Statins have no effect on survival rates in high-risk patients who do not have established cardiovascular disease, a comprehensive meta-analysis has demonstrated. The huge meta-analysis published in Archives of Internal Medicine included eleven randomised, controlled trials involving 65,229 patients. 'This was the largest analysis of statin therapy in a purely primary prevention setting and probably includes the totality of evidence available for primary prevention. However, it is important to consider that mortality rates are low in primary prevention trials and it is therefore difficult to show a mortality benefit. It must also be remembered that the analysis looked at the short term, <4 years, benefit of statin therapy and it is possible that longer-term trials may reveal important benefits. Statin use in these populations can significantly reduce the incidence of non-fatal cardiovascular events. Therefore, from a practical perspective I would not necessarily look to statins to help people without established cardiovascular disease live longer but they might reduce the incidence of other, not necessarily fatal, outcomes such as MI and stroke and this may be just as important to our patients.'