{"id":15519,"date":"2012-01-23T13:28:01","date_gmt":"2012-01-23T18:28:01","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&p=15519"},"modified":"2012-01-23T13:28:01","modified_gmt":"2012-01-23T18:28:01","slug":"rita-redberg-and-roger-blumenthal-clash-over-statins-for-primary-prevention-in-the-wall-street-journal","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/01\/23\/rita-redberg-and-roger-blumenthal-clash-over-statins-for-primary-prevention-in-the-wall-street-journal\/","title":{"rendered":"Rita Redberg and Roger Blumenthal Clash Over Statins for Primary Prevention in the Wall Street Journal"},"content":{"rendered":"

The debate over\u00a0whether statins should be used for primary prevention moved to the Wall Street Journal<\/em><\/a>\u00a0with opposing perspectives from cardiologists Roger Blumenthal and Rita Redberg.<\/p>\n

Blumenthal argues that \u201cthere is a mountain of high-quality scientific evidence\u201d to support the use of statins in people without known heart disease but \u201cdemonstrated to be at high risk for heart disease.\u201d<\/p>\n

Redberg argues that \u201cfor most healthy people, data show that statins do not prevent heart disease, nor extend life or improve quality of life. And they come with considerable side effects. That\u2019s why I don\u2019t recommend giving statins to healthy people, even those with higher cholesterol.\u201d<\/p>\n

Both authors cite the\u00a0West of Scotland Study<\/a>\u00a0and\u00a0JUPITER<\/a>\u00a0in support of their position.\u00a0Blumenthal concedes that long-term studies looking at mortality have not been performed, noting that such a study \u201cwould be enormously expensive and unwieldy, and take decades to complete.\u201d Instead, Blumenthal cites evidence from meta-analyses, and the example of the wide acceptance of primary prevention for the treatment of high blood pressure, despite a similar lack of evidence.<\/p>\n

Redberg says that the blood pressure data are more convincing than the statin data. No evidence supports a mortality benefit, she writes.\u00a0The most \u201coptimistic projections,\u201d she writes, suggest that \u201cfor every 100 healthy people who take statins for five years, one or two will avoid a heart attack. One will develop diabetes.\u201d<\/p>\n

Both authors agree that diet and exercise are important. Blumenthal writes that \u201ctreatment doesn\u2019t have to be all or none \u2014 all statin or all lifestyle. The two can be effectively combined to help our patients.\u201d\u00a0Blumenthal rejects the idea that statins are a moral hazard:<\/p>\n

Think of it this way. If your doctor recommended a statin to you because of high risk of heart disease, would you eat more hamburgers because of this safety net or would you try to exercise a little more?<\/p>\n

Redberg believes statins take resources away from lifestyle changes:<\/p>\n

If we were to spend a small fraction of the annual cost of statins on making fruits and vegetables and physical activity more accessible, the effect on heart disease, as well as high blood pressure, diabetes, cancer and overall life span, would be far greater than any benefit statins can produce.<\/p>\n","protected":false},"excerpt":{"rendered":"

The debate over\u00a0whether statins should be used for primary prevention moved to the Wall Street Journal\u00a0with opposing perspectives from cardiologists Roger Blumenthal and Rita Redberg. Blumenthal argues that \u201cthere is a mountain of high-quality scientific evidence\u201d to support the use of statins in people without known heart disease but \u201cdemonstrated to be at high risk […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[211,665,584,1121],"class_list":["post-15519","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention","tag-jupiter","tag-primary-prevention","tag-statins","tag-woscops"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15519","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=15519"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15519\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=15519"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=15519"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=15519"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}