Statin therapy for the primary prevention of cardiovascular disease: Cons

While recent decades have seen substantial reductions in cardiovascular mortality, heart disease remains the number one cause of death both in the United States and globally. This has led many to advocate for prescribing statins even more widely, including to patients with low risk of cardiovascular disease, based on the hypothesis that any reduction in lipid levels will eventually translate to a reduction in the development of atherosclerosis and thus to subsequent mortality. However, empirical evidence to date has not substantiated the hoped for benefits of this strategy. When healthy patients without cardiovascular disease are prescribed statins they do not live longer, and they have only a marginal reduction in the risk of ischemic events. Furthermore, statins cause numerous side effects which substantially limit their net benefit. These tradeoffs are even more lopsided in elderly patients treated for primary prevention, in whom statin therapy does not lead to a reduction in mortality or ischemic events and has the potential for significant harms. Strategies to reduce the risk of cardiovascular disease should therefore avoid a focus on cholesterol levels and subsequent pharmacological therapy and should instead redouble efforts to improve the lifestyle factors that are far more consequential to the development of cardiovascular disease and overall good health.