Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Statins as primary prevention: Helpful or harmful?

Robert Centor, MD
Meds
October 18, 2016
Share
Tweet
Share

A friend asked me recently about statins. He takes a statin for primary prevention but is concerned that he has muscle pain and weakness as a side effect. So he posed the question: “How important is the statin?”

The Washington Post had this recent article: “Who should take statins? A vicious debate over cholesterol drugs.”

But while nearly all experts agree that statins are beneficial for people at a substantial risk for heart disease, some medical researchers argue that statins do little or no good — and possible harm — for people at lower risk of heart disease. The conflict has burst into public view in the United Kingdom — and is likely heading here, too.

A bruising battle has played out for several years between Britain’s two leading medical research journals, the Lancet and the British Medical Journal (BMJ), which have accused each other of endangering public health. The debate has gotten so heated that it has made tabloid headlines (“STATIN WAR,” blasted the Daily Mail). It began when BMJ first questioned statins’ usefulness in 2014, publishing two articles that argued that the drug was being overprescribed to people with low risk of heart disease. It also claimed that the side effects from the drugs were worse than previously thought.

Statins have two major effects. First, they lower cholesterol levels. Lowering cholesterol likely decreases plaque size, therefore, patients will less likely have atherosclerotic complications. Second, they stabilize plaques, making plaque rupture and clot formation less likely.

In patients with known atherosclerotic disease (previous myocardial infarction, atherosclerotic stroke or symptomatic peripheral vascular disease), statins clearly decrease the probability of further events. Some patients with significant genetic predispositions and most patients with type II diabetes mellitus also fit into this secondary prevention category. For these patients, we really have no debate.

For the remaining patients, the debate becomes much more complex. Primary prevention in patients who do not fit into the previous paragraph has a minimal impact. Statins do decrease the risk of coronary artery disease, but the risk reduction is rather small. Statins, like almost all drugs, are not benign — they have side effects. The question, therefore, becomes the classic one — how does one balance the potential of the benefits and risks? (Or more simply put: Is the juice worth the squeeze?)

I explained this as best I could to my friend. I would not encourage statins for true primary prevention. Strong genetic predisposition and type 2 diabetes fit into a separate category. Statins help many patients and the benefits are strong as a secondary prevention medication. But the side effects are real and make the primary prevention question much more difficult. Currently, I do not favor primary prevention.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Image credit: Shutterstock.com

Prev

The final vestiges of life evaporating

October 18, 2016 Kevin 0
…
Next

Transplantation for alcoholic liver disease: 6-month rule or death sentence?

October 18, 2016 Kevin 0
…

Tagged as: Cardiology

Post navigation

< Previous Post
The final vestiges of life evaporating
Next Post >
Transplantation for alcoholic liver disease: 6-month rule or death sentence?

ADVERTISEMENT

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

Related Posts

  • When should you prescribe statins for older adults?

    Kenneth Lin, MD
  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD
  • Primary care faces a very difficult winter

    Ken Terry
  • How the CPT system shortchanges primary care

    Richard Young, MD
  • The hidden work of primary care

    Michelle Nall, MPH, ANP-BC
  • Nurse practitioners will save primary care

    Leah Hellerstein, LCSW

More in Meds

  • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

    Adwait Chafale
  • A psychiatrist’s 20-year journey with ketamine

    Muhamad Aly Rifai, MD
  • How drug companies profit by inventing diseases

    Martha Rosenberg
  • Every medication error is a system failure, not a personal flaw

    Muhammad Abdullah Khan
  • Why kratom addiction is the next public health crisis

    Muhamad Aly Rifai, MD
  • FDA delays could end vital treatment for rare disease patients

    GJ van Londen, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Why Hollywood’s allergy jokes are dangerous

      Lianne Mandelbaum, PT | Conditions
    • How I learned to love my unique name as a doctor

      Zoran Naumovski, MD | Physician
    • My first week on night float as a medical student

      Amish Jain | Education
    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician
    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Why Hollywood’s allergy jokes are dangerous

      Lianne Mandelbaum, PT | Conditions
    • How I learned to love my unique name as a doctor

      Zoran Naumovski, MD | Physician
    • My first week on night float as a medical student

      Amish Jain | Education
    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician
    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Statins as primary prevention: Helpful or harmful?
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...