Image: A new study suggests statins can reduce cardiovascular disease mortality in spite of elevated LDL-C (Photo courtesy of Getty Images).
A new study demonstrates the benefits of using statins to lower low-density lipoprotein cholesterol (LDL-C) levels for primary prevention of coronary heart disease (CHD).
Researchers at Imperial College London (ICL; United Kingdom), the University of Glasgow (United Kingdom), and other institutions conducted a long-term study to examine the cardiovascular effects of lowering LDL-C in people with primary elevations of LDL-C higher than 190 mg/dL without pre-exiting CHD at baseline. The study population included 6,595 men (45-64 years of age) without evidence of vascular disease who participated in the West of Scotland coronary prevention study (WOSCOPS).
The study participants were stratified by LDL-C levels into those with baseline LDL-C lower than 190 mg/dL (2,969 participants) and those with LDL-C higher than 190 mg/dL (2,560 participants). They were then randomized to pravastatin 40 mg/d or placebo. The effects of medication or placebo on CHD and major adverse cardiovascular events (MACE) were then assessed over a 4.9-year randomized-controlled trial phase, while the effect on mortality outcomes were monitored over a total of 20-years of follow-up.
The results revealed that among individuals without vascular disease, pravastatin reduced the risk of CHD by 27% and MACE by 25% consistently among all study participants, irrespective of baseline LDL-C. Among those with elevated LDL-C, pravastatin reduced the risk of CHD by 27% and MACE by 25% during initial trial phase, while risk of CHD death, cardiovascular death, and all-cause mortality were reduced by 28%, 25%, and 18%, respectively, over 20-years of follow-up. The study was published on September 6, 2017, in Circulation.
“This is the strongest evidence yet that statins reduce the risk of heart disease and death in men who appear largely healthy except for very high LDL levels. This legitimizes current guidelines which recommend treating this population with statins,” said senior author Professor Kausik Ray, MD, of ICL. “They also suggest that we should consider prescribing statins more readily for those with elevated cholesterol levels above 155 mg/dl, and who also appear otherwise healthy.”
LDL-C is one of the five major groups of lipoproteins, which enable transport of lipids such as cholesterol and triglycerides within the bloodstream. LDL particles also transport cholesterol into the artery wall, where it is retained by arterial proteoglycans, attracting macrophages and encouraging the formation of atherosclerotic plaques. Over time the vulnerable plaques rupture, activate blood clotting factors and producing arterial stenosis, which if severe enough results in heart attack, stroke, peripheral vascular disease symptoms, and major debilitating events.
Imperial College London
University of Glasgow