A Point-by-Point Response to Recent Arguments Against the Use of Statins in Primary Prevention This Statement Endorsed by the American Society for Preventive Cardiology

作者：Joshi Parag H; Chaudhari Sameer; Blaha Michael J; Jones Steven R; Martin Seth S; Post Wendy S; Cannon Christopher P; Fonarow Gregg C; Wong Nathan D; Amsterdam Ezra; Hirshfeld John W; Blumenthal Roger S^*

来源：Clinical Cardiology, 2012, 35(7): 404-409.

DOI：10.1002/clc.22016

Recently, a debate over the merits of statin therapy in primary prevention was published in the Wall Street Journal. The statin opponent claimed that statins should only be used in secondary prevention and never in any primary-prevention patients at risk for cardiovascular events. In this evidence-based rebuttal to those claims, we review the evidence supporting the efficacy of statin therapy in primary prevention. Cardiovascular risk is a continuum in which those at an elevated risk of events stand to benefit from early initiation of therapy. Statins should not be reserved until after a patient suffers the catastrophic consequences of atherosclerosis. Contrary to the assertions of the statin opponent, this principle has been demonstrated through reductions in heart attacks, strokes, and mortality in numerous randomized controlled primary-prevention statin trials. Furthermore, data show that once a patient tolerates the initial treatment period, the few side effects that subsequently emerge are largely reversible. Accordingly, every major guidelines committee endorses statin use in secondary prevention and selectively in primary prevention for those with risk factors. The foundation for prevention remains increased physical activity, better dietary habits, and smoking cessation. However, prevention of heart attacks, strokes, and death from cardiovascular disease does not have to be all or noneall statin or all lifestyle. In selected at-risk individuals, the combination of pharmacotherapy and lifestyle changes is more effective than either alone. Future investigation in prevention should focus on improving our ability to identify these at-risk individuals. Drs Amsterdam, Blumenthal, and Wong serve on the board of directors and/or are officers of the American Society for Preventive Cardiology. Dr Wong has received research support from Merck and Bristol Myers-Squibb and advisory board consultant fees from Merck in the past 12 months. Dr Cannon is a senior investigator in the TIMI Study Group; has received research support from Accumetrics, AstraZeneca, GlaxoSmithKline, Merck, Essentialis, and Takeda; has donated advisory board consultant fees to charity from Bristol-Myers Squibb/Sanofi, Novartis, and Alnylam; has received honoraria for development of independent educational symposia from Pfizer and AstraZeneca; and has equity in Automedics Medical Systems. Dr Jones has received research support and advisory board consultant fees from Atherotech Diagnostics Lab and has served as a consultant for Amylin Pharmaceuticals. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

• 出版日期2012-7