Continuation of statin treatment associated with lower risk of death

Feb 9 2009

Patients with high cholesterol levels who continually take statins appear to have a lower risk of death over four to five years, regardless of whether they already have diagnosed heart disease, according to a report in the February 9 issue of Archives of Internal Medicine.

Statin drugs have been shown to have a beneficial effect on levels of low-density lipoprotein (LDL, or "bad") cholesterol, according to background information in the article. The benefits of these medications have been demonstrated in clinical trials for secondary prevention (controlling risk factors and preventing death in patients who already have heart disease). However, some have questioned the effectiveness of statins for preventing deaths in patients taking them for primary prevention (delaying or preventing the development of heart disease).

Varda Shalev, M.D., and colleagues at Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv, Israel, analyzed data from 229,918 adults (average age 57.6) enrolled in a health maintenance organization who began taking statins between 1998 and 2006. This included 136,052 individuals without heart disease (primary prevention group), who were followed for an average of four years, and 93,866 already diagnosed with heart disease (secondary prevention group), with an average five years of follow-up. Researchers checked pharmacy records to calculate the proportion of days that each individual took statins.

During the study, 4,259 patients in the primary prevention group and 8,906 in the secondary prevention group died. In both groups, continuity of taking statins—defined as taking statins for at least 90 percent of the follow-up period—conferred at least a 45 percent reduction in the risk of death compared with patients who took statins less than 10 percent of the time. The risk reduction was stronger among patients with high levels of LDL cholesterol at the beginning of the study and among patients whose initial treatment was with high-efficacy statins.

"In conclusion, this study showed that the continuation of statin treatment provided an ongoing reduction in all-cause mortality [death] for up to 9.5 years among patients with and without a history of coronary heart disease," they continue. "The observed benefits from statins were greater than expected from randomized clinical trials, emphasizing the importance of promoting statin therapy and increasing its continuation over time for both primary and secondary prevention."