What are the facts about misinformation regarding HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors, commonly referred to as statins?

From the Guidelines

Fake news about statins is widespread and potentially harmful to public health, and patients should be aware that statins are well-established, evidence-based medications that effectively lower cholesterol and reduce cardiovascular risk. Statins (including atorvastatin, simvastatin, rosuvastatin, and pravastatin) have been shown to reduce the probability of CVD events (MI or ischemic stroke) and mortality by at least a moderate amount in adults aged 40 to 75 years who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater 1. Common misinformation claims that statins cause severe muscle damage in most users, lead to dementia, are unnecessary, or that their benefits are exaggerated by pharmaceutical companies. In reality, while statins can cause side effects like muscle aches in 5-10% of users, severe muscle damage is rare (occurring in fewer than 1 in 10,000 patients) 1.

Some key points to consider when evaluating the use of statins include:

• The USPSTF recommends using the ACC/AHA Pooled Cohort Equations to calculate 10-year risk of CVD events 1
• Statins reduce levels of total cholesterol and LDL-C and, to a lesser extent, triglycerides, and probably have anti-inflammatory and plaque stabilization effects as well 1
• The likelihood that a patient will benefit from statin use depends on his or her absolute baseline risk of having a future CVD event, a risk estimation that is imprecise based on the currently available risk estimation tools 1
• The USPSTF concludes with moderate certainty that initiating use of low- to moderate-dose statins in adults aged 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 10% or greater has at least a moderate net benefit 1

Multiple large clinical trials have consistently shown that statins reduce heart attacks, strokes, and cardiovascular deaths by 25-35% in at-risk populations 1. The scientific consensus supporting statin use is based on decades of research involving hundreds of thousands of patients. Patients should discuss concerns about statins with healthcare providers rather than discontinuing medication based on internet claims, as stopping statins can significantly increase cardiovascular risk. Healthcare decisions should be based on individual risk factors and medical guidance rather than misleading information circulating online.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Statin Efficacy and Safety

• Statins have been proven to reduce cardiovascular events and mortality, with a well-established efficacy in a large number of clinical conditions 2.
• The US Preventive Services Task Force recommends statin use for the primary prevention of cardiovascular disease in adults aged 40 to 75 years with one or more cardiovascular disease risk factors and an estimated 10-year cardiovascular disease event risk of 10% or greater 3.

Combination Therapies

• A fixed-dose combination of rosuvastatin and ezetimibe has been shown to be more effective in reducing low-density lipoprotein cholesterol and total cholesterol than rosuvastatin monotherapy or simvastatin/ezetimibe 4.
• A study comparing the effects of monotherapy with rosuvastatin, atorvastatin, or ezetimibe versus combination treatment with rosuvastatin-ezetimibe and atorvastatin-ezetimibe found that the combination therapies had less direct effect on the endothelial barrier than the statins alone 5.

Clinical Trials and Studies

• A randomized, double-blind, multicenter, phase III study found that a fixed-dose combination of low-intensity rosuvastatin and ezetimibe was more effective in lowering low-density lipoprotein cholesterol and achieving low-density lipoprotein cholesterol goals than moderate-intensity rosuvastatin monotherapy 6.
• A study published in the Journal of the American Medical Association found that statin use for the prevention of cardiovascular disease events and all-cause mortality in adults aged 40 to 75 years with no history of cardiovascular disease and who have one or more cardiovascular disease risk factors has at least a moderate net benefit 3.

Addressing Fake News About Statins

• There is no evidence to support the claim that statins are ineffective or harmful, with numerous studies demonstrating their efficacy and safety in reducing cardiovascular events and mortality 2, 3, 4, 6, 5.
• Clinicians should be aware of the benefits and risks of statin therapy and individualize treatment based on patient-specific factors, such as cardiovascular disease risk and potential side effects 2.