It would be “wrong to deny” the benefits of long-term statin treatment to people without established cardiovascular disease but with cardiovascular risk factors, a new meta-analysis has concluded.
The study, led by Dr Jasper Brugts of the Erasmus MC Thoraxcenter in Rotterdam, the Netherlands, and involving a total of 70,388 participants from 10 clinical trials, found that statin therapy was associated with significant risk reductions of 12% in all-cause mortality, 30% in major coronary events and 19% in major cerebrovascular events compared with control groups. The results were published online in the BMJ.
There was no evidence of increased cancer risk associated with statins in the meta-analysis (as seen, for example, in the PROSPER or Prospective Study of Pravastatin in the Elderly at Risk study), nor was there any significant difference in treatment benefit across a range of clinical sub-groups (men and women, the elderly, people with diabetes).
The results showed that the relative risk reduction from long-term statin use in a primary care setting was comparable to that observed in secondary prevention, the authors noted. The findings also confirmed the outcome of the JUPITER study in terms of the beneficial effects of statins on survival across a broader range of patients at different levels of risk.
In the JUPITER study, AstraZeneca’s Crestor (rosuvastatin) was found to reduce the risk of cardiovascular death and heart attacks by 44% compared with patients on a placebo. The JUPITER study participants were men over 50 and women over 60 years of age who had elevated high-sensitivity levels of C-reactive protein but low-to-normal cholesterol levels.
Despite their strong message in favour of long-term statin therapy in the higher-risk population, Brugts et al did have some caveats. The absolute overall treatment benefit in the current study population “would certainly be less than 1%” and significant numbers of participants would need to be treated to prevent a single cardiac event, they pointed out. Moreover, from the existing pooled data it was not possible to define exactly one group of people who would benefit most from long-term statin use.
“From current risk-scoring systems, as well as from current data, it is obvious that older men (>65 years) with risk factors, or older women with diabetes and risk factors, constitute the highest risk group,” the authors wrote. “In view of the large treatment effects described here, it is likely that a considerable number of such people would benefit from long-term statin use at reasonable costs.”
However, identifying these people correctly “remains a challenge”, Brugts et al added, suggesting that auxiliary diagnostic or prognostic assessments to improve risk prediction could be useful in this respect.
