Does the Benefit from Statin Therapy Extend Beyond 5 Years?
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Large randomized trials have shown that lowering the concentration of LDL cholesterol with statins reduces vascular morbidity and mortality rapidly, with further benefit emerging during each year of treatment allocation. But, limited evidence is available about the long-term efficacy and safety of statin treatment. Long-term follow-up of surviving trial participants allows direct assessment of the benefits (and any hazards) of a sustained reduction in LDL cholesterol concentration during the post-trial period. Post-trial follow-up of several large statin trials (of which the Heart Protection Study was the largest) confirms that the substantial absolute benefits and cost-effectiveness of statin therapy were, in fact, underestimated in previous analyses restricted to the “in-trial” periods of randomized studies. Reassuringly, no adverse effects on cancer incidence or non-vascular mortality emerged during the extended follow-up of the Heart Protection Study. These findings support the prompt initiation and long-term continuation of statin therapy in individuals at increased vascular risk.
KeywordsStatins LDL-lowering therapy Long-term follow-up Safety Benefits Cancer incidence
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- 4.• Cholesterol Treatment Trialists Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81. This large individual patient data meta-analysis provides clear evidence that lowering LDL cholesterol concentrations by 1.0 mmol/L reduces the annual risk of a major vascular event by around one fifth. Therefore, a reduction in LDL cholesterol concentrations of around 2–3 mmol/L (easily achievable with modern lipid-lowering drugs) could reduce vascular risk by 40–50 %.CrossRefGoogle Scholar
- 5.•• Heart Protection Study Collaborative Group. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20,536 high-risk individuals: a randomised controlled trial. Lancet. 2011;378:2013–20. Long-term follow-up of HPS provides uniquely reliable evidence about the efficacy and safety of a substantial and sustained reduction in LDL cholesterol concentration. Significant reductions in the risk of major vascular events of around one quarter were seen after the first year, and these benefits persisted for several years after the treatment had stopped, confirming that more prolonged statin therapy will result in greater absolute benefits. Moreover, with 11 years’ combined follow-up, allocation to treatment with simvastatin was safe, with no adverse effects on cancer incidence or non-vascular mortality emerging.Google Scholar
- 14.• Cholesterol Treatment Trialists’ (CTT) Collaboration. Lack of effect of lowering LDL cholesterol on cancer risk: meta-analysis of individual data from 175,000 participants in 27 randomised trials of statin therapy. PLoS One. (1):e29849. In 27 randomized trials (including over 175,000 participants), a median of 5 years of statin therapy had no effect on the incidence of, or mortality from, any type of cancer. Google Scholar