Thousands of heart attacks and deaths could be prevented if patients took higher doses of statins and took them regularly, a new study finds. Especially for those who have trouble sticking to a schedule and taking their pills as prescribed, higher dosages might be beneficial, researchers said.
“In terms of risk reduction, we can see the people who do the best are those who are adhering to the recommended dosage and are on more potent drug regimens. But if someone is not going to take a treatment as recommended, they may actually be better off on higher doses of statins so that when they are taking the medication, they are achieving greater cholesterol reductions,” said Professor Kausik Ray, from the School of Public Health at Imperial College London, lead author of the study.
Ray’s research found that 12,000 cardiovascular events — such as a heart attack or stroke — among high-risk patients in the UK could be averted by placing patients on high intensity cholesterol-lowering drugs and ensuring patients stick to the correct treatment regimen.
The paper, published today in the journal JAMA Network Open, is the first to look at the combined effect of high intensity statin treatment and adherence in patients who have already had a cardiovascular event and who are at increased risk of future cardiovascular events compared to the general public.
It reveals that that those taking the highest doses of statins to reduce their LDL — or “bad” –cholesterol and, crucially, who take the medication as advised by their doctor, see the biggest reductions in risk for future cardiovascular events.
“The basic message here is that long-term adherence achieves better long-term cholesterol reductions, and in turn, achieves better long-term outcomes for patients,” Ray said.
“There is a lot of confusion around dietary cholesterol and medications that lower cholesterol,” Ray added. “While changing your diet is a good thing, it may not be enough for those patients who are already in the high-risk groups — such as those with heart disease. Here, statins provide additional benefits over and above lifestyle.
“What we know is that once you have one heart attack or other cardiovascular event, you are at much higher risk of more events in future and that lowering your LDL cholesterol levels is key to improving outcomes. For these patients, taking the right medication, at the right dose, at the right time — and sticking to this regimen — is critical in lowering their risk of future cardiovascular events.”
About the study
The team analysed patient data drawn from Clinical Practice Research Datalink (CPRD) which includes over five million records from more than 450 GP practices. They focused on three groups of patients at high risk of cardiovascular events: those with established heart disease; those with diabetes but no history of heart disease; and those with chronic kidney disease but no prior heart attack and stroke.
Almost 30,000 patients recently started on cholesterol lowering medications were scored using a measure which combined the intensity of treatment they received (statins alone or combined with another cholesterol-lowering drug called ezetimibe) and their adherence – with those who took their medication as prescribed 80% of the time over period classed as ‘adherent’.
When researchers measured the relative risk reduction compared to untreated patients an average of three years after treatment, they found those patients with the highest score (who were on the highest intensity treatment and had the highest adherence) had the greatest reduction in LDL cholesterol levels and cardiovascular risk, with a 40% reduction in their risk of cardiovascular events.
By comparison, those patients on the lowest intensity treatment and with poor adherence had a risk reduction of just 5% compared to those not on medication.
According to the team, in patients with established heart disease approximately 72 cardiovascular events were observed per 1000 patients per year. But with optimal treatment – high dose medication and high adherence – this would be expected to be reduced to 48 per 1000 patients per year, a reduction of 12,000 cases based on the estimated 500,000 heart disease patients in the UK.