Statins for healthy a step closer?
MedWire News: Oxford University researchers say prescribing statins more widely could prevent thousands of strokes and heart attacks.
In a meta-analysis of 22 trials of statins, the team compared the benefits of LDL cholesterol lowering across five levels of baseline cardiovascular risk.
A significant benefit was seen even among those whose initial 5-year risk of major vascular events was less than 10%, the authors say, with each 1 mmol/L reduction in LDL cholesterol resulting in 11 fewer vascular events per 1000 patients over 5 years.
Reporting their findings in The Lancet, Professor Colin Baigent and colleagues from the Cholesterol Treatment Trialists' Collaborators say that "this benefit greatly exceeds any known hazards of statin therapy".
Patients at such low baseline risk would not usually be regarded as suitable for a statin, as current NICE guidance recommends statins for people with a 20% or higher 10-year cardiovascular disease risk. Professor Baigent and colleagues now believe "these guidelines might need to be reconsidered".
In a related editorial, Professor Shah Ebrahim from the London School of Hygiene and Tropical Medicine and Dr Juan Pablo-Casas from University College London suggest that universal prescribing of statins to over-50s could be a pragmatic way to identify patients suitable for treatment, given that 83% of 50-year old men are at higher than 10% risk of cardiovascular disease in the next 10 years.
But they caution: "Whether populations will be well served by present pharmacologically dominated research findings for lifestyle-related diseases is debatable". They note that a policy to switch from palm to soya oil in Mauritius resulted in an average 0.8 mmol/L reduction in total cholesterol "at no cost and without the need to medicate the whole population with statins".
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By Caroline Price