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Evidence does not support statin use for non-CVD conditions
A review published in Annals of Internal Medicine indicated a lack of substantial evidence of an association between statin use and non-CVD outcomes.
“Statins have been widely used for reducing cardiac morbidity and mortality in both primary and secondary prevention of CVD,” Evropi Theodoratou, MSc, PhD, from University of Edinburgh, told Healio Internal Medicine. “Due to the worldwide extent of statin use in the past several years, interest has grown considerably regarding the potential effect of these drugs on non-CVD outcomes. Recently, many meta-analyses have claimed that statins are also associated with outcomes of several other diseases.”
Theodoratou and colleagues reviewed 112 meta-analyses of observational studies and 144 meta-analyses of randomized controlled trials to determine the quantity, validity and credibility of evidence regarding the effects of statins for 278 non-CVD outcomes.
The researchers found evidence that showed that statins were associated with reduced mortality in patients with cancer and reduced exacerbation in patients with COPD.
Additionally, statins were found to decrease all-cause mortality in patients with chronic kidney disease, but there was no evidence that they improve kidney function. There was also suggestive evidence that indicated that statins were associated with a higher risk for diabetes and myopathy.
The studies demonstrated no statistically significant effects of statins for myopathy, myalgia or rhabdomyolysis. More evidence is needed to determine the effects of statins on COPD disease progression and Alzheimer’s disease, according to researchers.
The vast majority of associations and effects observed suggested favorable outcomes related to statins, but almost none of these benefits seemed to have high credibility in researcher’s assessments except for all-cause mortality for patients with CKD, Theodoratou said.
“Therefore, the results of this umbrella review of existing meta-analyses do not support any change in the existing clinical recommendations regarding statin use for non-CVD conditions,” she said.
“The absence of harmful effects, especially those with highly convincing or highly suggestive evidence, is reassuring,” she added. “Yet, we cannot exclude the possibility that some of these harms, such as rhabdomyolysis or severe myopathy, may be too rare to rule out with certainty.”
The evidence is not robust enough to rationalize withholding statins due to concerns about development of diabetes, Theodoratou said.
“This is in accordance with expert consensus stating that statin therapy is to be prescribed to patients with or without type 2 diabetes risk factors to lower their risk for CVD events, without fear of increasing their risk for type 2 diabetes,” she said. “Recommendations to clinicians emphasize the importance of lifestyle modifications for patients about to begin statin therapy, to decrease their risk for both cardiovascular events and diabetes.”
“It is important to note that throughout our review, the data related to muscular adverse effects in 10 meta-analyses were reported as secondary outcomes and so were unavailable to be extracted for further evidence assessment. It is crucial for data of all secondary outcomes to be accessible for further analysis as part of future meta-research. Limited by incomplete reporting of original studies, our umbrella review may not have captured all the evidence on muscular adverse events with statin use,” Theodoratou added. – by Alaina Tedesco
Disclosure: He reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.