Statins for primary prevention of cardiovascular disease

Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world.12 Although prices have fallen since their patents expired, statins account for substantial drug expenditure in a context of often overstretched healthcare budgets, with estimated global sales approaching $1tn by 2020.3 Use of statins in people with established cardiovascular disease is generally uncontroversial, but debate remains about their use for primary prevention for people without cardiovascular disease.2 The controversy centres on uncertainty about whether the benefits of statins outweigh the harms and whether widespread statin use can be justified from a societal perspective.

Nevertheless, clinical guidelines have expanded the eligibility criteria over time, and in many countries the majority of people taking statins do so for primary prevention. For example, our study of a national cohort of people aged over 50 in Ireland found that nearly two thirds of those taking statins were in this category, with a higher proportion of women than men taking them for primary prevention (73% of women versus 57% of men).4 Similar findings have been reported in other countries, including Denmark.5

The polarised debate on statins may have caused some confusion among patients and doctors. Greater awareness of the limitations of our current knowledge could facilitate communication to aid informed choices that are aligned with the patient’s preferences and values. Indeed, shared decision making is particularly important in this context. We draw on the findings of our three recent peer reviewed papers on statins for primary prevention,467 to …