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New statin guidelines: WaPo story wisely mentions ongoing debate about their overuse

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3 Star

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New statin guidelines: Everyone 40 and older should be considered for the drug therapy

Our Review Summary

Prescription Drug Background

Despite an alarmist headline, this report of the USPSTF’s recommendations on statin therapy is relatively thorough, with some notable exceptions. The strength of the evidence underlying the recommendations is not discussed and the actual amount of potential benefit from statin therapy is not mentioned, nor is the potential for harm adequately elaborated upon.

Perhaps what is most missing from this “just-the-facts ma’am” article on the USPSTF’s recommendations is the larger sense of context: major statin trials have all been funded by statin manufacturers where we know that adverse event information is incomplete and sometimes hidden, benefits are typically exaggerated as they are expressed in relative risk reductions, and that most people, physicians and patients included, will likely overestimate the benefit they might derive from statin therapy.

Above all, the medicalizing of cholesterol levels in otherwise healthy people is considered by some to be among the biggest current scandals in medicine. Having said that, it was good to see this article tipping the hat toward those who have put forward very strong arguments against the measuring and altering of our blood cholesterols, mentioning the questionable chance of benefit and the many potential harms. It also was good to see that the article noted that there were at least two sides to this issue and that “Individual doctors are free to take the advice or leave it, and in recent months there has been a lot of debate about what the scientific evidence really shows regarding the therapy.”

 

Why This Matters

Because this recommendation affects millions of Americans, how well it is understood, especially around the potential magnitude of benefit and potential for harm from long-term statin treatment, has huge implications for the health of the population. This recommendation is a great invitation for health journalists, if they haven’t already done so, to dig deeper and to introduce themselves to the many controversies over statins.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Costs of the drugs are not included. Recently, total costs for statin therapy in the U.S. were estimated at approximately $17 billion. It would also be useful to know that there is a wide variety in prices over the many statins currently on the market.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

We don’t know to what extent people in this category of risk (more than 10% or more than 7.5%) would benefit from statins, which would seem an essential and basic element of the story. Any recommendation that has the potential to alter the drug-taking habits of a huge swath of the population must be explained in numerical terms and so this was an unfilled gap.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

It mentions “muscle pain and cataracts [and] an increased risk for diabetes in women.” This is sufficient, but the story would have been stronger if it had discussed frequency of these side effects, and mentioned the more serious (and thankfully more rare) risks of rhabdomyolysis and muscle breakdown.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The quality of the evidence is not explained, even though typically the level of evidence behind a USPSTF review is high, and the USPSTF goes to the trouble of quantifying its evidence. (ie: grade A, B or C, etc).

Does the story commit disease-mongering?

Not Satisfactory

This is a tough call, but the most widely-read part of the story–the headline–does cross the line by suggesting everyone over 40 with some level of cardiovascular risk (which means MOST of us) should consider taking a statin. Some have written extensively of the problems of creating diseases out of risk factors, such as high blood pressure, high cholesterol or low bone density, and have fairly criticized the widespread dissemination of this type of population-wide, drug-industry funded disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes independent sources and we didn’t see any apparent conflicts of interest.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There are many alternatives (cholesterol-altering agents, lifestyle factors and so on) that were worthy of mention.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

It’s pretty clear and obvious that statins are available via a doctor’s prescription.

Does the story establish the true novelty of the approach?

Satisfactory

The story establishes novelty of the task force report by explaining:

The report greatly expands the universe of people who should be screened to see if they need the medication to everyone over age 40 regardless of whether they have a history of cardiovascular disease.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The presence of outside critique of these recommendations suggest there was a low reliance on the news release.

Total Score: 4 of 9 Satisfactory

Comments (1)

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Stephen Cox, MD

November 21, 2016 at 11:23 am

Do most patients with cardiovascular risk factors absolutely benefit from statins or not in primary prevention?

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