Nice summary.  Thanks for posting it.  I should print it out for my
Joslin endo who denied statins did nothing for women.  She was probably
thinking lowering cholesterol was beneficial.  Uh, no.  Not necessarily.

PP

Hi Michelle,
I found the original article in The Lancet.Here is an abstract :

Abramson J, Wright JM.
Are lipid-lowering guidelines evidence-based? Lancet 2007; 369:168–69.

doi:10.1016/S0140-6736(07)60084-1
Comment
J Abramson and JM Wright
Harvard Medical School, Cambridge, Massachusetts, USA
Department of Anesthesiology, Pharmacology & Therapeutics and Medicine,
University of British Columbia, Vancouver, BC, Canada
Available online 18 January 2007

The last major revision of the US guidelines, in 2001,1 increased the number
of Americans for whom statins are recommended from 13 million to 36 million,
most of whom do not yet have but are estimated to be at moderately elevated
risk of developing coronary heart disease.In support of statin therapy for
the primary prevention of this disease in women and people aged over 65
years, the guidelines cite seven and nine randomised trials, respectively.
Yet not one of the studies provides such evidence.For adults aged between 30
and 80 years old who already have occlusive vascular disease, statins confer
a total and cardiovascular mortality benefit and are not controversial.The
controversy involves this question: which people without evident occlusive
vascular disease (true primary prevention) should be offered statins? With
about three-quarters of those taking statins in this category, the answer
has huge economic and health implications.In formulating recommendations for
primary prevention, why do authors of guidelines not rely on the data that
already exist from the primary prevention trials?

We have pooled the data from all eight randomised trials that compared
statins with placebo in primary prevention populations at increased risk.Our
analysis suggests that lipid-lowering statins should not be prescribed for
true primary prevention in women of any age or for men older than 69 years.
High-risk men aged 30–69 years should be advised that about 50 patients need
to be treated for 5 years to prevent one event. In our experience, many men
presented with this evidence do not choose to take a statin, especially when
informed of the potential benefits of lifestyle modification on
cardiovascular risk and overall health.8 This approach, based on the best
available evidence in the appropriate population, would lead to statins
being used by a much smaller proportion of the overall population than
recommended by any of the guidelines.

Why the disagreement? The current guidelines are based on the assumption
that cardiovascular risk is a continuum and that evidence of benefit in
people with occlusive vascular disease (secondary prevention) can be
extrapolated to primary prevention populations.This assumption, plus the
assumption that cardiovascular risk can be accurately predicted, leads to
the recommendation that a substantial proportion of the healthy population
should be placed on statin therapy.

There was a lot of comment on this article in later issues ....  :)
The subject still has a lot of controversies.I have read it all.I don't see
a clear cut message
I decided, long ago, that I will not use statins.Mainly because one of the
side effects : Muscle pain.As one of the critics also remarks : T2 patients
have to exercise to manage their condition.If you give them statins they
won't be able to exercise nough.They will have a lower lipid level and still
die sooner ... :( I completely agree with this mans analysis of the problem.

As always : Ymmv
Everybody has to decide for himself what his conclusion will be on the
(limited) available evidence ... :)

hth
Gys