Are statins overprescribed?

The use of HMG Co-A reductase inhibitors, colloquially known as statins, represent one of the most prescribed class of medications in history, exceeding 200 million prescriptions per year in the U.S. alone [1]. The confounding variable of adult onset diabetes (T2D) has added hundreds of millions of additional prescriptions to what are already prescribed [1], in a battle surrounding the inflammatory diseases plaguing modern civilization - diabetes, coronary artery disease and obesity [2]. Coupled with more than 10 million diagnostic studies done per year looking for heart disease [3], and the misrepresentation of how those drugs work [4], and you have a milieu for over prescription fueled by BigPharma.

In addition to what is already published about these drugs, are the unpublished studies one is only privy to as a reviewer for medical journals and conference presentations. Being such a reviewer, the first author has had the opportunity to see information which most physicians remain unaware of. This information would undoubtedly modify the prescribing practice of many medical colleagues.

One of the staunchest critics of statin use is Dr. Aseem Malhotra [5]. While Dr. Malhotra and the first author significantly disagree on which diets work best to address these inflammatory diseases-something we still need to address [6], particularly in light of the most recently retrospective study now being discussed [7], -we do agree on the need for more transparency over how these drugs are prescribed, their actual benefit versus side-effect profiles, and whether they truly provide the promised benefit to survival and quality of life. We must quantitatively determine whether the use of these medications in individuals with no prior history of known coronary artery disease [8], -in particular the older patient [9], -provides measureable benefit rather than merely treating a blood test.

The over prescription of drugs, either through misrepresentations made to the FDA or over zealous marketing to physicians needs to be addressed. This over prescription has burdened the health care system without demonstrating the benefit promised. If these drugs truly provide enhanced length and quality of life for those taking them, then there should be no problem with increased transparency and discussion of their use. Such discussions and transparency are long overdue.

FMTVDM issued to first author.

1. ClinCalc DrugStats Database. Link: http://bit.ly/36vtVqh
2. Fleming RM (1999) Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY 787-798. Link: http://bit.ly/35rae31
3. Nuclear Medicine Communications 1997 and Canadian Medical Association.
4. Fleming RM, Chaudhuri TK, McKusick A (2019) The FDA, HHS, Sestamibi Redistribution and Quantification. Acta Scientific Pharmaceutical Sciences 3: 47-49. Link: http://bit.ly/36rAMAW
5. Gallagher P (2019) Statin war of words: Matth Hancock dragged into ongoing debate over cholesterol-lowering drug taken by millions of Britons. Link: http://bit.ly/2NYlmxu
6. Fleming RM, Fleming MR, Chaudhuri TK (2019) Are we prescribing the right diets and drugs for CAD, T2D, Cancer and Obesity? Int J Nuclear Med Radioactive Subs 2: 000115. Link: http://bit.ly/2Rtlw2h
7. Zeraatkar D, Han A, Guyatt GH, Vernooij RWM, El Dib R, et al. (2019) Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes. A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med. Link: http://bit.ly/37BqZtz
8. Ledford H (2013) Cholesterol limits lose their luster. Nature 494: 410-411. Link: https://go.nature.com/2RqK9wz
9. Mortensen MB, Flak E (2018) Primary Prevention With Statins in the Elderly. J Am Coll Cardiol 71: 85-94. Link: http://bit.ly/2Rno3uL

© 2020 Fleming RM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.