Benefits of statin therapy identified

The greater the reduction in LDL (lower-density lipoprotein) cholesterol achieved by statin therapy the greater the reduction in incidence of major coronary events, coronary revascularisation and stroke, concludes a meta-analysis published online today by The Lancet. Goals for statin treatment should aim to achieve substantial absolute reductions in LDL cholesterol, state the authors.

Results of previous randomised trials have shown that statins can significantly reduce the incidence of coronary heart disease in a wide range of individuals. But uncertainties about their effects on mortality and major illness have persisted and some trials had suggested that statins increase the risk of particular cancers. In the first meta-analysis of its kind, Colin Baigent and colleagues from the Clinical Trial Service Unit (CTSU) at Oxford University and Anthony Keech and colleagues from the NHMRC Clinical Trials Centre (CTC) in Sydney, combined data from 14 randomised trials of statins involving over 90 000 patients.

The investigators found that statin therapy could reduce the 5-year incidence of major coronary events and stroke by about one fifth per mmol/L reduction in LDL cholesterol, irrespective of a person’s pre-treatment cholesterol level or other characteristics. Dr. Baigent states: “The absolute benefits increased with continuing treatment and treatment produced a clear reduction in all-cause mortality. There was no evidence that lowering LDL cholesterol by 1 mmol/L with 5 years of statin therapy increased the risk of any specific cancer.”

Professor Keech states: “Full compliance with available statin regimens can reduce LDL cholesterol by at least 1·5 mmol/L in many circumstances, and hence might be expected to reduce the incidence of major vascular events by about one third. Ensuring that patients at high 5-year risk of any type of occlusive major vascular event achieve and maintain a substantial reduction in LDL cholesterol would result in major clinical and public-health benefits."