An international group of researchers warn that cholesterol drugs may be widely overprescribed, indicating many individuals given the medications derive no medical benefits.
The study looked at the current practice of recommending cholesterol drugs based on estimated cardiovascular risks. In findings published last week in the medical journal BMJ Evidence-Based Medicine, researchers found that many high-risk patients are currently being missed by the current guidelines, and many low-risk individuals receive unnecessary prescriptions for widely used drugs like Lipitor, Crestor and similar cholesterol medications.
Researchers from New Mexico, Brazil and France looked at cholesterol guidelines issued in 2018 by the American Heart Association and the American College of Cardiology, conducting a systemic review of all randomized clinical trials (RCTs) examining cholesterol reduction involving three classes of drugs: statins, like Lipitor and Zocor; cholesterol absorption inhibitors, like Zetia; and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9), like Repatha.
Of the 13 clinical trials which saw patients meet cholesterol reduction targets, only five showed a reduction in cardiovascular events, and only one found a mortality benefit. However, of the 22 clinical trials which did not meet cholesterol reduction targets, four found a mortality benefit and 14 found a reduction in cardiovascular events.
“The lack of consistent mortality and cardiovascular benefit was seen with all three drug classes,” the researchers determined. “In summary, mortality and cardiovascular benefit was more frequently reported in RCTs that did not meet the LCL-C targets than in those that did.”
There have been questions about the consequences of over prescription and overuse of statins for years, due to the large number of patients that have been prescribed cholesterol drugs like Lipitor and Zocor.
Many critics have raised concerns that statins are being pushed on the populace too heavily, in what is often referred to as the “statinization” of America. Those concerns came after guidelines issued by the American Heart Association and the American College of Cardiology, who indicated that statins are the only drugs doctors should prescribe to lower cholesterol and called for doctors to toss out
Statins are among the best-selling drugs in the United States, using the liver to block the body’s creation of cholesterol, which is a key contributor to coronary artery disease. However, a number of studies have linked the drugs to an increased risk of potentially serious injuries, including muscle damage, kidney problems and diabetes.
The researchers of this latest study found that while statin use in the U.S. nearly doubled from 2002 and 2013, and cholesterol levels are falling, cardiovascular deaths still appear to be on the rise.
“These population studies suggest that, despite the widespread use of statins, there has been no accompanying decline in the risk of cardiovascular events or cardiovascular mortality. In fact, there is some evidence that statin usage may lead to unhealthy behaviors that may actually increase the risk of cardiovascular disease,” the researchers concluded. “Given the lack of clarity on how best to prevent cardiovascular disease, we encourage informed decision-making. Ideally, this includes a discussion of absolute risk reduction and/or number needed to treat at an individual patient level in addition to reviewing the potential benefits and harms of any intervention.