Statins Help Healthy Hearts

Cholesterol reducing statins cut vascular risk in low risk patients

(RxWiki News) Cholesterol-lowering statins are known to reduce cardiovascular events such as stroke or heart attack. They also appear to offer a benefit for individuals at low risk of heart events.

Prior to the study, researchers were not sure whether statins could aid low-risk patients, even though the drugs were known to offer protection to high-risk heart patients, such as those with elevated cholesterol.

"Engage in regular exercise to keep your cholesterol healthy."

The Cholesterol Treatment Trialists’ Collaborators found that reducing "bad" LDL cholesterol with statin therapy for low-risk patients outweighs any risk, though many individuals would not be considered candidates for the medication under current guidelines. They note that the findings support reconsidering those guidelines.

During the meta-analysis researchers reviewed data from 22 trials that included 134,537 patients examining statins as opposed to no therapy, and five studies with 39,612 participants that examined the effects of varying doses of statins. Both included selected low-risk patients and followed patients for about five years.

Patients taking low-intensity statins or no therapy were divided into five groups defined by risk of a major vascular event such as a heart attack, stroke, coronary revascularization or coronary death.

Investigators found that reducing LDL cholesterol by 1mmol/L, or about 38 mg/dl, with statins reduced the risk of major vascular events by 21 percent across all five groups, including those at the lowest risk. The reduced risk was not affected by age, gender, LDL cholesterol level at the time therapy was started or previous heart disease.

Researchers determined that in low-risk patients, each 1 mmo/L reduction in LDL cholesterol prompted 11 fewer major heart events per 1,000 low-risk patients over five years. Vascular mortality was reduced by 12 percent across all groups.

Authors indicated that the reduction in LDL cholesterol by taking statins does not appear to increase the risk of cancer. The study did not examine side effects or the effects of taking statins longer than five years.

Sarah Samaan, MD, a cardiologist with Legacy Heart Center and co-director of the Women’s Cardiovascular Institute at the Baylor Heart Hospital, said physicians and low-risk patients should jointly make a decision about whether statins could be beneficial.

"In higher risk patients, including those with known heart disease, stroke, other vascular disease, or diabetes, statins are unequivocally the standard of care, and should be prescribed unless there is a very good reason to avoid them," said Dr. Samaan, also author of "Best Practices for a Healthy Heart: How to Stop Heart Disease Before or After It Starts."

"But we know that although statins very rarely cause fatal or permanent injury, somewhere between 5 and 10 percent of people will experience more subtle side effects such as muscle pain or weakness. Of course, this means that 90-95 percent of people will experience none of these problems at all."

She also noted that high-dose statins may increase the risk of diabetes, and said it is important to consider the cost of the medication and required regular blood tests to monitor cholesterol levels and liver function while taking statins.

"For someone at high risk, these negatives are outweighed by the positives, but the benefits are less clear in the low risk patient," Dr. Samaan said.

The research, funded by the British Heart Foundation, UK Medical Research Council, Cancer Research UK, European Community Biomed Programme, Australian National Health and Medical Research Council and Australia's National Heart Foundation, was recently published in The Lancet.

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Review Date: 
August 11, 2012