Even people at low risk of heart problems would benefit from statins, cheap drugs that lower levels of ‘bad’ cholesterol in the blood.
That’s the main finding of a giant collaborative study coordinated by Oxford’s Clinical Trial Service Unit and the Health Economics Research Centre, and published in The Lancet today.
About half of deaths from cardiovascular disease occur in people with no previous history of the disease, so preventing such deaths can only be done by targeting seemingly healthy people. The new research shows that treating healthy people who are for some reason at increased risk of disease would be effective, and safe, and it could see moves made toward offering these drugs to many millions of middle-aged people around the world, saving hundreds of thousands of lives.
‘The study settles once and for all previous uncertainties about whether people at low-risk of heart disease – healthy, middle-aged people – would see benefits from taking statins,’ says Professor Colin Baigent, who led the study. There would be fewer ‘events’ such as heart attacks and strokes, and this would greatly outweigh risks of any side-effects of the drugs.
The study used data for 175,000 individual participants taking part in 27 different randomised trials of statins that on average ran for around 5 years. Well over 50,000 of those people included in the analysis were at low risk of heart disease, with this group experiencing around 2000 heart attacks, strokes or similar.
With the potential of statins to save many lives, low risks of known side-effects, and the cheap cost of the pills (now that generic versions have become available over recent years), the question now switches to what should the guidelines be: how low should your risk of heart problems be before your doctor starts prescribing these pills?
Colin puts it like this: ‘To what extent should society spend resources on healthy people where there are small individual benefits but it offers the possibility of saving more lives across populations?
‘Should everyone get a statin? No. But where do you draw the line? GPs currently offer statins to people with a previous history of cardiovascular disease, and also to healthy people whose risk of such an event exceeds about 20% over 10 years. Our work suggests that we could save many more lives if we lowered that threshold, and we think that it would be sensible for NICE to review their recommendations in the UK to see whether they agree.’
Measures for preventing cardiovascular disease include encouraging healthy exercise, improving diet and stopping smoking, and all have their part to play in preventing these problems. But Colin emphasises that additional benefits are possible through wider use of statin therapy.
‘Now we have these enormously beneficial tablets that our research shows could play an even greater role in an effective public health strategy,’ says Colin.
Statins are not just for people with high cholesterol, but may be appropriate for anyone who is at increased risk. ‘The emphasis has been on treating according to people’s cholesterol levels,’ says Colin. ‘We need to get away from that focus on cholesterol levels in people’s blood and instead think about their level of risk of cardiovascular problems. Our research shows that if a person has an increased risk of heart attacks, perhaps because they are overweight or a smoker, and yet have normal cholesterol levels, then that person would benefit if their cholesterol was reduced to lower levels. It’s a different way of thinking about it, because we have been encouraged to know our ‘cholesterol level’, whereas what we really need to know is our ‘risk level’, and we should base our decisions about whether to commence statin treatment on that information and not solely on cholesterol levels.’
So what did the study published today in The Lancet do?
Colin explains: ‘We were interested in low-risk people and whether these very healthy people would still experience a benefit from taking statins. There had been controversy over whether there was a benefit of statins for those at low risk of heart attacks. Some studies suggested it didn’t exist, some did.
‘We used information recorded in the trials to set participants [all 175,000] in order of risk. We used measures like cholesterol level, blood pressure, whether or not someone was a smoker to calculate their risk of a heart attack or stroke. We worked out who had the lowest, who the highest and ordered them in line for every trial.’