There seems to be little controversy regarding treating patients with coronary artery disease with statins,what we call secondary prevention. Primary prevention, treating patients, who have no clinical evidence of heart disease,with statins is another matter being more than a little controversial.
Now we have a new meta-analysis that concluded primary prevention is a good idea. See here for a discussion of that study which reported a reduction in cardio-vascular mortality and all cause mortality in so called low risk patients. On the other hand (clinicians may yearn for the mythical one handed epidemiologist) a large meta-analysis by Dr. K. Ray and colleagues found no benefit in terms of all cause mortality.see here.
A few years ago I felt reasonably confident that I could a)determine a person's cardiac risk with a risk equation and b) advise that person about taking statins to lower his risk. I am much less sure about both those two things now but I still obstinately take pravastatin. In regard to risk equations I said all I can say about that in this several years old post entitled "Individual risk assessment,a peculiar,elusive,ambiguous concept." I would add another modifier, "faith based".
So how good can the risk equations ( yes there are more than one for predicting risk of coronary heart disease events and death ) be when studies perched on the highest rung on the ladder of evidence based medicines give contradictory results?