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‘Remarkable’ long-term benefits of statins on non-cardiovascular deaths reported

Long-term prescribing of statins has a beneficial ‘legacy' effects on all-cause mortality, including protection from death from infections and lung diseases, according to the results of a UK study.

An analysis of 11 years of follow-up data from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) found all-cause mortality remained significantly lower in patients taking atorvastatin, mostly due to a reduction in deaths due to infection and respiratory illness.

The ASCOT trial randomised patients to either atorvastatin 10 mg daily for the primary prevention of coronary heart disease in hypertensive patients who had a total cholesterol level of ?6.5 mmol/L.

The trial was stopped prematurely after a median 3.3-year follow-up due to an average 1.1 mmol/L reduction in total and LDL cholesterol and a 36% relative risk reduction in non-fatal myocardial infarction and fatal CHD in patients on atorvastatin, together with non-significant reductions in cardiovascular death and all-cause mortality.

The UK researchers analysed post-mortality data supplied by the Office for National Statistics and the General Register Office for Scotland for all deaths until 31 December 2010, during which 377 deaths occurred among 2,234 in-trial survivors in the atorvastatin group and 430 in the 2,198 in the placebo group.

A median of 11 years after randomisation, all-cause mortality remained a significant 14% lower in those originally assigned atorvastatin and non-cardiovascular deaths were 15% lower.

There were fewer cardiovascular deaths in the atorvastatin group, but the 11% reduction was not statistically significant.

There was a significant 36% reduction in deaths from infection or respiratory illness over the entire 11-year follow-up period. There was a 40% reduction in infection-related deaths, but this was of borderline significance.

The researchers estimated the number needed to treat to prevent one death from treatment with atorvastatin for 3.3 years was 286, but after 11 years the number needed to treat fell to 35.

Presenting the results at the European Society of Cardiology conference in Paris this week, study leader professor Professor Peter Sever, professor of clinical pharmacology and therapeutics at Imperial College London and a former president of the British Hypertension Society, concluded: ‘The present report, however, suggests an important new finding that the legacy effect may be largely contributed to by benefits on non-CV deaths, and particularly those due to infection and respiratory illness, thereby raising the question as to possible underlying mechanisms.'

Professor Sever said: ‘This result is very unexpected. The benefits of statins for preventing heart attacks and strokes are well-established, but after long-term follow-up the most significant effects seem to be on deaths from other causes.'

‘It's quite remarkable that there is still this difference between the two groups, eight years after the trial finished. Some studies have suggested that statins protect people against death from infectious diseases such as pneumonia. More research is needed to explain how these drugs might have unforeseen actions that prevent deaths from other illnesses.'

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