Benefit of statins ‘100 times the harm’, but non-statins may be just as effective

  • Statins are arguably one of the most widely used medications for lowering cholesterol and preventing certain heart diseases.1
  • A study has shown that other treatment options can be as effective as statins.1
  • When considering treatments for high cholesterol, it would be prudent to look at all the options available.

It’s accepted that lowering cholesterol, particularly low density lipoprotein cholesterol (LDL-c), can reduce the risk of certain heart diseases including stroke and heart attack.2

Guidelines suggest that effective ways to lower cholesterol to prevent such heart diseases start with diet and exercise, followed by treatments such as statins.2

But imagine my reaction when I saw this headline: “Benefit of statins ‘100 times the harm’”. Really?

Actually, this claim was supported by a major review published last fall in the journal Lancet, but that’s hardly enough to support a concrete claim like “100-times the harm”. I mean, just how did they even quantify benefit vs harm to say it’s ‘100-times’ better? But of course, if that was just an expression of opinion, you won’t need any evidence for support.

Reviews are subjective by definition – a mixture of evidence and opinion. Trouble with opinion is that when it comes to treating patients, every situation might be just different enough from the ‘normal’ that it warrants careful consideration of the body of evidence out there every single time. A generic opinion should not apply.

Speaking of the body of evidence, are statins the only effective treatment option available?

To my surprise, not so. A study published shortly after this review was released showed that non-statins can be just as effective as statins for lowering cholesterol and preventing heart diseases.1

statins-vs-non-statins2

Granted that this study wasn’t a head-to-head study, the golden standard of drug-drug comparisons, but a meta-analysis of a number of studies; the results nonetheless are a good reminder that statins are not the only solution when it comes to lowering cholesterol.2

Bottom line

  • When diet and exercise are no longer enough to control cholesterol levels, statins may not be the only option to consider.
  • Non-statins may be just as effective as statins at reducing cholesterol and preventing heart diseases.1
  • Non-statins include further improvements in diet, bile acid sequestrants, ileal bypass surgery, and ezetimibe.1
  • Every medication or medical procedure comes with risks. Be sure to talk to your doctor before deciding on what’s right for you.

Source study: Silverman MG, et al. JAMA 2016;316(12)1289-97. A paid subscription may be required.

References: 1. Silverman MG, et al. JAMA 2016;316(12)1289-97. 2. Stone NJ, et al. Circulation. 2014;129(25 suppl2):S1–S45.

Photo adapted from original by williamnyk, used under license.

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