Statins Cut Heart Attack Risk

A meta-analysis of previously published studies has found statin therapy can reduce the risk of major heart and cerebrovascular events in individuals who don’t have cardiovascular disease. The medications however don’t reduce the risk of coronary heart disease or overall death.

Statins have been proven to help patients with heart and cerebrovascular diseases by cutting down the risk of death and other negative outcomes. However it is not clear how statins help those without cardiovascular disease. Statin therapy is currently prescribed for patients on the basis of their cardiovascular risk profile. This includes LDL-C or “bad cholesterol” levels as well.

Patient who do not have cardiovascular disease and have normal LDL-C levels are generally not recommended statins. However if the patient has diabetes or two or more cardiac risk factors that raise their 10-year risk of a heart attack of other heart events by at least 10%, statin therapy is normally considered.

The results of seven previously published clinical trials were analyzed by a team of researchers led by Dr. Paaladinesh Thavendiranathan from the University of Toronto, Ontario. The trials had assessed the benefits of statins in a total of 42,848 patients, 90% of whom had no known cardiovascular disease. Patients were randomly assigned to receive either statins or another form of treatment in each of the studies. All patients were followed for a period of at least one year.

Each study group had at least 100 major cardiovascular events recorded with 80% or more of the participants having no cardiovascular disease. Total of 21,409 patients were administered statins while the remaining 21,439 patients received a placebo. The average follow-up period for the studies ranged between 3.2 and 5.2 years. The participants’ age ranged from 55.1 to 75.4 years.

The proportion of men as part of the study population ranged from 42% to 100%. The analysis found there were 924 major coronary events such as heart attacks in the group on statin therapy as compared to 1,219 in the control group. This meant a 29.2% reduction in risk. 440 patients taking statins suffered from major cerebrovascular events like strokes while this figure was 517 for patients on placebo – a 14.4% lower risk.

A 31.7% reduction in non-fatal heart attack risk and a 33.8% drop in the number of revascularization procedures (procedures like angioplasty and bypass surgery meant to restore blood flow) was also recorded. The differences in rates of patients dying from cardiovascular disease or from all causes between the statin and control groups was not statistically significant.

Commenting on their assumption that patients not being treated with statins have at least a 5.7% risk of suffering a major heart event over a 4.3 year period and that statin therapy can reduce this risk to 4%, the researchers said, “60 patients would need to be treated for an average of 4.3 years to prevent one major coronary event. Similarly, 268 patients would need to be treated to prevent one stroke or other major cerebrovascular event; 61 to prevent one non-fatal heart attack; and 93 to prevent one revascularization procedure.”

Statin treatment is expensive and in the opinion of the researchers other therapies may also work to reduce risk in a similar manner. “Therefore, even though universal lipid-lowering therapy appears attractive, especially in an intermediate-risk primary prevention population, further studies are needed to clarify the cost-effectiveness of therapy in this group.”

Results of the analysis are reported in the November 27 issue of Archives of Internal Medicine.

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