Communicating Statin Evidence to Support Shared Decision-Making

Bruce Barrett; Jason Ricco; Margaret Wallace; David Kiefer; Dave Rakel


BMC Fam Pract. 2016;17(41) 

In This Article


There is strong evidence that statins can reduce the risk of heart attacks and other cardiovascular events. The degree-of-benefit increases across the risk spectrum, so that people with higher risk derive greater benefit. For example, best evidence suggests that someone with a pre-existing 20 % 10-year risk of a CV event might reduce that risk by 5 to 15 %, while someone with a 7.5 % estimated risk might reduce that risk by 1.9 to 5.6 %. Probabilities of harms, such as inflammatory muscle pain and increased incidence of diabetes are known less precisely, but may be important to patients, and should be taken into consideration. Other patient-oriented factors, such as the positive value of reassurance that one-is-doing-all-that-one-can to prevent a heart attack, or negatively-valued attributes, such as co-pays or other monetary costs, or the hassle of having to take a pill every day, or the need to regularly see doctors and have blood drawn, may be important to patients, but have not been assessed properly, and are not addressed by current guidelines. Medicine's guiding ethics, such as beneficence and autonomy, have been recognized since Hippocrates, and have in principle changed little since Osler's days. What has changed substantively is the quality and quantity of evidence available, and the gradual shift from paternalism towards patient-orientation. We hope that this essay may beneficially contribute in this direction.