Utilization of statins: Guiding principles and the new United States guidelines

摘要

Despite remarkable declines in mortality, cardiovascular disease (CVD) will remain the major cause of premature death in the United States and is becoming the major cause of premature deaths worldwide [1]. The small-to-moderate net benefits of statins in the treatment and prevention of CVD are statistically significant and clinically important for this common and serious disease [2]. There is a large, robust, and consistent totality of evidence that includes cogent findings from basic research, descriptive and observational analytic epidemiological studies as well as large-scale randomized trials [3]. For the reliable detection of small-to-moderate effects, randomized evidence is crucial because the amount of uncontrolled and uncontrollable confounding inherent in all nonrandomized design strategies may be as big as the effect sizes [4]. Randomized evidence is necessary to develop guidelines which have recently been revised and widely disseminated throughout the USA [5]. We believe that such guidelines are necessary but not sufficient for astute clinical judgments. In this manuscript we prefer general guiding principles to further aid the clinician to making the best individual judgment after weighing the benefits and risks of a statin in light of the entire risk profile of the patient. The benefits and risks of statins have recently been updated in comprehensive worldwide meta-analy-ses of large-scale randomized trials designed a priori to test the hypothesis in secondary prevention patients as well as high-risk primary prevention subjects [6].