Do statins work years after use?

Media reports claim that statins have a long-lasting effect. Sanjay Tanday investigates.

What is the story?
People who take statins are protected against heart disease and premature death years after they stop taking them, media reports have claimed.

Latest research into statins, which are taken by three million people in Britain, has found that those who took statins were still showing benefits of the drugs 10 years after they had finished taking them.

The chances of suffering a fatal heart attack over the period dropped by more than 25 per cent, while there was no evidence of unexpected side-effects.

But the study researchers stressed that people who are already taking statins should continue to take them.

In July, DoH heart czar Professor Roger Boyle said all men over 50 and women over 60 should be prescribed statins to protect against heart disease.

The study findings may increase the pressure on GPs to prescribe statins to an even greater number of middle-aged people with raised cholesterol levels, say the papers.

The study raises the question of whether statins should be given to an even wider group, including younger people in whom heart disease has yet to develop.

What is the research?
The reports are based on a long-term follow-up of the West Scotland coronary prevention study. This was a randomised clinical trial that compared the use of 40mg pravastatin daily with placebo in 6,595 men, aged 45-64, with hypercholesterolaemia who did not have a history of MI.

The original West Scotland study was launched between 1989 and 1991. The participants were followed up for five years until May 1995.

The study then followed up the same men for another 10 years, comparing heart attack and death rates in the original statin group against the original placebo group using hospital admissions and cancer registrations.

However, since the original trial the researchers found that both groups had changed medication patterns.

The statin group tended to give up talking the medication, and many of those in the placebo group started to take statins.

After the initial five-year trial, 38 per cent of the original statin group were found to be still on the drugs along with 35 per cent of the placebo group.

But no account was taken of these changes and a comparison was made of the 15-year experience of the original statin group against the placebo group.

The gap between the statin and placebo groups narrowed after the trial ended, and their use of statins tended to converge. But up to the 15-year follow-up point, the statin group did better than the placebo group.

Five years of treatment with pravastatin resulted in 27 per cent fewer non-fatal MIs or deaths due to heart disease over the period of 15 years, compared with placebo.

What do the researchers say?
Lead researcher Professor Ian Ford, from the University of Glasgow, said: 'We believe the ongoing benefit of statins is due to a stabilising of existing disease in coronary arteries and slowing of further progression of disease.

'This benefit appears to have persisted for 10 years and may have conferred a lifelong advantage on those treated with the statin,' he added.

The results of the follow-up study provide strong support for the safety profile of five years of statin use, said Professor Ford.

'When fatal and non-fatal heart disease events were studied, it was found that, despite the fact that most of the participants were not treated with a statin after the first five years of the trial, there was evidence of the group originally receiving the statin continuing to be at lower risk of having a heart disease event,' he said.

Professor Stuart Cobbe also from the University of Glasgow, who was the lead cardiologist for the study, said: 'We were very surprised to find that patients who had been treated for five years with a statin continued to have significantly fewer heart attacks compared with these treated with a placebo treatment.'

These results are reassuring for patients who might be concerned about safety when taking statins for a very long period of time, he added.

But the researchers emphasised that the findings did not suggest that patients should stop taking statins after five years.

What other researchers say
Dr Tony Wierzbicki, chairman of the medical and scientific research committee at cholesterol charity Heart UK, said patients should remain on statin therapy if they have been advised to take it.

'However, if statin therapy is changed then cholesterol levels should be checked afterwards and the dose of statin should be adjusted appropriately.'

Informing patients

  • Statins may protect against heart disease 10 years after patients finish taking them.
  • Patients treated with statins for five years had 27 per cent fewer heart attacks or deaths due to heart disease over the study period compared with non-statin users.
  • Researchers advise that patients on statins should continue with their treatment regime. 

sanjay.tanday@haymarket.com

N Eng J Med 2007; 357: 1,477-85


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