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Should people at low risk of cardiovascular disease take a statin?

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6123 (Published 22 October 2013) Cite this as: BMJ 2013;347:f6123

Rapid Response:

Re: Should people at low risk of cardiovascular disease take a statin?

John Abramson and colleagues (Oct 26) provide a useful review and raise more uncertainty about whether the benefits of statin in those at low risk are sufficient to justify their use, The CTT study, which supports their use even in low risk patients, recorded muscle problems in 0.05% of the patients included (0.5/1000 treated with statins), raising concerns that the study did not document all those with symptoms as they quoted a large study of 13626 persons on statins compared with 32623 controls when the incidence of muscle problems were 100 times greater in a statin treated group i.e. 1 out of every 19 patients.

In clinical practice any musclulo-skeletal pains or other symptoms in statin users are a diagnostic and management problem, whether at high risk or low risk of cardio-vascular events. Is the symptom statin-induced or is there some other cause? The use of a statin free period has been suggested to evaluate any possible relationship. When a statin-free period is to be trialed it would be useful if packs of commonly presribed statin-like tablets were available with similar packs containing active but unlabelled statin available. These would enable a practioner to try a statin-free and a non-statin free period without patient or doctor knowing which is being taken i.e double blind. To add sophistication the patient could keep symptom scores and to add further sophistication statistical analysis of the results of the symptom scores using n=1 methods - which are available for time-series analysis (Knapp, MS, Using clinical evidence. Randomised controlled trials are not the only evidence. BMJ Jul 2001; 323: 165).

Providing packs for a double-blind trial of statin-cessation in individual patients seen in routine clinical practise, with a kit for the analysis of data collected, could be a service from the pharmaceutical companies who market statins to prescribers and patients.

Competing interests: No competing interests

11 November 2013
Martin S Knapp
Physician/Nephrologist
Mildura Nephrology
12 Townsend Street, Ivanhoe, Vic. 3079, Australia