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Props to NPR for highlighting the need for balanced decision-making around statins

Rating

4 Star

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Before Starting A Statin, Talk It Over With Your Doctor

Our Review Summary

The story reports on a study that re-assessed who benefits from taking a statin to prevent heart disease, with different risk thresholds based on sex, age group, and statin type.

It reports the view that current guidelines “haven’t adequately considered” the harms from taking these widely used drugs.

The story laudably focuses attention on potential adverse events and a need for balanced decision-making. It also incorporated a variety of sources. In our view, the story could done a better job in discussing costs, the quality of evidence, and alternative strategies to prevent heart disease.

 

 

Why This Matters

Statins are among the most widely prescribed drugs, with their use encouraged under guidelines such as those of the American Heart Association of the American College of Cardiology.

However, data isn’t crystal clear on the benefits and harms of statins for people who don’t already have heart disease. As a result, there’s concern that they are being overused.

It’s laudable that some news organizations — including CNN as well as NPR — highlighted research that explores these complexities and points out the need for patients and physicians to weigh benefits and harms.

The headline of this story is, in our view, a winner.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There’s no discussion of cost, even to mention that statins are relatively inexpensive these days and are mostly generically available. To its credit, the article does mention the cost of a calcium scan.

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

Satisfactory

We learn that “anywhere from 50 to 200 healthy people need to take a statin daily to prevent a single heart attack for five years.” That’s helpful information. It also notes that the observed benefit is less for older patients.

The story could have added that even those numbers might disputed by some experts who perceive no meaningful benefit. For example, one review found being on a statin does not help people with low risk for heart disease live longer.

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

Satisfactory

The story does a service by highlighting the harms of statins. It explains: “The most common side effect of these drugs is muscle pain, which usually goes away if patients stop taking the medicines. People taking statins are also at a higher risk of developing diabetes, which is harder to reverse.”

It also mentions the potential for overtreatment with the use of coronary calcium scans.

However, we wish it had included absolute numbers. The story says harms are “uncommon,” but provides no data to back that up.

Rates of adverse effects with statins have been measured at 1 to 10%, which makes them “common” in the definition of the European Medicines Agency. Also noteworthy is that some contend that adverse effects of statins have not been reliably reported.

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

Not Satisfactory

The story doesn’t explain the quality of the study, or of studies on which current guidelines are based.

We don’t explicitly learn that this is a modelling study. In other words, this study consisted mostly of reinterpretations of math, not re-evaluations of real-life patients.

The researchers said they were unable to obtain enough data on all possible harms and age-specific data on some harm outcomes, “so the risk thresholds we determined may still be too low.”

Does the story commit disease-mongering?

Satisfactory

There is no disease-mongering here.

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

Satisfactory

This story includes sources that weren’t involved in the study. The study’s authors reported no conflicts of interest.

The story could have acknowledged the influence of pharmaceutical companies in creating guidelines for statin use.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The alternative of not taking a statin was the key message here, and that’s laudable. However, we have a couple of concerns.

First, we learn that “some statins were more effective than others, with atorvastatin (the generic name for Lipitor) being the best of the bunch.”  However, the story doesn’t explain on what basis some statins are “more effective.” In fact, some statins may be more effective at lower cholesterol, but the study found that no statin rises above others when it comes to the outcomes that counts most to patients — reducing cardiovascular deaths.

Also, the story doesn’t mention lifestyle interventions — diet and exercise.

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

Satisfactory

The story makes it clear that statins are widely prescribed.

Does the story establish the true novelty of the approach?

Satisfactory

The story states this an attempt to better weigh the benefits and harms of statin use.

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

Satisfactory

There was a good range of interviewees with no reliance on a news release

Total Score: 7 of 10 Satisfactory

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