Mansi and colleagues appropriately advocate for shared decision making when considering statins for secondary prevention of cardiovascular disease.1 But their article doesn’t provide the information that would allow patients and clinicians to balance the risks and benefits of using a statin.The benefit of avoiding a cardiovascular event—a relatively discrete outcome with appreciable symptoms, disability, and risk of death—is compared with the disbenefit of developing type 2 diabetes—passing a particular level of a continuous biochemical variable, with a low likelihood of directly related symptoms. What we need to compare is the risk of experiencing patient relevant outcomes—such as reduced exercise tolerance, need for dialysis, amputation, subsequent treatment burden, or death—with a statin or without, regardless of the ultimate cause.Without this information, shared decisions that take account of the small risk of statin induced diabetes are unlikely to be any better informed. Still less would patients and clinicians be able to interpret…
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