Statins Benefit Patients at Risk for Coronary Disease, Even When Cholesterol Levels Are Normal
In the partly industry-funded Heart Protection Study, 20,536 British patients (75% male; age range, 40 to 80) with total cholesterol levels of at least 135 mg/dL (3.5 mmol/L) were randomized to receive simvastatin (40 mg daily) or placebo for 5 years. Enrollment criteria were histories of coronary disease, other occlusive arterial diseases, diabetes, or (in men aged 65 or older) treated hypertension.
Five-year all-cause mortality was significantly lower in the simvastatin group than in the placebo group (12.9% vs. 14.7%) -- a difference attributable mainly to a significantly lower coronary death rate. The simvastatin group also experienced significant reductions in nonfatal myocardial infarction (3.5% vs. 5.6%) and nonfatal stroke (3.6% vs. 4.9%). Simvastatin appeared to be effective regardless of age, sex, or initial cholesterol level. Because 17% of placebo patients also received nonstudy statins, the reductions may underestimate the true benefits.
These findings expand the universe of patients for whom statin therapy should be considered. An editorialist notes that, in high-risk patients, aspirin, -blockers, angiotensin-converting-enzyme inhibitors, and lipid-lowering therapies each have been shown to lower risk for vascular events by about a quarter; together, these therapies might yield risk reductions approaching 75%. If smoking cessation and treatment for hypertension are added, then even larger risk reductions are possible. At the time of publication, the full text of the vitamin study and the editorial were available at https://www.thelancet.com/journal/vol360/iss9326/full/llan.360.9326.original_research.21714.1 and https://www.thelancet.com/journal/vol360/iss9326/full/llan.360.9326.editorial_and_review.21679.1 free of charge.
Sir Brian Jarman, PhD, FRCP, FRCGP, FFPHM, FMedSci
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