LITERATURE WATCH: Statin Safety, Primary Prevention

Two sets of guidelines important to the primary-care physician were published recently. Following are brief recaps of each; literature citations are also provided for review of the complete articles.

Pasternak RC, Smith SC Jr, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. J Am Coll Cardiol. 2002;40:568-573.
Circulation. 2002;106:1024-1028.

    Three prominent medical organizations—the American College of Cardiology, American Heart Association, and National Heart, Lung, and Blood Institute—joined together to develop a consensus statement on the safety and effectiveness of HMG-CoA reductase inhibitors (statins).
    The authors note that the voluntary withdrawal of cerivastatin from the US market in August 2001 prompted concern among both physicians and patients about the safety of the class of drugs. They write that this advisory, which focuses on the aspect of myopathy, is meant to encourage the appropriate use of statins. It summarizes the current understanding of statin use, plus it provides recommendations for appropriate use of the agents. It also reviews cautions, contraindications, and safety monitoring for statin therapy.
    In their summary, the authors note that few significant side effects from statins have been observed in clinical trials and that reports of adverse events have been very limited when viewed in context of the number of patients who receive these drugs safely. They encourage the appropriate use of statins but do point out that there is a possibility of side effects in certain patients—most notably the elderly and those who have complex medical problems and/or are taking multiple medications. If statins are used with caution in these particular patients, however, it is likely that the development of clinically important myopathy would be reduced, the advisory concludes.

Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation. 2002;106:388-391.

    These guidelines, an update of those published in 1997, are intended to help primary-care providers in the assessment, management, and follow-up of patients who may be at risk for—but have not yet developed—cardiovascular disease. This report integrates other guidelines and consensus statements (such as ATP III) developed since the initial 1997 publication. The foundation of these guidelines continues to be the promotion of a healthy lifestyle—including good dietary habits, weight control, regular exercise, and avoidance of tobacco use.
     The guidelines include recommendations to help the physician assess a patient's risk and when and how to intervene if necessary. They conclude by issuing a challenge to healthcare professionals to engage more patients earlier in comprehensive cardiovascular risk reduction, thus allowing more individuals to receive the benefits of primary prevention.