Statin treatment shows ‘continued long-term benefit’
MedWire News: A long-term follow-up of the Heart Protection Study (HPS) suggests that the benefit of statin therapy increases as treatment continues, and persists for at least 5 years after treatment is stopped.
Moreover, no adverse effects on particular causes of nonvascular mortality or major morbidity were observed during the follow-up period.
"These findings provide further support for the prompt initiation and long-term continuation of statin treatment," say Rory Collins and co-authors from the University of Oxford in the UK.
The HPS included 20,536 patients (aged 40-80 years) at high risk for vascular events who were randomly allocated to receive 40 mg simvastatin daily or matching placebo. Mean follow-up during the in-trial period was 5.3 years and the mean total follow-up for participants who survived to the end of the post-trial period was 11.0 years.
The primary endpoint for the long-term follow-up was first post-randomization major vascular event (nonfatal myocardial infarction or coronary death, fatal or nonfatal stroke, coronary or noncoronary revascularization).
Writing in The Lancet, Collins et al report that patients receiving simvastatin during the in-trial period had an average reduction in low-density lipoprotein cholesterol of 1.0 mmol/L (38.61 mg/dL).
Over this period, first major vascular events occurred in 21.0% of participants allocated to simvastatin compared with 26.4% of those allocated placebo, corresponding to a significant 23% proportional reduction. Of note, no significant reduction in events was observed during the first year, but significant reductions, of about a quarter, were seen during each subsequent in-trial year.
Self-reported statin use and lipid concentrations were similar between the two groups during the post-trial period. A further 14% decrease in first major vascular events was noted in the first post-trial year among patients originally allocated simvastatin, writes the team. However, little difference was seen between treatment groups for the remainder of follow-up.
"As a result, the cumulative proportions of participants who had major vascular events diverged throughout the in-trial period, and this separation then persisted roughly unchanged throughout the post-trial period," say Collins and team.
In an accompanying comment, Christopher Cannon and Payal Kohli from Brigham and Women's Hospital in Boston, Massachusetts, USA, say: "We now have strong evidence from HPS and several other randomized controlled trials that prolonged treatment with statins is indeed efficacious, safe, and has long-lasting beneficial effects, even after discontinuation of therapy.
"For this reason, concerns should be put to rest and doctors should feel reassured about the long-term safety of this life-saving treatment for patients at increased cardiovascular risk," they conclude.
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By Nikki Withers