The following is a comment to the online article, “To Statin or not to Statin? – That is the question” by Dr Robin Park. This article is a very readable summary of a number of practical questions about statins for GPs.
Great summary Rob!
A few comments… The evidence for the benefit of LFT and CK monitoring for statins is poor, and the rationale for doing so is questionable in light of the accumulated safety data for statins. An argument can perhaps be made for baseline LFT (even in otherwise fit and well people), but the utility of a baseline CK is rather low in someone not at high risk of myopathy. Stopping a statin in someone who is at mod/high CVD risk, due to an asymptomatic rise in CK, probably does more harm than good.
We need to recognise that most of us (me included!) have an intrinsic bias to do biometric testing (rather than not) when there is uncertainty. We are always going to get apparent good patient outcomes by identifying and labelling non-disease. This type of practice is far from harmless, however, and contributes to overdiagnosis, overtreatment, and medicalising the human condition. For instance, we generally vastly over-order serum lipids for the purposes of screening/monitoring – who here can honestly say they typically only order serum lipids at the the frequency of 5-yearly intervals? I love EBM but even that makes me feel anxious… Nonetheless, as ethical practitioners, the testing we recommend should be directed at maximising meaningful patient outcomes, and not at managing our therapeutic neuroses!