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Call for more intensive statin treatment in high-risk patients

By Nigel Praities

GPs should consider using statins to reduce LDL-cholesterol to well below the guideline-recommended level of 2.0 mmol/L in high-risk patients, conclude the authors of a new analysis.

In the most comprehensive analysis to date looking at the benefits of intensive statin treatment, the authors conclude that bringing LDL-cholesterol levels below 2.0 mmol/L was beneficial, with little evidence of any adverse effects.

The meta-analysis – published in the Lancet today – looked at 26 clinical studies involving 1,000 patients, the majority of whom had prior coronary artery disease or diabetes. Two trials looked at primary prevention.

Across all 26 trials, all-cause mortality was reduced by 10% per 1.0 mmol/L LDL reduction, largely reflecting significant reductions in deaths from CHD (20% reduction) and other cardiac causes (11% risk reduction).

This benefit continued with intensive statin therapy below guideline-recommended limits for LDL-cholesterol of 2.0 mmol/L, with these kind of regimens showing a 15% additive benefit compared with less intensive regimens.

The study did not show any significant increase in cancer with more intensive statin treatment, but there was evidence of an excess in the number of cases of myopathy when simvastatin 80mg was used.

The authors – from the Cholesterol Treatment Trialists’ Collaboration – concluded that their study made a case for the routine use of combinations of statins or more potent statins to further lower LDL-cholesterol levels in high-risk patients.

‘These findings suggest that the primary goal for patients at high-risk of occlusive vascular events should be to achieve the largest LDL-cholesterol reduction possible without materially increasing myopathy risk,’ the study concluded.

Call for more intensive statin treatment in high-risk patients