keeping Pros and Cons of statins in mind as per recent evidences, I request you to answer the question."Is it appropriate to use statins for primary prevention of coronary artery disease?
Thanking you.
They is no rationale for using statins for primary prevention. May I remember you that the Framingham study clearly demonstrated that cholesterol and lipids were acting only as a "third" factor in coronary diseases. Which means that two other more important factors have to be present before any trouble caused by cholesterol, like a elevated hematocrit + alcool consumption or smoking.
Kindly go through the following RG links and PDF attachment.
Article Statins for the Primary Prevention of Coronary Heart Disease
Article Statins for primary prevention of cardiovascular events and ...
Article Statins in the Primary Prevention of Cardiovascular Diseases
Article Statins for Prevention of Cardiovascular Events in a Low-Ris...
Hi, I just think authors above are not speaking about the same things and circumstances. And particularly primary prevention. Now if we consider evidence base medicine, there is still a huge difference between statin result studies and their global effects on morbidity and mortality. And don't forget their secondary effects in some patients.
Speaking as one who has been interventional lipidology and preventive cardiology for over 50 years, I can answer:"Absolutely!!!!!" It is easier to prevent plaque than to stabilize/regress plaque. The trick is to identify with high accuracy the population at risk of atherothrombotic disease (ATD), and that you can see if you go to the next issues of Atherosclerosis or Journal of Clinical Lipidology, where you will the abstract I presented at NLA 2019 (Miami) and EAS 2019 (Maastricht). I have sent the paper to the IAS website, which may get posted on the site.
Well, I agree that statins would be efficient in a "sub-population", but should be reserved to people with real familial hypercholesterolemia or subjects with a really high cholesterol. Once again, these products have a lot of secondary effects and the benefice risk ratio should be weighted. One should also distinguish between the nice effects obtained in targeted studies and what is observed in meta analysis of the current products use, which is less gloomy.
I would note that about 90% of AT events occur in people with LDL-cholesterols lower than 190 mg/dl, so if one only treats FH patients, one will miss the opportunity to prevent most ATD events.
Well, I don't make a living on the subject... but yes, no need yo administer drugs to people where primary prevention could be obtained by other means like a good food regimen, which already does a lot, if compliant. I have been director of research a long time ago at the french blood bank centers. And we were very good specialists of animals models and particularly microcirculation. The "plaque" theory already looked like a joke thirty years ago. And listen to what I told yesterday: results from hypocholesterolemic drugs as a whole have a very very small effect ob morbidity and mortality. However, secondaries effects, that doctors should not ignore, may be destructive. Primare non nocere ?
The only problem is that in a number of people the first manifestation of atherothrombotic disease (ATD) is sudden death or a paralyzing stroke. Such people do not get a second chance--no do-overs.
Hello friend,
checking out this manuscript, you would find out more about statins
Hello, in people older than 74 years statin treatment was not associated with a reduction in atherosclerotic CVD or in all cause mortality. But, in detail you should find more checking out this paper: Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study
I have already reported the case of a 102 year old lady who was still taking her statin after a heart attack at age 75 years. (She died at age 104 and 1/2 years, having stopped her statin about 6 months earlier.) I am about to report the case of a 100 year old gentleman who is still taking his statin, though he has had a case of heart failure and does have an abdominal aortic aneurysm. My statin-treated patients live a very long time if they stop smoking.
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