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Relative Risk Reporting & Statins

Blog_5.30.23A recent review paper adds to the growing concern over clinical trial data related to the efficacy of statin drugs being reported in a misleading way.

The review focuses on the use of relative risk reduction rather than absolute risk reduction with regard to the efficacy of statins in five landmark randomized controlled trials (RCTs) over the course of four decades. The studies chosen were selected “because they played a key role in implicating high total serum cholesterol, in general, and low-density lipoprotein cholesterol (LDL-C), in particular, in causing heart disease and in promoting the pharmacological reduction of cholesterol to prevent coronary heart disease (CHD).”The authors assert that using relative risk is “a statistical strategy that can amplify a modest benefit of drug treatment to appear as if the effect is of great clinical significance” and that this way of reporting the data miscommunicates the real-world efficacy of these drugs. (A previous Research Forum covered similar findings.)

As the authors note, the reporting of relative risk rather than absolute risk (thus potentially conveying an overinflated benefit) would not be as problematic if statins were not associated with extensive side-effects, such as new-onset type 2 diabetes, cognitive dysfunction, kidney damage, and myopathy. These serious potential side-effects are especially concerning because statins may be prescribed for individuals deemed to be at high risk for a cardiovascular event based on elevated LDL-C when more advanced screening might reveal that, in fact, they are actually at low risk based on a more comprehensive assessment.

The present review also includes data showing that reporting absolute rather than relative risk reductions leads to significant changes both in physicians’ willingness to prescribe lipid-lowering medications and patients’ willingness to accept these treatments. On both sides of the prescription pad, it is essential to have an understanding of the true benefits versus risks for medications, particularly when they may be taken for decades.

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