Thread by @omlakhani

If you want to look about the use of Statins (Cholesterol lowering medications) to prevent heart attack and stroke, you don't need to look beyond the series of excellent meta-analysis conducted by the "Cholesterol Treatment Trialists' Collaboration"

A thread ....

#Medtwitter

This GIF sums up everything nicely. It tells us three things

1. Statins work
2. More LDL reduction - lower the risk of heart attack, stroke etc
3. More statins/ more powerful statins- more LDL reduction

Q1. Do statins reduce the risk of heart attack and stroke ?

"Statin therapy significantly reduces the incidence of major vascular events and vascular mortality in a wide range of people."

"Reduction of LDL cholesterol using statin therapy reduces all-cause mortality by about one tenth for each 1 mmol/L (39 mg/dl) reduction in LDL cholesterol, principally reflecting a significant reduction in vascular mortality."

Ref: cttcollaboration.org/efficacy-web-p…

Q2. Does more intensive LDL reduction with more dose of statin or with more powerful statins have incremental benefit ?

"Further reductions in LDL cholesterol produce definite further reductions in the incidence of major vascular events"

"Compared with less intensive statin regimens, more intensive regimens produced a highly significant 15% further reduction in major vascular events associated with a mean 0・51 mmol/L further LDL cholesterol reduction"

Ref: cttcollaboration.org/efficacy-web-p…

Q3. Do statins work in patients with diabetes ?

"Statin therapy is effective among patients with diabetes mellitus and should be considered for all diabetic individuals who are at sufficiently high risk of vascular events"

"There was a significant 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in people with diabetes, which was again similar to the effect observed in those without diabetes"

Ref: cttcollaboration.org/efficacy-web-p…

Q4. Do statins work in patients with low baseline risk of cardiovascular event (heart attack and stroke) ?

"The benefits of statins apply both to those at high risk and those at low risk of vascular disease"

"In individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction of about 11 fewer major vascular events per 1000 treated over 5 years."

Ref: cttcollaboration.org/efficacy-web-p…

Q5. Do statins work in women?

"In women and men at an equivalent risk of cardiovascular disease, statin therapy is of similar effectiveness for the prevention of major vascular events"

"the proportional reductions in major coronary events, coronary revascularization, and stroke did not differ significantly by sex."

Ref: cttcollaboration.org/efficacy-web-p…

So in brief cholesterol-lowering medications work.

Now if a WhatsApp message or someone on Twitter tells you to stop your cholesterol medications, you are better empowered to counter the same

If you still wish to discontinue your cholesterol medications after reading a series of meta-analysis done with data from more than 20 clinical trials involving more 175,000 trial participants and counting, you better get yourself good insurance because you are going to need it