Heart pills taken by millions of Britons are more effective than previously thought at slashing artery-clogging cholesterol and reducing the risk of heart attacks.
Even those who already have low levels of cholesterol can benefit from taking statins, according to latest research.
The cholesterol-busting pills could give such people a 15 per cent further reduction in heart attacks and strokes and risk of having to undergo gruelling heart surgery.
Statins have been credited with saving tens of thousands of lives in recent years.
Now a major study has found that they really are a wonder drug and that taking them in higher doses not only leads to even lower levels of “bad” cholesterol but also to still greater reductions in the number of heart attacks and strokes.
Experts now say that people with low levels of cholesterol can also benefit from them.
When the figures were broken down, the higher dose of statins led to a 13 per cent fall in heart-disease deaths or non-fatal heart attacks, 19 per cent less chance of having an operation to open a blocked artery and a 16 per cent reduction in strokes caused by a brain blood clot.
Statins have been hailed as a “wonder drug”
More than six million people in Britain take statins to reduce their levels of the “bad” LDL cholesterol and slash their chance of suffering a heart attack, usually in a 40mg dose. But the latest research has found that, for people at high risk of heart disease, more intensive statin treatment protected an extra four people in every 100 from having a heart attack, stroke or related hospital procedure over five years.
Commenting on the study, two academics, Professor Bernard Cheung and Professor Karen Lam, from the University of Hong Kong, said that people with a “substantial” heart or stroke risk should have intensive statin treatment.
Even those with apparently low LDL cholesterol could benefit, they said.
They added: “At the population level, statins are underused, so 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.”
However, the study authors warned that simply raising the dose of the most commonly-used statin in the UK, simvastatin, the version available direct from pharmacies, might be counterproductive.
A rare side-effect of low-dose simvastatin is muscle weakness, known as myopathy. In some cases this can lead to more serious muscle damage.
At a low dose, three in 10,000 (0.03%) patients developed myopathy, but when a higher dose of simvastatin was prescribed, this jumped to nine in a 1,000 (0.9%).
Dr Louise Bowman, one of the researchers, said: “It may be safer to lower cholesterol using low doses of the more potent statins rather than increasing the dose of simvastatin.”
This advice was echoed by the British Heart Foundation, which part-funded the study.
Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said that simply “ramping up the dose” of simvastatin might not be the best option.
He said: “We know that cholesterol is a major risk factor for heart disease – cutting it cuts your risk of a heart attack. However it’s been unclear whether going the extra mile to lower cholesterol even further, pays off.”
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Stepping up the intensity of statin therapy can reduce the rate of major vascular events such as heart attack and ischaemic stroke by an extra 15%, a meta-analysis by researchers from the UK and Australia has found.
The results of the study by members of the Cholesterol Treatment Trialists’ Collaboration from the Clinical Trial Service Unit and Epidemiological Studies Unit at the University of Oxford and the National Health and Medical Research Council Clinical Trial Centre at the University of Sydney were published in The Lancet.
They suggest “that the primary goal for patients at high risk of occlusive vascular events should be to achieve the largest LDL cholesterol reduction possible without materially increasing myopathy risk”, the authors commented.
The meta-analysis took in data from five trials involving 39,612 patients who were on more or less intensive statin regimens and from 21 trials involving 129,526 patients who were taking statins or were in control groups (placebo or usual care).
In the trials of more versus less intensive statin therapy, the weighted mean extra reduction in LDL cholesterol at one year on the more intensive regimens was 0.51 mmol/L.
That translated, the researchers reported, into a “highly significant” 15% further reduction in major vascular events, comprising 13% fewer coronary deaths or non-fatal myocardial infarctions, 19% fewer coronary revascularisations and 16% fewer ischaemic strokes.
For each 1.0 mmol/L cut in LDL cholesterol, the further reductions in risk were similar to the proportional reductions observed in the statin versus control trials.
When all 26 trials were combined, similar proportional reductions in major vascular events per 1.0 mmol/L decrease in LDL cholesterol were found in all types of patients studied, including those with LDL cholesterol under 2 mmol/L who were on less intensive statin or control regimens.
All-cause mortality in the combined trials was reduced by 10% per 1.0 mmol/L reduction in LDL cholesterol, largely reflecting significantly fewer deaths due to coronary heart disease and other cardiac causes but no significant effect on deaths due to stroke or other vascular causes, the authors noted.
Safe further reductions
Further reductions in LDL cholesterol using statin therapy can safely produce “definite further reductions” in the incidence of heart attack, revascularisation and ischaemic stroke, with each 1.0 mmol/L decrease lowering the annual rate of these major vascular events by just over a fifth, they concluded.
There was no evidence of any threshold within the cholesterol range studied, suggesting that cutting LDL cholesterol by 2-3 mmol/L would reduce risk by 40-50%, the researchers added.
Current therapeutic guidelines on cholesterol levels tend to emphasise the need to reach a particular LDL target, the authors pointed out. By contrast, “our results suggest that lowering of LDL cholesterol further in high-risk patients who achieve such targets would produce additional benefits, without an increased risk of cancer or non-vascular mortality”.
Some guidelines have proposed using high doses of generic statins (e.g., 80mg simvastatin daily) for this purpose, but these regimens may be associated with a higher risk of myopathy, the researchers cautioned.
Instead, they suggested relying on newer, more potent statins (e.g., 80mg atorvastatin or 20mg rosuvastatin daily) and, potentially, combining standard doses of generic statins (e.g., 40mg simvastatin or pravastatin daily) with other LDL cholesterol-lowering therapies.
Research has revealed that long-term use of statins is unlikely to substantially increase or decrease overall cancer risk.
Eric J. Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society, and colleagues examined the association between use of cholesterol-lowering drugs, predominantly statins, and the incidence of the 10 most common cancers, as well as overall cancer incidence.
Participants completed several questionnaires that included information about a range of lifestyle and medical factors, including use of cholesterol-lowering drugs, and were followed over a period of about 10 years, according to Jacobs.
During this time frame, more than 15,000 participants were diagnosed with cancer.
Using cholesterol-lowering drugs for five years or longer was not associated with overall cancer incidence, or incidence of bladder, breast, colorectal, lung, pancreatic, prostate, or renal cell cancer, but was associated with lower risk of melanoma, endometrial cancer and non-Hodgkin lymphoma.
The study was presented at the Ninth Annual AACR Frontiers in Cancer Prevention Research Conference, held Nov. 7-10, 2010, in Philadelphia.