Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures (“major vascular events”) by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual’s absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per month) for 5 years in 10,000 patients would typically prevent major vascular events from occurring in about 1000 patients (i.e. 10% absolute benefit) with pre-existing occlusive vascular disease (“secondary prevention”) and in 500 patients (i.e. 5% absolute benefit) who are at increased risk but have not yet had a vascular event (“primary prevention”). Statin therapy has been shown to reduce vascular disease risk during each year it continues to be taken, so larger absolute benefits would accrue with more prolonged therapy, and these benefits persist long-term. The only serious adverse events that have been shown by large-scale randomized trials to be caused by long-term statin therapy that is, are adverse effects of the – statin are myopathy (defined as muscle pain or weakness combined with large – increases in blood levels of creatine kinase), new onset diabetes mellitus and, probably, haemorrhagic stroke. Typically, treatment of 10,000 patients for 5 years with an effective regimen (e.g. atorvastatin 40 mg daily) would cause about 5 cases of myopathy (1 of which might progress, if the statin therapy is not stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases of diabetes, and 5 haemorrhagic strokes. However, any adverse impact of these side-effects on major vascular events has already been taken into account in the estimates of the absolute
Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures (“major vascular events”) by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual’s absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per month) for 5 years in 10,000 patients would typically prevent major vascular events from occurring in about 1000 patients (i.e. 10% absolute benefit) with pre-existing occlusive vascular disease (“secondary prevention”) and in 500 patients (i.e. 5% absolute benefit) who are at increased risk but have not yet had a vascular event (“primary prevention”). Statin therapy has been shown to reduce vascular disease risk during each year it continues to be taken, so larger absolute benefits would accrue with more prolonged therapy, and these benefits persist long-term. The only serious adverse events that have been shown by large-scale randomized trials to be caused by long-term statin therapy – that is, are adverse effects of the statin – are myopathy (defined as muscle pain or weakness combined with large increases in blood levels of creatine kinase), new onset diabetes mellitus and, probably, haemorrhagic stroke. Typically, treatment of 10,000 patients for 5 years with an effective regimen (e.g. atorvastatin 40 mg daily) would cause about 5 cases of myopathy (1 of which might progress, if the statin therapy is not stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases of diabetes, and 5 haemorrhagic strokes. However, any adverse impact of these side-effects on major vascular events has already been taken into account in the estimates of the absolute
Revised%20paper%20on%20statin%20evidence%20interpretation_110716_CLEAN%2c%20Collins%20et%20al.docx