates that, in reality, the benefits of taking statins are varied and can be quite modest," stated lead author Paula Byrne, MSc, PhD, of RCSI.

To reach those conclusions, researchers conducted a meta-analysis of 21 randomized clinical trials in primary and secondary prevention that examined the efficacy of statins in reducing total mortality and CV outcomes. The search of PubMed and Embase from January 1987 to June 2021 sought large, randomized clinical trials that assessed the effectiveness of statins in lowering total mortality and CV outcomes with an intended duration of 2 or more years and that reported absolute changes in LDL-C levels.

The researchers found significant heterogeneity but also reductions in the absolute risk of 0.8% for all-cause mortality, 1.3% for MI, and 0.4% for stroke in those randomized to treatment with statins compared with control, with relative risk reductions of 9%, 29%, and 14%, respectively. They noted that a metaregression was inconclusive regarding the association between the magnitude of statin-induced LDL-C reduction and all-cause mortality, MI, or stroke, however.

"The study results suggest that the absolute benefits of statins are modest, may not be strongly mediated through the degree of LDL-C reduction, and should be communicated to patients as part of informed clinical decision-making as well as to inform clinical guidelines and policy," the authors explained.

In adults randomized to treatment with statins, meta-analyses demonstrated declines in the absolute risk of:

• 0.8% (95% CI, 0.4%-1.2%) for all-cause mortality
• 1.3% (95% CI, 0.9%-1.7%) for MI
• 0.4% (95% CI, 0.2%-0.6%) for stroke.

That translates to associated relative risk reductions of 9% (95% CI, 5%-14%), 29% (95% CI, 22%-34%), and 14% (95% CI, 5%-22%), respectively, according to the report.

The authors wrote that their findings "underscore the importance of discussing absolute risk reductions when making informed clinical decisions with individual patients."

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