New research shows importance of cholesterol drugs
27 September 2005
A class of drugs known as the "statins", which are already widely used to treat high blood levels of cholesterol would be even more effective if they were targeted at all people with diseased arteries, regardless of the presenting cholesterol level, according to research published online in The Lancet.
The study was jointly coordinated by scientists from the National Health Medical Research Council (NHMRC) Clinical Trials Centre (CTC) at the University of Sydney, Australia and the Clinical Trial Service Unit (CTSU) at the University of Oxford. Funding was provided in Australia by the National Health and Medical Research Council (NHMRC) and the National Heart Foundation (NHF) and in the UK by the Medical Research Council (MRC) and The British Heart Foundation (BHF).
Statins are known to be effective in preventing 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 patients presenting with lower cholesterol levels could also benefit from statin treatment. Moreover, the biggest benefits occur in those with the largest absolute reductions in cholesterol after treatment, largely irrespective of the presenting cholesterol level.
NHMRC Scientist, Professor Anthony Keech who coordinated the study team in Sydney, 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. The Medical Research Council scientist, Dr Colin Baigent who coordinated the study team in Oxford, 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. Moreover, 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."