Intensive Statin Use Further Cuts Risk of Vascular Events

Larger reduction in LDL cholesterol tied to lower risk for vascular events

TUESDAY, Nov. 9 (HealthDay News) -- Intensive statin treatment to reduce low-density lipoprotein (LDL) cholesterol significantly reduces the incidence of major vascular events beyond that achieved by conventional statin therapy, according to research published online Nov. 9 in The Lancet.

In a meta-analysis, Colin Baigent, of the University of Oxford in the United Kingdom, and colleagues analyzed 26 randomized trials involving about 170,000 subjects. In the trials that compared intensive and conventional statin therapy, the further reduction in LDL cholesterol at one year with intensive treatment was 0.51 mmol/L, producing a 15 percent further reduction in major vascular events. In analysis across all 26 studies (also including trials comparing statin treatment with controls), there was a 22 percent reduction in major vascular events and a 10 percent reduction in all-cause mortality per 1.0 mmol/L LDL cholesterol reduction.

In one study whose data were included in the meta-analysis, Jane Armitage, also of the University of Oxford, and colleagues randomized 12,064 individuals with a history of myocardial infarction to 80 mg or 20 mg of simvastatin daily. They found that the higher dose resulted in an average 0.35 mmol/L greater reduction in LDL cholesterol than the lower dose and that major vascular events occurred in 24.5 percent of subjects taking the higher dose versus 25.7 percent of those on the lower dose (risk ratio 0.94; P = .10).

"The 6 percent (SE 3.5 percent) reduction in major vascular events with a further 0.35 mmol/L reduction in LDL cholesterol in our trial is consistent with previous trials. Myopathy was increased with 80 mg simvastatin daily, but intensive lowering of LDL cholesterol can be achieved safely with other regimens," Armitage and colleagues write.

Most of the trials analyzed in the meta-analysis were supported by pharmaceutical company grants. Also, some members of the writing committee reported receiving reimbursement of costs for participating in scientific meetings from pharmaceutical companies. The Armitage study was supported by Merck.

Abstract - Baigent
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Abstract - Armitage
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