Cochrane Review questioning statins = another shared decision-making moment

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A Cochrane Review published last week raises questions about the strength of the evidence for statin drugs to prevent heart problems in people at low risk. The summary states:

“Previous reviews of the effects of statins have highlighted their benefits in people with coronary artery disease. The case for primary prevention, however, is less clear.

This current systematic review highlights the shortcomings in the published trials and we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.

Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.”

(By the way, if you don’t know about Cochrane Reviews, you can learn more here. reports (registration required) that this “has provoked controversy.”

• It quotes one expert saying, “the absolute benefits are really rather small–1000 people have to be treated for one year to prevent one death. It is probably a real effect, but it means a lot of people have to be treated to gain this small benefit. As we don’t know the harms, it seems wrong-minded to me to treat everyone with a statin. In these circumstances, lifestyle changes and stopping smoking would be far preferable.”
• Then it quotes another expert saying: “I object to the conclusions they have drawn from their review. They say there is not good evidence of benefit, but their own data show significant reductions in deaths and cardiac events. They didn’t show any increase in adverse events in their review, but they then say the benefit is not worth the risk. That doesn’t make sense.”

The Boston Globe covers the controversy today.

But absent in any of the online reactions I’ve read to the Cochrane statins review is any discussion of what an important moment this is for shared decision-making. This is exactly the kind of issue that demands a deep discussion between patient and physician, and a clear communication of what’s known and isn’t known about the tradeoffs of benefits and harms.

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Susan Fitzgerald

January 24, 2011 at 1:30 pm

Thank you for validating my reality about this proposed expansion of statin use – I blogged about this for my company last year:


September 27, 2011 at 1:38 pm

Our family doctor sent an electronic prescription to our pharmacy after my husband told her he didn’t think he wanted to start taking statins and that he wanted to discuss it with me later.
Ironically, on my way to meet him at the doctor’s office, NPR broadcast an interview of the authors of “Mental Mind” who used statin prescriptions as an example of the pressures doctors feel from insurers. “Insurers want one-size fits all treatment,” the author said. “If the patient fails to comply, the doctor is ‘dinged’ by the insurance company. It reflects on the doctors ‘report card’ and can have financial consequences.” The author claimed that insurers insist doctors prescribe statins.
Shared decision-making is a myth when doctors schedule 15 minutes for vitals, exam, and discussion and ours claimed that patients who experience side effects are just affected by “the(news)media.” It feels more like bullying than sharing….