Even people who do not have high cholesterol and established heart disease could benefit from cholesterol-lowering statin drugs if they have other risk factors, a new study suggests.
In an analysis published on bmj.com, researchers reviewed 10 studies that followed more than 70,000 patients. They conclude that statins, such as Lipitor and Zocor, should be given to anyone who is at risk of heart disease, including those with high blood pressure and diabetes.
They say the data found a 12 per cent reduction in deaths among patients who took statins but who did not have established cardiovascular disease yet had other risk factors. The statin group also had 30 per cent fewer heart attacks and 20 per cent fewer strokes over four years of follow-up.
The benefits of statin therapy in patients with heart disease have been clearly demonstrated in patients who have had a heart attack or stroke, and in those with elevated LDL "bad" cholesterol and other risk factors for heart disease. But it has not been clear whether treating lower risk people without established disease would also be worthwhile.
So an international team of researchers looked into whether statins reduced deaths and cardiovascular events such as heart attacks and strokes in people without established heart disease.
They analyzed 10 studies that compared statins against placebos or control groups and tracked patients for an average of four years. Differences in study design and quality were taken into account.
Compared to controls, statins cut deaths from all causes by and cut the risk of major events in patients without established heart disease.
The safety of long-term statin therapy in women, the elderly, and patients with diabetes or other medical conditions has long been questioned, because these groups have been underrepresented in clinical trials.
This analysis found no significant treatment differences between men and women, elderly and young patients, and those with and without diabetes. There was also no evidence of an increased risk of cancer with statin therapy.
But the researchers concede that it is not entirely clear which patients without established heart disease would benefit most from statin therapy. They suggest though that men over 65 with risk factors, or older women with diabetes and risk factors, constitute the highest risk group.
Further work is needed to improve the identification of these people and to accurately assess their risk, the study authors say.
But, given the favourable of long-term statin treatment, the authors say it would be wrong to deny these benefits to people at increased risk for heart disease.
