The use of statins in patients without high cholesterol and pre-existing cardiovascular disease is controversial. Do risk factors alone justify taking them regularly? We’ll explain.
Our lifestyle impacts our heart health. If you don’t smoke, have a healthy diet, exercise and aren’t overweight, this can counteract the risk of cardiovascular disease.
A cardiovascular incident, such as a stroke or heart attack, can, among other things, be caused by a high percentage of fat in the blood – cholesterol. There are medications that can lower the level of cholesterol in the blood. These are known as statins.
Prescribing statins is not very controversial if the patient already has high cholesterol or cardiovascular disease.
However, opinions differ wildly when it comes to the prescription of statins in what is known as primary prevention – that is, when no illness or high cholesterol has yet been diagnosed. Specifically, people who have an increased risk of a cardiovascular episode due to certain pre-existing illnesses or their lifestyle can consider treatment using statins – even if their cholesterol isn’t very high.
When assessing exactly how high the individual risk is, medical staff are helped by algorithms that analyse risk factors such as obesity. Can such risk groups prevent cardiovascular disease by using statins?
The Harding Centre for Risk Literacy at the University of Potsdam has summarised the potential benefits and risks of statins to prevent cardiovascular disease based on scientific studies.
Without statins, around 14 in 1,000 people who did not have high cholesterol but did have an increased risk of illness due to their lifestyle or an underlying condition, had a stroke within six years. Just as many suffered a heart attack.
During the same period, about 11 in 1,000 people who took statins and did not have high cholesterol but did have an increased risk of illness, had a stroke and 8 in 1,000 suffered a heart attack.
So if someone has an increased risk of cardiovascular disease, taking statins could reduce the number of cardiovascular episodes.
Fewer people dying of cardiovascular disease or people dying less often during the period as a result of taking statins was not observed.
Adverse events as a result of statin use could not be confirmed.
In primary prevention, statins can be used after lifestyle-related risk factors have been reduced. As an example, these may include giving up smoking, a change in diet, doing more exercise and weight loss.
Ultimately, everyone must decide for themselves – after consulting a doctor – how much a healthy lifestyle can help reduce the personal risk of cardiovascular disease or whether medicinal therapy is the right option. We hope you now have a clearer overview of this complex issue.
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