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Statins: Now proven value in primary prevention of heart attack and stroke
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Statins vs. the competition
Primary prevention refers to no past history of CVD (cardiovascular disease: heart attack and stroke). It includes people who may have silent risk factors like high LDL cholesterol. Secondary prevention applies to someone who has had CVD.
The beneficial effects of statins on cardiovascular mortality in secondary prevention have been established in several long-term trials. But the value of statins on mortality in patients without known CVD has been debated. This study sought an answer.
Over 225,000 adults in Israel were followed for four to five years between 1998 and 2006 (mean age, 57.6 years; 50.8% female). Patients who took their statins more than 90% of the time had a 45 to 51% reduction in risk of death compared with patients who complied less than 10% of the time.
Those with high baseline LDL (bad) cholesterol levels, and patients initially treated with more potent statins (such as Lipitor and Crestor) had the best results.
Statin treatment reduced mortality among patients with and without a known history of CVD. Previous clinical trials had not shown a clear benefit in primary prevention. Statins are beneficial not only by reducing LDL cholesterol but by reducing inflammation, reducing clotting, and improving endothelial (inner arterial lining) function, all part of the atherosclerotic (plaque formation) process that leads to arterial blockage. These other benefits make a difference even in patients with LDL cholesterol levels currently accepted as normal.
This study supported a meta-analysis published in the same journal three years earlier, in which data from multiple studies were combined in reaching a similar but statistically less convincing conclusion.
Statins are generally well tolerated. Transient elevation of liver function tests may occur at the beginning of treatment. Another side effect, minor muscle aches, may very rarely progress to a serious muscle condition. so any muscle symptoms should promptly be reported to your physician and statins at least temporarily stopped, dose decreased, or another statin used. The prescribing physician should brief you on these issues. Overall, millions of people have used statins in the last 20 years with great benefit to their health, greatly outweighing any treatment associated problems.
Excellent and inexpensive generic statins such as simvastatin (Zocor) are available, and Lipitor (atorvastatin) should be going off patent in 2010.
From the Archives of Internal Medicine, February, 2009, and the NIH Nat. Libr. Med.
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