Although there are many articles showing the risk of use statins in primary prevention of coronary heart disease, many doctors prescribe statins for asymptomatic people with normal total cholesterol with low HDL and history of coronary atherosclerosis in family. I prefer phisical exercises and diet.
Hi Jose,
We now know that chronic inflammation is a contributor to future cardiovascular events. Have a read of this paper which provided some strong evidence that statin therapy administered to persons with 'normal' cholesterol levels but high CRP reduces the risk of CV events and mortality.
Ridker, P. M., et al. (2008) Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. New England Journal of Medicine 359, 2195-2207.
..and nothing about the side-efects of statins? at the end what is the benefit? you decrease the CRP and increase hepatocytolysis?
Dear Alexandra. I agree with you. The possible positive efects is bigger than side-efects of statins in PRIMARY PREVENTION. I don't talking about people with diagnosis of coronary disease.
Statins, cholesterol lowering drugs are the first-choice treatments to reduce high blood cholesterol and to reduce the chances of suffering a CVD event. Indeed, lowering of LDL-cholesterol by 25 to 30% with statins resulted in a highly significant reduction of coronary event rates in 2 large primary prevention trials (Paulweber, 1999). Some studies have been realized in some areas about statins as primary prevention trials in 1999. In the West of Scotland Primary Prevention Study (WOSCOPS) hypercholesterolemic asymptomatic men were treated with either 40 mg of pravastatin or placebo, in the Airforce/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) 6605 men and women with average levels of LDL-cholesterol and low levels of HDL-cholesterol were treated with either 20 to 40 mg of lovastatin or placebo. Moreover, in the WOSCOP study a marked reduction of total mortality was observed which approached the level of statistical significance (Paulweber, 1999). However, adverse effects associated with statins, including cognitive defects, muscle weakness and diabetes has been highlighted. In my opinion, non-pharmacologic measures such as physical exercises, diet are the preferred strategy for the reduction of coronary risk in the setting of primary prevention.
Hello. I think as long as we could avoid having to use chemicals to solve our health problems, as physical exercises, or natural methods while respecting the standard norms of solutions can be, the better. All this to say that I opted for the physical exercises and diet as the best strategy for reducing the risk of coronary heart disease in primary prevention. Although it has been proven that Statins are the first-choice treatments to reduce high blood cholesterol and to reduce the chances of suffering a CVD event.
I Think non-Pharmacological therapy like diet and enough, regular physical activity in primary prevention is the most affected strategy not only for the hyperlipidemia but for other risk factors such as hypertension and diabetes...etc
Hi,
In my opinion, we should use all the non-pharmacological methods before administering statins. My advise for the patient with CVD - is Ornish diet, and for low risk patient is mediterranean diet. Physical activity is necessity.... Best wishes
I am a strong believer of statins for primary prevention and there is enough data in literature to support it ,the side effects are far and few and the benefits out weigh the risks any day .You will repent in the future for not doing primary prevention for your patients and yourself once they get a heart attack
Hi Kostas,
I have seen the article you mention, from 2008, and I am surprised that authors did not checked for hepatic markers for cytolysis (transaminases, LDH) in order to take in consideration the side effects of possible treatment with statins, or at least to have an idea how many healthy subjects treated with statins will develop hepatocytolysis (of 17,800 participants). Our experience noticed that many patients with dislipidemia treated with statins, will increase in hepatic markers for cytolysis and therefore the first choice of treatment is to change their life style (diet and sport) and if that does not work, than medication. This is what I would recommend as well in healthy subjects to prevent vascular events.
Hi Kostas
In my opinion,according previous articles ,befor start drug for hyperlipidemia , we shoud advise for patient withCVD, healthy and economic prescribe that is change of life style(excercise.diet.management of stress,..) .
Dear Dr Jacobe
Based upon published evidences from 2001-2013 it seems in primary prevention of coronary artery disease , beyond general recommendation for whole population in individuals with elevated Hs CRP statin therapy has beneficial effects. especially Atorvastatin in both gender has been shown to be effective.
Physical exercise and diet should be the standard treatment for CHD prevention but depending on baseline LDL values (i.e. LDL above 190 mg/dL) asymptomatic people could benefit from statins.
Dear Javier. I agree with you about the use of statins if LDL > 190
Dear Atena, with due respect, your approach is beyond to what it is considered in clinical practice guidelines.