Do HMG-CoA reductase inhibitors (statins) increase life expectancy by approximately 4 days?

From the Guidelines

No, it is not true that statins only add 4 days to your life expectancy, as this claim significantly understates the benefits of statins for appropriate patients, with evidence suggesting they can reduce the probability of CVD events and mortality by at least a moderate amount in adults with 1 or more CVD risk factors 1. For individuals with established cardiovascular disease or at high risk for cardiovascular events, statins can extend life expectancy by months to years, not just days. Common statins include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor), typically prescribed at doses ranging from 10-80mg daily depending on the specific medication and patient needs. The benefits of statins are most pronounced in those with existing heart disease, diabetes, high cholesterol levels, or multiple cardiovascular risk factors. Statins work by reducing LDL ("bad") cholesterol production in the liver, which helps prevent plaque buildup in arteries that can lead to heart attacks and strokes. A recent meta-analysis of twenty-eight trials, including 186,854 participants, indicated that a 1 mM drop in LDL-cholesterol was associated with a 21 % drop in major vascular events, with beneficial effects seen across all age groups 1. The misunderstanding about "4 days" likely comes from misinterpreted or oversimplified analyses that averaged statin benefits across entire populations, including many low-risk individuals who would receive minimal benefit, thus diluting the substantial benefits seen in high-risk groups. Key points to consider when prescribing statins include:

• The patient's calculated 10-year CVD event risk
• The presence of 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking)
• The potential for statins to reduce the probability of CVD events and mortality by at least a moderate amount in adults with 1 or more CVD risk factors 1. Overall, the benefits of statins in reducing cardiovascular events and mortality are well-established, and they should be considered a crucial part of the treatment plan for individuals at high risk for cardiovascular disease.

From the Research

Statin Therapy and Life Expectancy

• The statement that statins only add 4 days to life expectancy is not directly supported by the provided evidence 2, 3, 4, 5, 6.
• A study published in the Journal of the American College of Cardiology estimated that statin therapy for individuals with elevated C-reactive protein levels could gain 6.6 months and 6.4 months of life expectancy for 58-year-old men and women, respectively 5.
• Another study published in Current Atherosclerosis Reports found that the benefit from statin therapy extends beyond 5 years, with long-term follow-up of surviving trial participants showing sustained reduction in LDL cholesterol concentration and substantial absolute benefits 6.
• 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 2.
• A systematic review and meta-analysis of randomized trials found that statins as a class showed statistically significant risk reductions in non-fatal myocardial infarction, cardiovascular disease mortality, all-cause mortality, non-fatal stroke, and composite major cardiovascular events 4.

Benefits and Harms of Statin Therapy

• Statins have been shown to reduce the rate of cardiovascular morbidity and mortality, with benefits independent of initial cholesterol or LDL-cholesterol concentrations 3.
• The likelihood of benefit from statin therapy is smaller in adults with a 10-year cardiovascular disease risk of 7.5% to less than 10% compared to those with a 10-year risk of 10% or greater 2.
• Statins have been associated with increased risks of myopathy, renal dysfunction, and hepatic dysfunction, although the benefit-harm profile differs by statin type 4.
• Atorvastatin and rosuvastatin were found to be the most effective in reducing cardiovascular disease events, while atorvastatin appeared to have the best safety profile 4.