Statins Beneficial for Otherwise Healthy Patients With High LDL Levels
Whether otherwise healthy or not, patients with "very high" LDL, defined as being above 190mg/dL, benefit from statins, a new study finds. How much did the cholesterol-lowering drugs reduce their risk of death from heart disease over a 20-year study period?
LONDON, UK -- As the debate about use of statins in different patient populations continues, questions have been raised about the benefit of using statins in patients with no established heart disease but with high levels of low density cholesterol (LDL).
A new study published in the journal Circulation, soughtto answer some of those concerns, ultimately determining that, over a 20-year study period, 40mg daily of pravastatin reduced deaths from heart disease by more than a quarter in participants meeting those criteria.
"For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy except for very high LDL levels," explained senior author Kausik Ray, BSc, MBChB, MRCP, MD, MPhil, of Imperial College's School of Public Health. "This legitimizes current guidelines which recommend treating this population with statins."
The results were based on continued analysis of a five-year 1995 study in which researchers observed the long-term effects of statins on patients involved in the West of Scotland Coronary Prevention Study (WOSCOPS). Because of trials such as the WOSCOPS study, which provided the first conclusive evidence that treating high LDL in men with pravastatin for five years significantly reduces the risk of heart attack or death from heart disease compared with placebo, statins were established as the standard treatment for primary prevention in patients with elevated cholesterol levels, background information in the article notes.
The recent study continued with a 15-year follow up of 5,529 men in the WOSCOPs trial, including 2,560 with LDL cholesterol above 190 mg/dL. Participants, who ranged in age from 45 to 64 years old, were selected because they had no evidence of heart disease at the beginning of the present study.
Study subjects were divided between those with "elevated" LDL, defined as being between 155 and 190mg/dL, and those with "very high" LDL, defined as being above 190mg/dL. Results indicate that men at the higher levels of LDL reduced their 20-year mortality by 20% when taking pravastatin and also drove down their risk of death by coronary heart disease by 28% and other cardiovascular disease by 25%.
The researchers emphasize that their findings are the first direct randomized trial evidence to confirm that current guidelines should remain for those with very high LDL. They also suggest that risk assessment is unnecessary to justify statin use because the LDL elevation is risk enough.
"This is the strongest evidence yet that statins reduce the risk of heart disease and death in men with high LDL," Ray added. "Our study lends support to LDL's status as a major driver of heart disease risk, and suggests that even modest LDL reductions might offer significant mortality benefits in the long-term. Our analysis firmly establishes that controlling LDL over time translates to fewer deaths in this population."
The study authors also posit that, based on their results, healthy, younger patients with high LDL, even as low as 155 mg/dl, should be put on statins instead of a "watch and wait" approach.