I’m so happy to see this.
Finding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease: A Modeling Study, Annals Of Internal Medicine, 4 December 2018
A study published Monday is pushing back against the notion that up to 40 percent of Americans should be taking statin drugs to reduce the risk of heart disease. The study … argues that current medical guidelines haven’t adequately considered the risks from these widely used drugs.
“Some harms are mentioned, but it’s entirely unclear how they were considered when coming up with the recommendations,” says Milo Puhan, a physician and epidemiologist at the University of Zurich and senior author of the new study. “In our approach we very explicitly considered the harms.”
Anywhere from 50 to 200 healthy people need to take a statin daily to prevent a single heart attack for five years, so even small harms may outweigh the potential benefits, the Swiss scientists say.
The most common side effect of these drugs is muscle pain, which usually goes away if patients stop taking the medicines. People taking statins are also at a higher risk of developing diabetes, which is harder to reverse.
He also finds that benefits fade compared with harms as people get older. “The elderly do not benefit as much as previous studies might have thought,” he says.
“One size doesn’t fit it all,” he concludes. “That’s a very important message.”
Puhan says, based on his assessment, perhaps 15 to 20 percent of older adults should be taking statins – far less than the 30 or 40 percent suggested by current medical guidelines.
“I think for me, as a physician,” says Ilana Richman, an internist at the Yale School of Medicine, “this kind of data suggests that if we give more weight to the potential for adverse events, then maybe it’s reasonable to hold off for lower-risk patients.”
She co-wrote an editorial about the paper and came away from it thinking that doctors need to spend more time talking about the plusses and minuses of statin treatment, personalizing their recommendations more than they do now. She says it’s a challenge to convey these sophisticated concepts in the short amount of time doctors have to spend with their patients.
Yet that kind of dialog is increasingly the expectation. In mid-November, the American Heart Association and American College of Cardiology published new guidelines calling for more nuanced conversations around who would most benefit from statins.
No one should be taking a drug or other therapy without a healthcare worker sitting down with them and discussing the risks and side effects. Sitting down with them and talking, not handing them a pamphlet. The decision to take a drug, ultimately, should be a made by the patient or their designated spokesperson. No patient should be coerced or ridiculed for their decision. This is called patient-centered care:
” … providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”