Statins Reduce Heart Disease Death Significantly in Men

Pravastatin reduced 20-year mortality rates by 18% for patients with very high LDL cholesterol.

Statins are known to significantly lower cholesterol levels and the associated risk of heart disease among different populations. Prior studies have not confirmed the benefits of statin use for patients with high levels of low density lipoprotein (LDL) cholesterol and no diagnosed heart disease.

Over a 20-year period, the authors of a new study published by Circulation found that 40-mg of pravastatin per day reduced heart disease-related mortality by more than one-quarter.

"For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy except for very high LDL levels,” said senior author Klausik Ray, MD. “This legitimises [sic] current guidelines which recommend treating this population with statins."

These findings challenge the monitoring approach currently used to treat younger adults with high LDL, according to the study. The authors caution that patients with slightly high cholesterol levels are at risk of heart disease, which may be prevented with LDL reduction.

"Our findings provide the first trial-based evidence to support the guidelines for treating patients with LDL above 190mg/dL and no signs of heart disease,” Dr Ray said. “They also suggest that we should consider prescribing statins more readily for those with elevated cholesterol levels above 155 mg/dl and who also appear otherwise healthy."

The authors followed patients who were included in the 5-year West of Scotland Coronary Prevention Study (WOSCOPS) trial. Patients were followed up with for an additional 15 years.

Findings from the WOSCOPS study suggest that treating men with pravastatin for 5 years significantly reduces heart disease-related mortality or heart attack compared with placebo. These results led to the implementation of statins as a preventive treatment for patients with high cholesterol, the authors reported.

Included in the study were 5529 men with high cholesterol and 6595 men with no evidence of heart disease at baseline. All patients were aged 45 to 64 years.

The 5529 men were split into cohorts: high LDL levels (between 155-mg dL and 190-mg/dL) and very high LDL levels (above 190-mg/dL).

The authors found that pravastatin treatment for patients with very high LDL reduced 20-year mortality rates by 18%.

Statin therapy was also found to reduce the risk of coronary heart disease-related mortality by 28% and reduced the risk of other cardiovascular-related mortality by 25%, according to the study.

The authors also compared the patients’ original risk assessment with the observed risk. Approximately 67% of patients included in the trial with very high cholesterol had a 10-year heart disease risk of less than 7.5%, meaning that they would not be treated with statins; however, the authors found that the actual risk at 10 years was 15%, according to the study.

Due to statin therapy, patients with very high LDL levels had a reduced 10-year risk compared with the placebo group, highlighting the benefits of the drugs.

"This is the strongest evidence yet that statins reduce the risk of heart disease and death in men with high LDL,” Dr Ray said. “Our study lends support to LDL's status as a major driver of heart disease risk, and suggests that even modest LDL reductions might offer significant mortality benefits in the long-term. Our analysis firmly establishes that controlling LDL over time translates to fewer deaths in this population.”