Intensive statin therapy reduces CV risk
MedWire News: Patients at high risk for cardiovascular (CV) events may benefit from intensive lipid-lowering therapy, even if their baseline level of low-density lipoprotein (LDL) cholesterol is already less than 2 mmol/l (77.3 mg/dl), research suggests.
Writing in The Lancet, two research groups (Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine [SEARCH] and Cholesterol Treatment Trialists' [CTT]) suggest that intensive statin therapy is beneficial for high risk patients and has a good safety profile.
Researchers in the SEARCH trial randomly allocated 12,064 men and women (aged 18-80) with a history of myocardial infarction to receive simvastatin 80 mg (n=6031) or 20 mg (n=6033) daily.
The patients were all either using statins or had a clear indication for statin therapy, and had total cholesterol levels of more than 3.5 mmol/l ([135.3 mg/dl] if using statins) or 4.5 mmol/l ([174.0 mg/dl] if not using statins).
The occurrence of major vascular events, defined as coronary death, myocardial infarction, stroke, or arterial revascularization, was assessed for all patients during follow-up averaging 6.7 years.
On average, there was a 0.35 mmol/l (13.5 mg/dl) greater reduction in LDL cholesterol levels in patients using simvastatin 80 mg, compared with simvastatin 20 mg, and a nonsignificant 6% reduction in the risk for major vascular events.
Major vascular events occurred in 24.5% of patients allocated simvastatin 80 mg, compared with 25.7% of those allocated simvastatin 20 mg.
The research team says there is a direct association between a reduction in LDL cholesterol and reductions in major vascular events.
They add that "although not significant on its own," the 6% risk reduction associated with the 0·35 mmol/l (13.5 mg/dl) decrease in LDL cholesterol is in line with the 7% reduction that would be expected on the basis of previous trials.
Patients using simvastatin 80 mg had a 10 times higher risk for statin-related myopathy than patients using simvastatin 20 mg. However, the researchers note that other, higher potency statins or combination therapy can achieve similar LDL cholesterol reductions at a lower risk for myopathy.
In the CTT study, the researchers performed a meta-analysis of 26 randomized control trials, of data from 170,000 participants.
Results from the study show that for each 1 mmol/l (38.7 mg/dl) reduction in LDL cholesterol, the risk for vascular events (coronary death, myocardial infarction, revascularization, stroke) was reduced by 22%.
In addition, there was no evidence to suggest that reducing LDL cholesterol levels to as low as 2 mmol/l (77.3 mg/dl) resulted in increased incidence of non-vascular mortality or site-specific cancer.
The team says: "These findings 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."
In an accompanying editorial, Bernard Cheung and Karen Lam, from the University of Hong Kong, Pokfulam, said that patients at risk for cardiovascular events would benefit from intensive statin therapy, even if their baseline LDL cholesterol was less than 2 mmol/l (77.3 mg/dl).
"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."
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By Nikki Withers