Long-Term Statin Use Best Way to Cut Cardiovascular Deaths
TUESDAY Jan. 12, 2010 -- A 50 percent increase in patients adhering to long-term treatment with cholesterol-lowering statins could prevent twice as many deaths from heart attack and stroke, British researchers say.
It's estimated that only about half of patients prescribed statins to prevent cardiovascular disease are still taking them five years later, according to background information in the analysis.
The researchers reviewed published studies on the sustained use of statins by patients to calculate an assumed average of their capacity to continue treatment over 10 years. The team then used cholesterol and blood pressure data from more than 38,000 patients in Australia to calculate the likelihood of developing cardiovascular disease and the advantages of preventive strategies.
The study authors then calculated patient risk scores according to three scenarios: using the current U.K. National Institute for Health and Clinical Excellence (NICE) guidelines, which recommend that anyone with a 20 percent or greater risk of heart attack or stroke over the next 10 years be prescribed a statin; increased adherence to statin treatment; and lowering the threshold for starting on statins to increase the number of patients taking the drugs.
On the basis of risk factors among the Australian patients, the researchers calculated that 5,390 new cases of cardiovascular disease and 710 related deaths would occur over 10 years. They also determined that 24 percent of patients would be eligible for statin treatment under NICE guidelines. If half (4,563) of those patients fully complied with statin treatment, an estimated 174 cases of cardiovascular disease and 70 deaths would be prevented.
Expanding treatment criteria to allow for 6,991 patients to take statins over the long term would prevent an additional 70 cases of cardiovascular disease and 18 deaths. Improving long-term statin compliance among 6,971 patients would prevent an additional 91 cases of cardiovascular disease and stave off 37 related deaths -- about twice as many as expanding treatment criteria to increase the number of patients eligible to take the drugs.
It's no surprise that focusing on patients most at risk should yield more impressive results, said Dr. Amir Shroufi, who is currently at the Cambridge Institute of Public Health in the United Kingdom, and colleagues.
"However, the magnitude of the difference is notable. And it serves to emphasize the need to find more effective means of increasing adherence -- especially over the long term," the study authors wrote.
The study was released online Jan. 12 in advance of publication in an upcoming print issue of the Journal of Epidemiology and Community Health.
The U.S. Food and Drug Administration has more about statins.
Posted: January 2010