Statin therapy may benefit low-risk patients

Statin therapy is safe and effective for people at low risk of major vascular events and, therefore, current guidelines might need to be reconsidered, according to a study published online in The Lancet.

Authors of the study note the results are important because half of all vascular events occur among individuals at low risk, a population typically not judged suitable for statin treatment under current treatment guidelines.

In previous meta-analyses, Borislava Mihaylova, MSc, DPhil, and colleagues on the Cholesterol Treatment Trialists' (CTT) Collaborators writing team, found that reducing LDL cholesterol with a statin in participants with no previous history of vascular disease reduced the risk of major vascular events by about 20%. However, the analyses did not address the overall net benefit of statins in primary prevention.

In this more complete analysis, the researchers reviewed individual participant data from 27 trials within the CTT database. They found that each 1 mmol/L reduction in LDL cholesterol in individuals with a 5-year risk of major vascular events lower than 10% produced a significant reduction in the risk of major vascular events of about 11 per 1,000 over 5 years. The reduction was largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality-a benefit that greatly outweighs known risks of statin therapy, they noted.

“These findings confirm the efficacy of statins for primary prevention, resolving concerns about possible serious adverse effects, and potential sources of bias in randomized trials," Shah Ebrahim, MD, and Juan P. Casas, MD, PhD, from the London School of Hygiene and Tropical Medicine, wrote in a comment accompanying the study.

They suggest it may be appropriate to use age as an indicator of statin prescription since most people over age 50 years are likely to be at a greater than 10%, 10-year risk of cardiovascular disease.