individuals with a 1% risk of heart attack or stroke, 35 or older, could benefit from taking statins to lower cholesterol.

My risk of a heart attack or stroke is 1-2% according to my recent cholesterol and blood pressure tests. Should I take statins?

Widening the use of statins, beyond current guidelines to people at low risk of heart attack or stroke, could be beneficial reported three newspapers (10 November 2006). The papers gave an accurate summary of a cost-effectiveness study, though the model had limitations that should be considered when interpreting the findings.

• Three newspapers (1-3) reported that individuals with a 1% risk of heart attack or stroke, who are as young as 35, could benefit from taking statins to lower cholesterol. Two reported that the cost of prescribing statins for people at lower risk than currently receive this medication was less than the cost of caring for patients who have a heart attack or stroke (2,3).

• The newspaper articles are based on a cost-effectiveness model (4). The researchers extrapolated data from a randomised controlled trial of patients with heart disease or diabetes comparing the drug simvastatin to placebo for an average of five years. They used the data to develop a model assessing the lifetime cost effectiveness of taking statins and the cost effectiveness of using the drug with older and younger age groups and people at lower risk of disease than those included in the RCT. The authors concluded that treatment with statins is cost-effective in a wider population than is currently routinely treated based on current UK guidelines.

• The newspaper articles were accurate in their report of the research. However, the research did not aim to investigate the benefits of taking statins in lower risk groups; it was specifically concerned with cost-effectiveness. It is not clear that all relevant costs were considered in the analysis. Further, the exclusion of adverse events, given the life time horizon of the analysis, is likely to impact on the results obtained. The results should be interpreted in the context of these limitations.

Systematic reviews

Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.

There was one related systematic review identified on the Cochrane Database of Systematic Reviews (CDSR) (5) and one review which is currently being undertaken and will be available in the future (6). Five related systematic reviews were identified on the Database of Abstracts of Reviews of Effects (DARE) (7-11).

References and resources

1. 'Widen use of cholesterol drug'. The Independent, 10 November 2006, p22.

2. Lifesaver that costs £4 a month. Daily Express, 10 November 2006, p25.

3. Put 6m patients on statins, say doctors. Daily Mail, 10 November 2006, p4.

4. Heart Protection Study Collaborative Group. Lifetime cost effectiveness of simvastatin in a range or risk groups and age groups derived from a randomised controlled trial of 20 536 people. BMJ Online First.

5. Manktelow B, Gillies C, Potter JF. Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002091. DOI: 10.1002/14651858.CD002091

6. Moore THM, Bartlett C, Burke MA, Davey Smith G, Ebrahim SBJ. Statins for preventing cardiovascular disease. (Protocol) Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004816. DOI: 10.1002/14651858.CD004816.

7. Vrecer M, Turk S, Drinovec J, Mrhar A. Use of statins in primary and secondary prevention of coronary heart disease . and ischemic stroke: meta-analysis of randomized trials. International Journal of Clinical Pharmacology and Therapeutics, 2003;41(12):567-557. [DARE Abstract]

8. Law M R, Wald N J, Rudnicka A R. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ, 2003;326:1423-1427. [DARE Abstract]

9. Balk E M, Lau J, Goudas L C, Jordan H S, Kupelnick B, Kim L U, Karas R H. Effects of statins on nonlipid serum markers associated with cardiovascular disease. Annals of Internal Medicine, 2003;139(8):670-682. [DARE Abstract]

10. Cheung B M, Lauder I J, Lau C P, Kumana C R. Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes. British Journal of Clinical Pharmacology, 2004;57(5):640-651. [DARE Abstract]

11. Amarenco P, Labreuche J, Lavallee P, Touboul P J. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke, 2004;35(12):2902-2909. [DARE Abstract]

Consumer information

British Heart Foundation

NHS Direct - cholesterol

Previous Hitting the Headlines summaries on this topic

'Statins cut heart risk for diabetics'. Hitting the Headlines archive, 8 June 2004.