Statin Drugs Reduce Heart Attacks and Strokes Even in Low-Risk Patients





 

 

A pivotal new study concludes that statin drugs sharply reduce the risk of heart attack and stroke even in patients who are at low risk for cardiovascular disease.




 

 

STATIN DRUGS REDUCE HEART ATTACKS AND STROKES EVEN IN LOW-RISK PATIENTS

The cholesterol-lowering drugs known as “statins” are among the most commonly prescribed medications in the world, and they have been credited with sharply reducing the risk of death due to cardiovascular disease, including coronary artery disease, peripheral vascular disease, and stroke.  The statin drugs work primarily by lowering blood levels of LDL cholesterol (the “bad” cholesterol), thus reducing the risk of developing the arterial plaques that cause cardiovascular disease.

There is a huge body of research data showing that statin drugs reduce death rates due to cardiovascular disease in patients with elevated levels of LDL cholesterol, including patients with only mildly-to-moderately elevated LDL cholesterol levels. However, there have also been several intriguing public health studies that have suggested a potential benefit associated with statin drugs even in patients with normal LDL cholesterol levels.  Despite these research findings, however, there has been a general reluctance to prescribe statin drugs to patients with normal LDL levels, or to patients with mildly elevated LDL levels, particularly as statin drugs, like all medications, are associated with known side effects, including potential injury to the muscles, liver and kidneys, as well as a possible increase in the risk of diabetes.  Now a massive new research study, which appears in an early-release edition of the journal Lancet, may lead to a wholesale change in the way that physicians prescribe statin drugs.

This newly published study, a meta-analysis study, combined and analyzed the data from 27 different statin research studies, which included nearly 175,000 adult research participants, making this an enormously powerful research study.  In this study LDL cholesterol levels were measured, and the impact of statin drugs on the incidence of heart attacks (myocardial infarction) and stroke, and death due to cardiovascular disease, was observed.  Study participants were grouped into five different categories, based upon their estimated 5-year “cardiovascular event” risk, ranging from less than 5 percent to greater than 30 percent 5-year risk.  This risk assessment was, in turn, calculated using LDL cholesterol levels, age, gender, blood pressure, and lifestyle factors such as tobacco use and physical activity levels.

Not surprisingly, the use of statins decreased the risk of cardiovascular events, on average, by about 21 percent for every 1 mmol/liter reduction in LDL cholesterol among the entire volunteer group of nearly 175,000 study participants.  What is particularly important about this study’s findings, however, is that the study participants in the two lowest risk groups experienced at least as much (if not more) benefit, in terms of reducing the risk of heart attack and stroke, as did the participants in the higher risk groups.  For example, patients with a calculated 5-year risk of heart attack or stroke of less than 5 percent experienced a 38 percent reduction in the risk (for every1 mmol/liter reduction in LDL cholesterol) of either of these cardiovascular events, while patients with a calculated 5-year risk of 30 percent or higher experienced a 21 percent reduction (for every1 mmol/liter reduction in LDL cholesterol) in the risk of a major cardiovascular event.

When looking at heart attack or death due to heart attack, specifically, the study participants with a 5-year predicted risk of heart attack or stroke of less than 5 percent experienced an enormous reduction in the risk of heart attack or death due to heart attack (43 percent for every1 mmol/liter reduction in LDL cholesterol) while taking statin drugs.  This same low-risk group, when taking statins, also had a 48 percent reduction (for every1 mmol/liter reduction in LDL cholesterol) in the likelihood that they would have to undergo surgical procedures to stent or bypass blocked coronary arteries.

The risk of stroke was also significantly reduced in both low-risk and high-risk study participants.  For example, patients with a calculated 5-year risk of major cardiovascular events of less than 10 percent were 24 percent less likely to have a stroke (for every1 mmol/liter reduction in LDL cholesterol) if they were taking a statin drug, which was similar to the reduction in stroke risk that was observed in the higher risk patients.

The public health implications of this very large study’s findings are highly significant.  For the first time, this study provides extremely compelling data that even patients who are at low risk of suffering a heart attack or stroke may derive as much, or perhaps even more, benefit from taking a statin drug when compared to patients who are high or very high risk of experiencing these major cardiovascular events.  When measured against the known risks of the adverse side effects of statin drugs, this study still showed an overwhelming health benefit associated with statin drugs in both patients at low-risk for cardiovascular disease and in high-risk patients.  It will now fall to public health experts, internists, cardiologists and family practice physicians to incorporate the findings of this exceptionally compelling, and powerful, meta-analysis study into their management of adult patients, and particularly those over the age of 50, even if these patients are predicted to be at low risk for heart attack and stroke.  I see this research study as a health care game changer, and I predict that it will, eventually, dramatically alter the current prescribing patterns for statin drugs.  (As always, I recommend that you consult your physician before starting any new medication or dietary supplement, including statin drugs.)


 

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Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 





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