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Letters Statins for everyone?

Authors’ reply to Huffman and colleagues

BMJ 2014; 348 doi: (Published 26 February 2014) Cite this as: BMJ 2014;348:g1523
  1. John D Abramson, lecturer1,
  2. Harriet G Rosenberg, professor emeritus2,
  3. Nicholas Jewell, professor3,
  4. James M Wright, co-managing director and chair4
  1. 1Department of Health Care Policy, Harvard Medical School, Ipswich, MA 01938, USA
  2. 2Department of Social Science, York University, Toronto, Ontario, Canada
  3. 3Division of Biostatistics, School of Public Health Department of Statistics, University of California, Berkeley, CA, USA
  4. 4Therapeutics Initiative, Departments of Anesthesiology, Pharmacology and Therapeutics and Medicine, University of British Columbia, Vancouver, BC, Canada
  1. john_abramson{at}

We thank the Cochrane review authors for their thoughtful comments (highlighted in quotes below), which give us the opportunity to clarify unresolved issues about the benefits and harms of statins in low risk people.1

“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.”

The “proposed standards” that we referred to in our article were not the yet to be published 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on cholesterol treatment.2 3 Rather, they were the 2013 update of the Cochrane review on statins for the primary prevention of cardiovascular disease,4 which had incorporated the findings and recommendations of the 2012 Cholesterol Treatment Trialists’ (CTT) meta-analysis.5

The 2012 CTT meta-analysis reported that statins significantly reduce major vascular events in people “with 5-year risk of major vascular events lower than 10%.” It concluded that the current major guidelines—ATP-III in the US, the European Society of Cardiology task force, and the National Institute for Health and Care Excellence guidelines in the UK—“might need to be reconsidered.”

The 2013 Cochrane review stated: “in light of new evidence derived from the CTT Collaboration on primary prevention, there is a need to update existing cost-effective analysis.”

We based our comments about “proposed standards” on these calls to update existing recommendations. Although we had no advanced knowledge of the contents of the forthcoming ACC/AHA cholesterol treatment guidelines, we anticipated that these findings and recommendations would be influential.

“Abramson and colleagues state: ‘Under the proposed 2013 standards, however, no level of risk would preclude statin therapy’”

The 2012 CTT meta-analysis concluded: “The present report shows that statins are indeed both effective and safe for …

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