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Statins proven to cut deaths in low-risk patients

By Nigel Praities

Statins have been shown for the first time to lower all-cause mortality when used for primary prevention across patients with a wide variety of conditions that would not normally qualify for treatment.

The landmark meta-analysis adds to the findings of the JUPITER trial, which came out too recently to be included, but which found significant benefits for rosuvastatin in low-risk patients.

Researchers analysed data from 19 clinical trials including more than 65,000 patients, covering those with hypertension, persistent microalbuminuria, asymptomatic early carotid atherosclerosis and diabetes – many of whom had average or low cholesterol levels.

The study, published in the latest edition of the Journal of the American College of Cardiology, found satins reduced all-cause mortality by 7%. The amount, although not a huge amount, suggests statins for primary prevention can do more than simply change the disease on a patient's death certificate.

NICE, which is under pressure to revise its risk threshold for primary prevention, said it was holding a consultation on whether to review its statin guidance.

The analysis - the ‘most comprehensive meta-analysis to date' according to the UK and Canadian researchers – also found a 11% reduction in cardiovascular deaths and a 15% reduction in major cardiovascular events.

There was no significant increase in adverse events such as rhabdomyolysis.

Study leader Professor Edward Mills, assistant professor in clinical epidemiology and biostatistics at McMaster University in Ontario, Canada, insisted the findings should ‘put to rest the debate on statin effectiveness for primary prevention'.

Last month, the JUPITER study showed a 20% reduction in all-cause mortality and a 54% reduction in myocardial infarction with rosuvastatin in patients with normal cholesterol levels but raised C-reactive protein.

Dr George Kassianos, a GP in Bracknell, Berkshire and fellow of the European Society of Cardiology, said the study added to a growing sense NICE's 20% 10-year CVD risk threshold for primary prevention needed revision.

‘We cannot go anymore without advice from NICE - we need it now because this is affecting out patients,' he said.

Dr. Tom Marshall, senior lecturer in public health at the University of Birmingham and a member of the development group for the NICE lipid modification guideline, said it was cost-effective to treat patients below 20% but questioned whether changing the threshold would make any difference.

‘In theory we could offer treatment to patients at 15% 10-year CVD risk. But in practice the real question is how do we ensure we are offering treatment to everyone at 30%?'

Statins study will increase pressure on NICE to revise its risk threshold Statins study will increase pressure on NICE to revise its risk threshold

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