Benefits of cholesterol-lowering drugs

 

Sir, – In an article, “Cholesterol-lowering drugs may not have much benefit, review finds” (Front page, August 4th) The Irish Times details a review paper in a relatively obscure medical journal that questions the benefits of statin therapy.

This review paper lists the prior studies of statins and reports “three-quarters of the [statin] trials reported no positive impact on risk of death” and that “nearly half reported no positive impact on risk of future cardiovascular disease”. However, far from being a repudiation of the well-accepted benefits of statin therapy, these results if anything show the remarkable effectiveness of statins when prescribed appropriately. This is because few if any of these studies were designed to show a difference in mortality (to do so generally requires very large trials with long follow-up periods).

So, the fact that one quarter of them actually showed a reduction in mortality is quite impressive. Similarly, half reported a statistically conclusive reduction in cardiovascular disease and the half that did not almost always showed strong trends to a reduction in cardiovascular events.

None, zero trials, showed an increase in cardiovascular events with statin therapy. The field of medicine has decades ago moved away from simple crude tallies of trial results, like those published in the paper on which this article was based, and instead uses a method called meta-analysis when collating the results of a series of trials. Meta-analysis is similar to taking a weighted average of the overall result when all trials are accounted for. Numerous meta-analyses have been reported in numerous journals (that doctors actually read); all showing beyond doubt that statins do reduce mortality and cardiovascular disease in at risk patients who have elevated cholesterol.

The Irish Times has published this piece without any balancing perspective representing the vast majority of scientists and physicians who believe the boundless data showing beyond reasonable doubt that LDL-cholesterol does cause heart disease and that reducing LDL-cholesterol with statin therapy prevents heart disease. Would The Irish Times publish a piece of creationism or climate-change denial without a balancing perspective? The stakes are higher here as non-compliance with statin therapies that reduce LDL-cholesterol is associated with adverse health outcomes. – Yours, etc,

Prof JOHN W McEVOY MB,

Professor of Preventive Cardiology, NUIG,

Medical and Research Director,

National Institute for Preventiion and Cardiovascular Health,

Newcastle, Galway.