Statins benefit ‘at risk’ patients but are underused: Study

By Dr. Ananya Mandal, MDNov 10 2010

A look at some of the large clinical trials and studies has shown that thousands of deaths could be prevented a year if people at risk of heart attack or stroke are prescribed high doses of statins. The review involves data from 170,000 patients in 26 randomized trials. The paper is published in the journal The Lancet.

The research was carried out at the University Oxford and the University of Sydney. It was funded by the UK Medical Research Council, British Heart Foundation, European Community Biomed Programme, Australian National Health and Medical Research Council and National Heart Foundation.

Results of the analysis showed that in the five trials of intensive therapy versus standard therapy, more intensive statins produced an overall further reduction of 15% in first major vascular events like stroke and heart attacks, a 13% further reduction in coronary death or non-fatal heart attack, a 19% further reduction in revascularization (procedures to improve blood supply to the heart), a 16% further reduction in ischemic stroke and an average further risk reduction in cholesterol of 0.51mmol/L after one year. Across all 26 trials, deaths from all causes were reduced by 10% for every 1.0 mmol/L reduction in LDL.

The British Heart Foundation hailed the study as an important step in the battle against heart disease. Spokesman Professor Jeremy Pearson said, “Cutting cholesterol cuts your risk of a heart attack. However it’s been unclear whether going the extra mile to lower cholesterol even further pays off…This research, funded partly by the British Heart Foundation, proves that a bigger drop in cholesterol from more intensive treatment with statins cuts the chance of having a heart attack even more.”

Prof Colin Baigent, of Oxford University’s Clinical Trials Service Unit, also said, “Even among people who have reached very low bad cholesterol levels further reductions of LDL provide further benefit in terms of reduced incidence of major vascular events.”

However experts warned that benefits are seen only in high risk individuals and side effects of statins like muscle damage etc. should be kept in mind.

In a commentary, Bernard Cheung and Karen Lam of the University of Hong Kong, who were not involved in the research, also said “at the population level, statins are underused.” “The urgent priority is to identify people who would benefit most from statin therapy and to lower their LDL cholesterol aggressively, with the more potent statins if necessary," they wrote in the same issue of The Lancet, where the research was published.