I thought this was interesting commentary in a fairly recent issue of JAMA arguing for the 2 different viewpoints. To prescrtibe or not to prescribe statins for healthy people with high cholesterol?
Healthy Men Should Not Take StatinsNo. What is the benefit of statin therapy in healthy men with high cholesterol levels? Data from a meta-analysis of 11 trials including 65 229 persons with 244 000 person-years of follow-up in healthy but high-risk men and women showed no reduction in mortality associated with treatment with statins. A 2011 Cochrane review of treatment with statins among persons without documented coronary disease came to similar conclusions...Do the potential benefits outweigh the potential risks? Based on all current evidence, a healthy man with elevated cholesterol will not live any longer if he takes statins. For every 100 patients with elevated cholesterol levels who take statins for 5 years, a myocardial infarction will be prevented in 1 or 2 patients. Preventing a heart attack is a meaningful outcome. However, by taking statins, 1 or more patients will develop diabetes and 20% or more will experience disabling symptoms, including muscle weakness, fatigue, and memory loss.
Statin Therapy for Healthy Men Identified as “Increased Risk”Yes. In the shared decision-making process, the clinician should explicitly inform this patient that a statin is likely to reduce the chance of a first CHD event and reduce the chance of stroke and may offer a survival benefit that is likely to become more evident over a lifetime. Is there a durable benefit to statin therapy, or should statins be prescribed only after a myocardial infarction? There is no apparent logic in waiting for a myocardial infarction or a stroke to occur before starting a risk-reducing therapy. A recent meta-analysis of trials confirms that statins retain their benefit after discontinuation of randomized therapy...Do patients expect medications to prolong survival within 5 years? Most patients do not expect near-term survival benefit from medicine; they are concerned about myocardial infarction, stroke, venous thrombosis, and the resulting chronic disease and disability that may occur. They see their parents, who have vascular dementia and congestive heart failure, and seek safe strategies to reduce their risk. In fact, more than ever, the modern patient is focused on quality of life and not exclusively on longevity.