Statins sunset

There are many publications of the results of the Lipid-Lowering Trial component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)  with the findings:

  • Lack of benefit from statins in primary prevention of cardiovascular events in the elderly (JAMA Intern Med., 2017; 177 (7): 955-965.)
  • Statins are ineffective in the primary prevention of cardiovascular events and mortality in older people with and without diabetes (BMJ 2018; 362)
  • Recommendations on the use of statins should be individualized (JAMA Intern Med. 2017; 177 (7): 955-965.)

Why so?

  • Atherosclerosis cannot be avoided
  • There are many clinical forms of atherosclerosis

– cerebral, cardiac, peripheral arterial (e.g. peripheral artery disease) with characteristic symptoms

– asymptomatic

  • Turning asymptomatic atherosclerosis into symptomatic

– endophytic atherosclerotic plaques reach  critical sizes

– exophytic atherosclerotic plaques explode with the onset of the thrombotic cascade, …

  • Primary prevention of atherosclerosis (including statins) in the elderly is not more than fantasy

Secondary prevention how?

  • When plaques have formed, even if they still not calcified, is it possible to reverse the development of atherosclerosis?!
  • Since the reverse development of atherosclerosis is not possible, secondary prophylaxis with statins is a problem
  • Confirmation in the quote that all the time of statins clinical use there were no received objective evidence that they are more effective than placebo (JAMA Intern Med. 2017 May 22. 1442.)

Take care of your patient money

  • Information in clinical practice guidelines should always be filtered, for statins in the first place
  • The patient first
  • The criterion of the effectiveness of the patients’ treatment is not in the clinical practice guidelines but is in their reactions to the treatment

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