Cholesterol drugs can prevent heart attacks and strokes regardless of presenting cholesterol levels
27 September 2005
A class of drugs known as the "statins", that is already widely used to treat high blood levels of cholesterol, would give benefit to more people if targeted at all patients with diseased arteries, regardless of their presenting cholesterol level. The findings are published online in The Lancet today.
The study was jointly coordinated by scientists from the Clinical Trial Service Unit (CTSU) at the University of Oxford and the National Health Medical Research Council (NHMRC) Clinical Trials Centre (CTC) at the University of Sydney, Australia. Funding was provided by the Medical Research Council (MRC) and The British Heart Foundation (BHF) in the UK, and the National Heart Foundation (NHF) in Australia.
Statins are known to be effective in preventing the number of heart attacks and strokes in a wide range of patients who are at high risk of such disease. But most doctors consider statin treatment only when the blood cholesterol level is above a certain threshold. As a consequence, patients with narrowed blood vessels are generally not treated with a statin if their blood cholesterol is below this threshold level.
This new study combined detailed results from more than 90,000 participants in 14 previously completed trials involving statin treatments. It shows that many people presenting with lower cholesterol levels could also benefit from statin treatment. Moreover, the biggest benefits occur in those patients with the largest absolute reductions in cholesterol after treatment, largely irrespective of the presenting cholesterol level.
The Medical Research Council scientist, Dr Colin Baigent who coordinated the study team in Oxford said: "This study shows that statin drugs could be beneficial in a much wider range of patients than is currently considered for treatment. What matters most is that doctors identify all patients at risk of a heart attack or stroke, largely ignoring their presenting blood cholesterol level, and then prescribe a statin at a daily dose that reduces their cholesterol substantially. Lowering the bad 'LDL' cholesterol by 1.5 mmol/L units with a statin should reduce the risk of a heart attack or stroke by at least one third."
This study suggests that many patients given a statin would experience greater benefits if doctors aimed to achieve larger reductions in cholesterol levels. Professor Anthony Keech, NHMRC Scientist who coordinated the study team in Sydney said: "Statins are often prescribed in relatively small doses which may only reduce cholesterol modestly. Our results indicate that the benefits of statins appear directly proportional to the size of the reduction in cholesterol produced by treatment. So, bigger cholesterol reductions with more intensive treatment regimens should lead to greater benefits."
These analyses also provide reassuring new information about the safety of statins. Some earlier studies had raised concerns that statin use might be associated with increased risk of certain cancers or of dying from certain diseases. British Heart Foundation Professor Rory Collins, Co-Director of CTSU and one of the study authors, said: "This work shows clearly that statins are very safe. There is no good evidence that statins cause cancer, and nor do they increase the risk of other diseases. And although statins can cause muscle pain or weakness, our study shows that serious cases are extremely rare. The small excess of serious muscle problems is far outweighed by the large benefits on heart attacks and strokes."
Professor John Simes, director of CTC and one of the study authors, added: "The benefits of statin treatment were seen in all the many different patient groups studied, including women, the elderly, individuals with diabetes and those with and without prior heart attack or stroke. The largest benefits were seen among those at greatest risk of a vascular event."
For further information, or to arrange an interview with Colin Baigent, contact the MRC Press Office on 020 7637 6011.
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