Study Supports Wider Use of Statins
TUESDAY June 30, 2009 -- An analysis of studies supports a growing belief that guidelines for prescribing cholesterol-lowering statin drugs should be expanded to include healthy people without established heart disease, cardiologists say.
The meta-analysis of 10 trials involving more than 70,000 participants found that statin therapy reduced overall mortality by 12 percent, major coronary events by 30 percent and strokes by 19 percent.
It supports the findings of the JUPITER trial, reported last year, which noted 54 percent fewer heart attacks and 48 percent fewer strokes among people taking a statin who had normal cholesterol levels but high levels of C-reactive protein, a marker of inflammation, said Dr. Antonio M. Gotto, Jr., dean of Weill Cornell Medical College, a member of the international team reporting on the meta-analysis in the BMJ online.
The analysis shows that "the more risk factors you have, the more aggressive you should be, and the lower the cholesterol level you should consider using statins for," Gotto said.
Primarily as a result of the JUPITER trial, the U.S. National Institutes of Health has announced that it will review the guidelines for prescribing statins, Gotto said. Those guidelines now focus on reducing elevated levels of LDL cholesterol, the "bad" kind that clogs arteries.
The increased benefit of statins is believed to be due to their anti-inflammatory activity, Gotto said.
The meta-analysis was undertaken before the JUPITER results were reported, Gotto said, because "there was a push against statin use in primary prevention in women and the elderly." Primary prevention is aimed at people who have cardiovascular risk factors, such as high blood pressure and diabetes, but have not been diagnosed with heart disease.
"We thought it was an important health problem that was not being addressed," Gotto said.
Previous trials were too small to provide definitive evidence that statin therapy would help women and older people who had risk factors for heart disease, he said. In the studies that were amassed for the meta-analysis, 34 percent of participants were women and 23 percent had diabetes.
Age should be a major consideration when considering statin therapy, but gender should also be taken into account, said Dr. Jacob W. Deckers of the department of cardiology at Erasmus Medical Center in the Netherlands, a member of the international team. The study indicates that statin therapy should be started 10 years earlier in men than in women with the same risk factors, he said.
"Statins should be prescribed in older men with a single risk factor and in older women with several risk factors," he said.
Only minimal side effects of statin therapy were found in the meta-analysis, Deckers said. No increased risk of cancer was seen, and the incidence of myalgia, the muscle pain that can accompany statin use, was one case in 10,000 persons, he said.
Many people who now take aspirin to reduce cardiovascular risk would be better off with statin therapy, Deckers said. Aspirin's anti-clotting effects reduce the risk of artery blockage but increase the risk of excess bleeding, he noted.
"It would be better to switch to a statin because of a better benefit-risk ratio," Deckers added. "With aspirin, the benefit is relatively low and the risk is relatively high."
Learn more about statins from the U.S. National Library of Medicine.
Posted: June 2009