Background: Lipid-lowering drugs, mostly statines, were dispensed during 2011 to 815 000 people from the pharmacies in Sweden. High cholesterol is a major risk factor for development of coronary heart disease (myocardial infarction, angina, intermittent claudicatio intermittens and stroke). Coronary heart disease is the causes of more than 40% of all deaths in Sweden.Lifestyle changes, together with lipid-lowering drugs, statines, are effective treatments. Statines can be administered either to patients that have had a cardiac event i.e. heart attack, stroke (secondary care) or to persons with risk factors i.e. high levels of cholesterol, diabetes, primary care.
Objective: with the help of published clinical trials and meta-analysis examine what effect statines have on morbidity / mortality in cardiovascular diseases in primary and secondary care.
Results: The studies showed that statins reduce TC, LDL and TG and increase HDL. They also showed that statins reduce major coronary events, cerebrovascular events, mortality from coronary heart disease, unstable angina and revascularization. Statin therapy was associated with increased risk of moderate or severe liver failure, acute renal failure, moderate or severe myopathy and cataracts in both men and women. The risk was dose-dependent and greatest at the first year of treatment.
Conclusion: The studies showed that statine treatment reduced the blood level of harmful cholesterol, prevented the atherosclerotic process and thus reduced the need for revascularization. Statin therapy is about two - three times as effective in secondary care as in primary care. One need to treat 60 people, who have had a coronary heart event, during about 5 years to prevent one death and 180 people to prevent a nonfatal cardiovascular event. The effect is similar for men and women and for older and middle aged people. Life expectancy increases by two years. For patients who not have had a coronary heart event but have risk factors i.e. high cholesterol levels, diabetes, one need to treat two - three times as many to achieve the same results (120 patients to prevent one death and 330 to prevent one nonfatal cardiovascular event). The effects of treating healthy individuals with statines are low.Statines are well-established and safe drugs. One noteworthy side effect is myopathy, (rhablomyelos) which is quite unusual as reported from studies.One problem that exists in all prescribed preventive treatments is poor adherence to prescriptions.