Statin Benefits: Yes for CVD but No for Everything Else, Says New Review

Statins should continue to be used only for the prevention of cardiovascular disease events and not for reducing the risk of other clinical outcomes outside the cardiovascular realm, according to the results of a new review.

Published October 8, 2018, in the Annals of Internal Medicine, the analysis includes an assessment of 278 unique noncardiovascular disease outcomes, and researchers, led by Yazhou He, MD (Sichuan University West China School of Medicine, Chengdu, China), conclude there is a “dearth of evidence” to support the use of statins for noncardiovascular indications. As such, they recommend no changes to current clinical guidelines for statin use.

To TCTMD, senior investigator Evropi Theodoratou, PhD (University of Edinburgh, Scotland), explained that there is considerable interest regarding the potential effects of statins on noncardiovascular disease outcomes. Although statins are used for reducing cardiac morbidity and mortality in both primary and secondary prevention of cardiovascular disease, previous meta-analyses have suggested statins might be associated with outcomes of several other diseases.

To evaluate the validity and credibility of the evidence regarding these claims, the researchers performed an “umbrella” review, which analyzed 112 meta-analyses of observational studies and 144 meta-analyses of randomized controlled trials.  

In the observational studies, there was a “highly suggestive association” between decreased cancer mortality in patients with cancer and decreased exacerbation of chronic obstructive pulmonary disease, as well as other “suggestive” or “weak” associations with various outcomes. In the randomized trials, there was evidence showing statins decreased all-cause mortality in patients with chronic kidney disease (CKD).

“What we found was that, overall, the vast majority of associations and effects that we observed in the statin meta-analyses suggested favourable effects for these drugs,” said Theodoratou. “Yet, almost none of these positive effects seemed to have high credibility in our assessments. The exception was the outcome of all-cause mortality for patients with CKD.”

Almost none of these positive effects seemed to have high credibility in our assessments. Evropi Theodoratou

The benefit in CKD patients, however, might be largely to a reduction in cardiovascular disease events, she said.  

Regarding adverse events, the observational studies suggested statins increased the risk of diabetes and myopathy, while there was no evidence in the randomized trials statins increased the risk of myopathy, myalgia, or rhabdomyolysis.

“Despite the muscle problems commonly reported by statin users, our study failed to identify strong evidence for adverse muscular events with statin use,” said Theodoratou. “The absence of harmful effects, especially those with highly convincing or highly suggestive evidence, is reassuring. Yet, we cannot exclude the possibility that some of these harms—such as rhabdomyolysis or severe myopathy—may be too rare to rule out with certainty.”  

While there was consistent evidence that statins modestly increased the risk of diabetes, Theodoratou said the data are not strong enough to justify withholding statins because of these concerns. “This is in accordance with expert consensus stating that statin therapy is to be prescribed to patients with or without type 2 diabetes risk factors to lower their risk for cardiovascular events, without fear of increasing their risk for type 2 diabetes,” said Theodoratou.

She pointed out that clinical recommendations also emphasize the importance of lifestyle modifications for patients initiating statin therapy to decrease their risk for both cardiovascular events and diabetes.