Dalla prevenzione alla riabilitazione cardiovascolare: Statine e medicina basata sulle evidenze

The recent "Lipobay affair" prompted us to review the biomedical literature focusing on statins, in a prevention and rehabilitation perspective, and to prepare a pertinent evidence-based report. A number of randomized controlled clinical trials have assessed the efficacy and the safety of statins in cardiovascular prevention; these drugs have proved to be effective (number needed to treat values between 20 and 40) and safe (number needed to harm value for myopathy even when in association with fibrates around 833, as deduced from literature data). Fatal rhabdomyolysis is virtually not detectable in current scientific literature when statin therapy is administered in an appropriate fashion and when the patient undergoes periodical check-ups. In the individual patient, the benefits and risks related to his treatment have to be precisely tailored, evaluating his individual risk profile, the strength of the indication to statin therapy, the concomitant presence of other treatments and/or habits and the potential and actual adverse events foreseeable (to an extent) if established risk factors which predispose to myopathy are taken into consideration. The hematological lipids management strategy including a correct diet, physical exercise and statin therapy represents a key component of every evidence-based rehabilitation program too. Cardiovascular prevention and rehabilitation are major priorities at an individual as well as at a public health level. Both these strategies are based on a careful management of known risk factors, among them hypercholesterolemia, that today can be effectively and safely treated with statins.