Results of the world's largest trial into the effects of cholesterol lowering therapy show that routine use of cholesterol lowering drugs in patients at high risk of vascular disease reduces the incidence of heart attacks and strokes by a third, even in people whose cholesterol concentration is normal.
Professor Rory Collins, lead investigator of the Heart Protection Study (HPS) and codirector of Oxford University's Clinical Trial Service Unit, declared statins to be the new aspirin, when he presented the findings at the American Heart Association's Scientific Sessions 2001 this week.
“This is a stunning result, with massive public health implications. We've found that cholesterol-lowering treatment can protect a far wider range of people than was previously thought, and can prevent strokes as well as heart attacks,” he said.
The researchers estimate that if an extra 10 million high risk people around the world had statin treatment it would save about 50000 lives each year or 1000 lives a week. Plus many more patients could avoid the need for arterial surgery, angioplasty, and amputations.
“These results are at least as important as previous findings for aspirin's effects on heart attack and strokes. Those findings changed medical practice, and we expect these to have the same effect. In fact, statins are the new aspirin,” said Professor Collins.
The Heart Protection Study, which involved more than 20000 people aged between 40 and 80 years at high risk of coronary heart disease, also looked at the effect of a cocktail of antioxidant vitamins (600 mg vitamin E, 250 mg vitamin C, and 20 mg b carotene). But this failed to show any protective effect.
Professor Collins said: “We knew from other studies that statins lowered ‘bad’ LDL cholesterol, and reduced heart disease risk in some circumstances. But HPS now provides the first direct evidence that cholesterol-lowering therapy cuts the risk of heart attacks and strokes by at least one third not just in people who already have coronary disease but also in those who have diabetes, narrowing of arteries in their legs or a previous history of stroke.
“It shows that, for high- risk patients, cholesterol-lowering therapy produces substantial benefits even among those considered to have ‘low’ cholesterol levels. It also provides the first clear evidence of benefit in women and the over 70s.”
The drug used in the trial was simvastatin (40 mg daily), but all statins should have the same effect, he added.
Summary of results
Five years of statin treatment typically prevents heart attacks, strokes, or other major vascular events in:
l 1 in 10 people who have had a heart attack
8 in 100 people with angina or some other signs of coronary heart disease
7 in 100 people who have ever had a stroke
7 in 100 people with diabetes.
Figure.
Professor Rory Collins