Is statin-modified reduction in lipids the most important preventive therapy for cardiovascular disease? A pro/con debate

Abstract

The most prescribed medications in the world are statins, lipid modifiers that have been available for over 25 years and amongst the most investigated of all drug classes. With over a million patient years of trial data and publications in the most prestigious medical journals, it is remarkable that quite so much debate remains as to their place in healthcare. They have had a bittersweet passage, with vocal concerns over their possible risks, from suicide to cancer, and allegations that they do not work in women or the elderly, to statements that the whole published dataset, on over 200,000 patients consenting to enter trials, was fatally compromised by being industry-funded by and large. On the other side, there have been billions of dollars spent on generating their evidence base followed by promotion which has returned that investment many times over in profits, and a powerful scientific lobby that argue they are wonder drugs and that continued nihilism on their value risks patient lives. So who is right?

Fig. 1

FD Richard Hobbs is Professor of Primary Care Health Sciences at the Nuffield Department of Primary Care Health Sciences, Oxford, UK. He is also Director of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care, and the NIHR School for Primary Care Research. Professor Hobbs is a longstanding part-time practising general practitioner (GP) serving a deprived inner-city population. His research interests focus on cardiovascular epidemiology and clinical trials, particularly relating to vascular and stroke risk, and heart failure

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Maciej Banach is Professor of Cardiology at the Medical University of Lodz and President of the Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland. He is also Visiting Professor at the University of Alabama at Birmingham, Birmingham, AL, USA, and Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. He is a member of the Executive Committee of the European Atherosclerosis Society (EAS), Founder and Head of the Polish Lipid Association (PoLA), and the founder of the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. His main area of research concerns hypertension, lipid disorders, dyslipidemia therapy and new drugs in CVD therapy

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Dimitri P. Mikhailidis is Reader and Honorary Consultant at the Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, London, UK. He is also Visiting Professor at the Robert Gordon University, Aberdeen, Scotland. His main clinical interest is vascular disease prevention, and his research interests include lipids and atherothrombosis

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Aseem Malhotra is an Honorary Consultant Cardiologist at Frimley Park Hospital, Surrey, UK, and founding member and cardiologist advisor to the campaign group, Action on Sugar. He also serves on the external advisory board of Saving Londoners’ Lives (SLL). Dr Malhotra is widely regarded as a central figure in the debate on harms of excess sugar consumption. His research interests include preventative and personalized medicine, CVD, hypercholesterolaemia and hypertension

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Simon Capewell is Professor of Clinical Epidemiology at the Department of Public Health and Policy, University of Liverpool, Liverpool, UK. He is President of the Society for Social Medicine and Vice President (Policy) of the Faculty of Public Health. His research interests include examining global trends in CVD prevalence, and developing effective and cost-saving CVD prevention strategies which build on empirical evidence, policy analyses and quantitative modelling in high, middle and low-income countries