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[Correspondence] Lessons from the controversy over statins

Jane Armitage and colleagues, led by senior author Rory Collins, (Nov 5, p 2237)1 and Richard Horton (Nov 5, p 2237)2 appear to believe that retraction of an article from The BMJ will end the debate about statins and primary prevention. Even were there grounds for retraction, I fear they would be disappointed. Questions about the evidence base for statins continue to emerge from many quarters: how strong is the evidence, how large is the benefit for individuals at lowest risk of heart disease, how well did the trials record common minor side-effects, how representative were the trials of women and the elderly, what was the effect of active run-in periods and composite endpoints, how does taking a statin affect a person’s diet and exercise patterns, why is there a discrepancy between the real-life experience of muscle pain and what was reported in the trials, why have the data for harms not yet been given the same levels of scrutiny as the data for benefits, and is cholesterol a reliable surrogate endpoint to guide prevention of cardiovascular disease?3,4