Cholesterol-lowering drugs help average-risk people too: study
The findings came from three trials, which included more than 12,000 people in 21 countries, and were released at the American College of Cardiology conference in Chicago.
Until now, statins have mainly been recommended for people at high-risk of heart disease, which kills 18 million people around the world each year and causes some 50 million heart attacks and strokes.
“The implications for practice are huge,” said senior researcher Salim Yusuf, professor of medicine at McMaster University.
“I think we certainly should consider using statins much more widely than we have used them thus far.”
The trials, called Heart Outcomes Prevention Evaluation-3 (HOPE-3), were the first of their kind to examine the impact of using statins, sometimes in combination with blood-pressure lowering drugs and other times with a placebo, in a large, globally diverse population.
Those enrolled in the trial were considered at “intermediate risk for developing cardiovascular disease” because they had at least one risk factor, such as smoking, a large waist to hip ratio, or a family history of heart disease.
However, none had been diagnosed with heart disease at the start of the trial.
For the study, people were randomly assigned to either a cholesterol-lowering drug (rosuvastatin, which is also known as Crestor) or a placebo pill daily.
Some were also given a blood pressure lowering drug — a combination pill with candesartan (Atacand) and hydrocholothiazide (Microzide) — or a placebo.
They were followed for a median of 5.6 years as researchers noted how many people died or suffered heart attack or stroke.
Statin therapy was able to “significantly and safely reduce cardiovascular events by 25 percent,” said the findings published in the New England Journal of Medicine.
Drugs to lower blood pressure did not reduce major cardiovascular events like heart attack or stroke in the overall population, including those who did not have elevated blood pressure.
“There was no benefit in those with lower blood pressure and even a tendency towards harm in those in the lowest third of the blood pressure distribution,” said Eva Lonn, professor of cardiology at McMaster University.
“These data suggest blood pressure lowering medications are appropriate for people with hypertension but that people with lower blood pressure who have no other reasons to use blood pressure reducing drugs should avoid taking these drugs.”
Anti-hypertensives did help people with high blood pressure, and those who took statins in addition to anti-hypertensive drugs reduced cardiovascular events by 40 percent.
“The take-home message is that statins are safe and effective, and that because benefits were similar irrespective of pretreatment cholesterol levels or levels of inflammatory markers, no baseline blood tests are required to identify the patients who will derive benefits from this treatment,” said Jackie Bosch, associate professor of rehabilitation science at McMaster University.
“Our results were remarkably consistent across all subgroups.”
The research was funded by the Canadian Institutes of Health Research and AstraZeneca, the manufacturer of the drugs tested.
The study was independently designed and conducted by the Population Health Research Institute at McMaster University and Hamilton Health Sciences in Canada.
Researchers said the subjects in the study will be followed for another three to five years for additional analysis of the effects of the treatments on cognitive decline, erectile dysfunction and vision.