Letters Statins for everyone?

Huffman and colleagues’ response to Abramson and colleagues’ article on statins in low risk people

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1520 (Published 26 February 2014) Cite this as: BMJ 2014;348:g1520
  1. Mark Huffman, assistant professor of preventive medicine and medicine-cardiology1,
  2. Fiona Taylor, editor, Cochrane Heart Unit2,
  3. Shah Ebrahim, professor of public health2
  1. 1Departments of Preventive Medicine and Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  2. 2Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  1. m-huffman{at}northwestern.edu

The BMJ Analysis article on statins in low risk people stated, “the evidence does not show that the benefits of statins in low risk patients outweigh the harms and that the advice for treatment of this group should not be changed.”1 It criticises our Cochrane systematic review on statins for the primary prevention of cardiovascular disease for not coming to the same conclusion.2 Readers of the BMJ may be interested in our views on their arguments.

This article predated by three weeks the publication of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol treatment guidelines (12 November 2013), but statements were made about “proposed standards” without full knowledge of these guidelines. Notably, none of the authors were acknowledged reviewers of the ACC/AHA guidelines.3

Abramson and colleagues state: “Under the proposed 2013 standards, however, no level of risk would preclude statin therapy, raising the question whether all people over the age of 50 should be treated.” Neither the Cochrane review nor the ACC/AHA cholesterol guidelines proposed treatment for everyone over the age of 50 years. The ACC/AHA guidelines recommend that initiation of moderate intensity statin treatment be considered for patients with a predicted 10 …

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