In recent years an increasing number of health experts have advocated giving cholesterol-lowering statin drugs to healthy people in an attempt to make a dent in the number of people dying from cardiovascular disease.
But now a review by the widely respected Cochrane Collaboration suggests there is little evidence such a strategy is cost effective. In addition, the mainly industry-funded trials in this area are guilty of horrific selective reporting and an unwillingness to give up their data, according to an editorial accompanying the latest review.
A team led by Fiona Taylor, of the London School of Hygiene and Tropical Medicine, analysed data from 14 randomized controlled trials on statin use for so-called ‘primary preventions’, ie: trying to prevent people from getting the disease in the first place.
Although they found reductions in mortality from all causes resulting from people getting statins, they found “only limited evidence” that doling out statins was cost effective or actually a way of improving quality of life for otherwise healthy people. In addition, they say, “there was evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease”.
The last point is important because we know statins can improve things for people with existing cardiovascular disease, so if those people end up in primary prevention studies it can skew the results.
In an editorial accompanying the new review, Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford, UK, brands these issues “unacceptable”.
“All of these shortcomings significantly undermine the findings of this review,” he notes. “To date only one trial has been publicly funded, while the authors of nine trials reported having been sponsored either fully or partially by pharmaceutical companies.”
Some trials that address the issues raised by the team really are needed. Another Cochrane review published today looks at other ways of trying to prevent cardiovascular disease, such as counselling and educating people at risk of problems in later life.
Their conclusion: “The evidence suggests that such interventions have limited utility in the general population.”