Statin guidelines ‘should be reconsidered’
MedWire News: Statin therapy reduces the risk for major vascular events by around 20% in a wide range of individuals, including those with no previous history of vascular disease, show results of a meta-analysis published in The Lancet.
"The present report shows that statins are indeed both effective and safe for people with 5-year risk of major vascular events lower than 10% and, therefore, suggests that [current] guidelines might need to be reconsidered," write the study's authors, the Cholesterol Treatment Trialists' (CTT) Collaborators who are based at the University of Oxford in the UK.
At present, guidelines in the USA, Europe, and the UK restrict statins to people whose 10-year risk for a major vascular event is at least 20%.
The study included data from 27 trials of statins versus control treatment (n=174,149 participants; median follow-up 5 years). The authors assessed rates of major coronary events (non-fatal myocardial infarction or coronary death), strokes, or coronary revascularizations among study participants.
The participants were grouped into five categories according to their baseline 5-year major vascular event risk on control therapy (no statin or low-intensity statin): less than 5.0% risk,5.0% to 9.9% risk,10.0% to 19.9% risk, 20.0% to 29.9% risk, and 30.0% or higher risk.
Overall, statins reduced the risk for major vascular events by 21% per 1.0 mmol/L reduction in low-density lipoprotein (LDL) cholesterol compared with control treatment.
Furthermore, the proportional reduction in major vascular events in the two lowest risk categories was at least as big as in the higher risk categories. Specifically, the risk reductions were 38%, 31%, 21%, 19%, and 21% in the lowest to highest 5-year event risk categories.
The higher risk reductions in the two lowest risk categories were mainly due to significant reductions in major coronary events (43% and 39% reductions per 1.0 mmol/L reduction in LDL cholesterol for those with <5.0% and ≥5.0% to 9.9% risks, respectively) and revascularization surgery (48% and 37% reductions, respectively)
The reduction in stroke risk was similar among the categories, at approximately 15% per 1.0 mmol/L reduction LDL cholesterol for those who received statins compared with those who did not.
There were also significant 15% and 9% overall reductions in risks for vascular and all-cause mortality per 1.0 mmol/L reduction in LDL cholesterol.
The authors say: "In individuals with 5-year risk of major vascular events lower than 10%, each 1mmol/L reduction in LDL cholesterol produces 11 fewer major vascular events per 1000 treated over 5 years, a benefit that greatly exceeds any known hazards of statin therapy."
They note that there was no evidence that statin therapy increased cancer incidence or deaths from cancer or other non-vascular causes, adding in a press statement that: "Statins may produce small increased risks of hemorrhagic strokes and in diagnoses of diabetes, but the definite benefits of statins greatly outweigh these potential hazards."
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By Laura Dean