Intensive statins cut vascular risk further
Intensifying patients' statin therapy further reduces their risk of vascular events compared with standard statin therapy, shows research published in the Lancet.
In a meta-analysis of five trials, including 39,612 patients, treatment with more intensive compared with less intensive statin regimens resulted in an average 0.51-mmol/l greater reduction in low-density lipoprotein (LDL) cholesterol levels at 1 year and a highly significant 15% further reduction in the relative risk of major vascular events over 5 years.
Per 1.0-mmol/l LDL cholesterol reduction, the relative reduction in vascular events was consistent with that seen in a separate meta-analysis comparing standard statin therapy with control. Furthermore, "these further reductions in vascular risk can be achieved safely even in individuals with low LDL cholesterol", report the study authors, led by Professor Colin Baigent, from the Clinical Trial Service Unit (CTSU) at the University of Oxford.
A second study, the SEARCH randomized trial conducted in over 12,000 people, showed that participants who took a high, 80-mg daily dose of simvastatin had a 6% further reduction in vascular event risk over 7 years compared with those who took simvastatin 20 mg daily. Although not significant, the authors say this reduction is consistent with the meta-analysis findings and what would be expected from the average 0.35-mmol/l further reduction in LDL cholesterol achieved at the higher dose.
However, there were significantly more cases of myopathy in the high-dose group, including seven cases of rhabdomyolysis. SEARCH clinical co-ordinator Dr Louise Bowman, also from the CTSU, commented that "it may be safer to lower cholesterol using low doses of more potent statins rather than by increasing the dose of simvastatin", adding that the findings mean current NICE guidelines may need to be reviewed.
Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, agreed that the research "may change GPs' guidelines on how to prescribe statins", but said the increase in side effects with high-dose simvastatin in SEARCH raises concern.
"Doctors may wish to consider switching patients to alternative treatments… rather than ramping up the dose," he said.
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