Re: Are statins overprescribed? Why the risks and benefits are so complex
posted on
Dec 04, 2018 04:25PM
"So I googled "what is the NNT for Lipitor" This is what I got.....I guess that is not so great, right?"
A little piece of advice....don't take the first hit in a google search as your final answer. One needs more context to put this statin NNT in perspective. What trial was this from? Were these high-risk patients? What risk factors did the patients have? Did they have a previous ACS event? Were they diabetics? What was their baseline LDL-C level, what dose of statin was used and what LDL-C was acheived? What about other adverse events other than heart attack like stroke, CVD death?
Here's a nice review for you to look at to remind you that the LDL-C hypothesis is solid.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837225/
The more contemporary view is that in high-risk patients, especially those with baseline LDL-C above 100 mg/dL, robust and prolonged LDL-C lowering reduces MACE incidence. It's not just about statins. It's about LDL-C lowering. Statins, PCSK9s, ezetimide, maybe bempedoic acid in the future.....lot's of tools to achieve LDL-C lowering. NNTs of well below 100 have been seen depending upon the residual risk, basline LDL-C, LDL-C achieved and duration of treatment. Note, the above review was published before the ODYSSEY trial, which further supports LDL-C lowering for MACE risk reduction in high-risk patients.
BDAZ