Statins have established benefits in the general population for primary and secondary prevention of cardiovascular disease. There has been a trend towards increasing the potency of statin treatment, either with larger doses—such as simvastatin or atorvastatin 40-80 mg—or with more potent forms, such as rosuvastatin. Potency is usually defined by the drug’s effect on reducing absolute low density lipoprotein-cholesterol, although the drugs’ well known pleiotropic effects are less easily quantified. Increased use of higher potency statins has partly stemmed from the outcomes of clinical trials such as the Treating to New Targets study, where high potency statins improved cardiovascular outcomes more than lower potency ones.

Because statins are now used so extensively, concerns have been expressed about their associated adverse events. In a linked paper (doi:10.1136/bmj.f880), using information from large patient databases, Dormuth and colleagues found that newly prescribed high potency statins were associated with increased risk of hospital admission for acute kidney …