Can’t believe I’m going to get sucked into this, but here goes.
The evidence for statins in preventing both death after a heart attack (secondary prevention) and death in those without known cardiovascular disease (primary prevention) is overwhelming. Their mode of action isn’t fully known, but we know that it’s not all about absolute reduction in cholesterol levels (because non-statin drugs like ezetimibe reduce cholesterol but don’t save lives).
However, we’ve known that there is a link between high cholesterol and cardiovascular disease since the Framingham Heart Study in the 1940s. This was the first study to observe the link between smoking, high blood pressure, lack of exercise, obesity and high cholesterol with cardiovascular disease.
We’ve known that statins work since the mid-1990s with some very big trials eg:
1) 4S study – a Scandinavian study of >4000 people WITH cardiovascular disease showed that treatment of 100 patients for six years would prevent four deaths of the disease and seven non-fatal myocardial infarcts (Wiki link)
2) WOSCOPS – a study from Glasgow that looked at >6500 patients WITHOUT cardiovascular disease and showed that statins prevented death from cardiac causes (compelling evidence here)
From a personal, anecdotal, point of view, it’s a well held belief amongst my cardiology colleagues that statins have contributed significantly to the decline in major heart attacks that we’ve seen over the last 20 years. And that can only be a good thing (unless you’re training to be a cardiologist and you’re worried that statins might put you out of a job…)