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Statins evidence: when answers also raise questions

BMJ 2016; 354 doi: (Published 14 September 2016) Cite this as: BMJ 2016;354:i4963
  1. Harlan M Krumholz, professor
  1. Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510, USA
  1. harlan.krumholz{at}

Sharing the data is more likely to settle the debate than another review

Statins are likely to have contributed to the large reductions in cardiovascular disease that have occurred in North America and Europe. Clinical trials of these affordable drugs have a remarkable record of showing benefit, with side effects mostly uncommon and minor and resolving after discontinuation of the drug.1 Moreover, many complaints among statin users are misattributed to the drug.

Nevertheless, some scientists have raised persistent concerns.2 They have asked questions about the effectiveness and adverse effects of statins, particularly in low risk populations and those not well represented in the trials. Advocates for statins equate the dissent to yelling “Fire” in a crowded theatre when no fire exists, and causing harm with words.3 Others defend the rights of well intentioned scientists and clinicians to question evidence.4

Into this fray comes a publication from some prominent clinical scientists—a review article with an attitude. The authors’ intent is to provide “the appropriate interpretation of evidence.”5 The review, which consolidates previously published information, aims to explain “how evidence from randomized trials yields reliable information about both the …

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