Lower death rates seen up to a decade later, study found
WEDNESDAY, Oct. 10 (HealthDay News) -- The beneficial effects of cholesterol-lowering statin therapy lingered for a decade, with significantly lower death rates from cardiovascular disease and all other causes in men who not had been taking the drug for years, a Scottish study found.
"It seems to be that the drugs have the power of patching up damage in the arteries and preventing progression of the disease," said Ian Ford, professor of biostatistics at the University of Glasgow and lead author of the report. "That leads to long-term benefits."
The trial originally included almost 6,600 men with high levels of LDL (bad) cholesterol. Half were assigned to take the statin pravastatin (Pravachol), while half took a placebo, an inactive substance. In the planned five-year duration of the trial, the cardiovascular death rate was 24 percent lower in the men taking the statin.
Some men in both groups took the statin after the trial ended -- 38.7 percent of those in the statin group and 35.2 percent of those in the placebo group. An analysis 10 years after the trial ended found that the cardiovascular death rate was 8.6 percent for those who started in the statin group, and 10.3 percent for those who started in the placebo group. Over the entire 15-year period, the cardiovascular death rate was 11.8 percent in the statin group and 15.5 percent in the placebo group.
"About 50 percent of the benefits were seen in men no longer taking the drug," Ford said. "We believe that five years of treatment essentially restored damage done by diet, smoking and high blood pressure, stopping the buildup of cholesterol in the arterial wall."
Those benefits were seen in men who originally had LDL cholesterol levels as high as 190, Ford said. Other studies have found benefits from statin treatment in people who weren't at such high risk of cardiovascular problems, he said.
The new findings are published in the Oct. 11 issue of the New England Journal of Medicine.
Dr. Michael J. Domanski, chief of the atherothrombosis and coronary disease branch of the U.S. National Heart, Lung, and Blood Institute, said it was unclear whether a statin or another cholesterol-lowering drug given before there's evidence of cardiovascular disease could lower the risk considerably. But that possibility exists, he said.
"There is the notion that if you start at a really, really low LDL rate, you might have a major impact on the incidence of the disease," said Domanski, who wrote an editorial that accompanied the study in the journal.
The last sentence of his editorial raises the possibility that sufficient lowering of LDL levels "will reduce the incidence of coronary disease to the point that it becomes a relatively uncommon diagnosis."
Coronary disease is the leading cause of death in the United States and other industrialized countries.
A first step in learning whether that reduction is a real possibility is to learn about the effect of having very low LDL levels in people with no cardiovascular problems, Domanski said.
"We need to understand that geometry," he said. "We have to understand whether or not we can dramatically reduce the incidence of this disease by treating asymptomatic patients early in life."
The National Heart, Lung, and Blood Institute has no plans for such a major study now, Domanski added. But, he said, "the full potential of LDL lowering needs to be explored because of the potential benefits of dramatically lowered incidence of coronary disease."
To learn more about statins and how they work, visit the U.S. National Heart, Lung, and Blood Institute.
SOURCES: Ian Ford, Ph.D., professor of biostatistics, University of Glasgow, Scotland; Michael J. Domanski, M.D., chief, atherothrombosis and coronary disease branch, U.S. National Heart, Lung, and Blood Institute, Bethesda, Md.; Oct. 11, 2007, New England Journal of Medicine
All rights reserved