Two new studies confirm statins do not help in primary prevention of cardiovascular disease

Although there is evidence that pharmacological lowering of lipids with statins may reduce mortality when coronary heart disease has already been established, there is a massive accumulation of data that confirm they do not reduce mortality when used for prevention. The authors of a study just published in Archives of Internal Medicine observe:

"...it remains uncertain whether statins have similar mortality benefit in a high-risk primary prevention setting. Notably, all systematic reviews to date included trials that in part incorporated participants with prior cardiovascular disease (CVD) at baseline. Our objective was to reliably determine if statin therapy reduces all-cause mortality among intermediate to high-risk individuals without a history of CVD."

The authors synthesized data from 11 studies including 65,229 participants encompassing 244,000 person-years. What did the data show?

"The use of statins in this high-risk primary prevention setting was not associated with a statistically significant reduction in the risk of all-cause mortality."

To fully appreciate the significance of their findings, consider the editorial statement in the same issue:

"Ray and colleagues present what is to date the cleanest and most complete meta-analysis of pharmacological lipid lowering for primary prevention. Limiting the analysis to patients without existing coronary disease is critical because studies that include both groups of patients may appear to show benefit for all patients, when all the benefit accrues to those with existing disease. The patients in their analysis reduced their average levels of low-density lipoprotein cholesterol from 139 to 98 mg/dL and are therefore representative of those being treated in primary care today."

This puts the authors' conclusion in perspective:

"This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up."

And this same issue of Archives includes a critical reappraisal of the evidence for the use of statins for prevention from the much-touted JUPITER ((Justification for the Use of Statins in Primary Prevention) study. Their forthright conclusion is consonant with the rest of the evidence:

"The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors."

IMHO: I consider elevated lipoprotein phospholipase A2 (Lp-PLA2) as evidence of already existing vascular disease even when the person has not suffered a heart attack or stroke. I then seriously consider recommending a natural statin with the appropriate co-factors and customized supports until we confirm that the condition has been brought under control.