http://bmj.com/cgi/content/full/325/7354/5/a
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Cardiovascular Medicine |
Treating patients at high risk of cardiovascular events with the HMG-CoA (hydroxymethyl glutaryl coenzyme A) reductase inhibitor simvastatin reduced the risk of myocardial infarction, stroke, and revascularisation by about one third, even in patients with normal or low blood cholesterol levels, according to the latest findings from the heart protection study published this week.
The study randomised 20536 adults with coronary disease, other occlusive artery disease, or diabetes to treatment with simvastatin (40 mg daily) or placebo for five years.
Results showed that deaths from all causes were reduced from 14.7% in patients allocated to placebo to 12.9% (P=0.0003) in those treated with simvastatin, mainly owing to an 18% relative reduction in the coronary death rate with statin treatment (6.9% v 5.7%; P=0.0005). The risk of a first non-fatal myocardial infarction, coronary death, non-fatal or fatal stroke, coronary or non-coronary revascularisation was reduced by 24% (25.2% v 19.8%; P<0.0001).
Allowing for non-compliance, the researchers estimated that risk was reduced by about a third in patients who took simvastatin as prescribed. The benefits were similar in patients with lipid levels that have previously been regarded as normal and not requiring statin treatment, with starting low density lipoprotein cholesterol below 3.0 mmol/l or total cholesterol below 5.0 mmol/l. (Lancet 2002;360:7-22).
Jane Armitage, senior research fellow and honorary consultant in public health medicine at the University of Oxford and clinical coordinator of the heart protection study, said: "The study shows unequivocally that statins can produce substantial benefit in a very much wider range of high risk people than had been thought."
She added: "What really matters is vascular risk. We should be treating risk, not cholesterol. If a patient is at high enough vascular risk that it is worth reducing by about one third, then it is worth considering statin treatment regardless of their cholesterol."
Results from the study estimated that five years of simvastatin treatment
would prevent about 70-100 people per 1000 from experiencing at least
one major vascular event
and
longer treatment would produce further benefit. Long term statin
treatment was well tolerated in the study, with no significant
adverse effects on cancer incidence, admission to hospital for other
non-vascular causes, or effect on liver enzymes.
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