Statins Reduce Risk of Major Cardiovascular Events

A new study shows that statin therapy lowers the risk of major vascular events irrespective of age, although the benefit is less certain for patients older than 75 without existing occlusive disease.

Researchers at the University of Oxford (United Kingdom), the University of Sydney (Australia), and other institutions participating in the Cholesterol Treatment Trialists' (CTT) collaboration conducted a meta-analysis that summarized evidence of 28 randomized controlled trials, including a total of 186,854 patients, 14,483 of whom were aged over 75. The researchers then estimated the effects of statin therapy on major vascular events, cause-specific mortality, and cancer incidence in five different age subgroups.

The results revealed that statin therapy significantly reduced major vascular events by approximately 21% per 38.7 mg/dL reduction in LDL cholesterol. For coronary revascularization, there was a reduction of about 25%, for stroke a 16% reduction, and for major coronary events, a reduction of 24%. The effect was seen across all age groups, with a trend towards smaller proportional reductions with older age. In all age groups, cancer incidence, cancer death, and non-vascular mortality were unaffected by statin therapy. The study was published on February 2, 2019, in The Lancet.

“Statins are useful and affordable drugs that reduce heart attacks and strokes in older patients. Until now there has been an evidence gap and we wanted to look at their efficacy and safety in older people,” said lead author Jordan Fulcher, BSC, MBBS, of the University of Sydney. “Our analysis indicates that major cardiovascular events were reduced by about a fifth (per mmol/L lower LDL cholesterol) by statin therapy across all age groups. Despite previous concerns, we found no adverse effect on cancer or non-vascular mortality in any age group.”

Statins lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Several mechanisms may explain the harmful effect of statin discontinuation following stroke. First, statins stabilize plaques in arteries supplying brain and heart, reducing the risk of recurrent cerebral infarction and coronary artery disease (CAD) related events. Second, statin cessation has been associated with reduced flow‐mediated vasodilation, increased atrial fibrillation (AF), and elevated C‐reactive protein serum levels.

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