Araştırmacılardan Statin Kılavuzunun revizyonu için çağrı…

Researchers call for revision of statin guidelines after analysis reveals benefits outweigh risks

(Ref: The Lancet, Daily Mail, The Telegraph, The Guardian, BBC News, The Australian, CTV News, Yahoo!News)

May 17th, 2012

By: Lianne Dane

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• Findings from a meta-analysis published in The Lancet suggest that statins reduce the risk of serious vascular events in adults by about 20 percent, regardless of their heart disease status. Moreover, the analysis revealed that this benefit greatly exceeds any known hazards of statin therapy, prompting the study’s authors to recommend for a review of UK and international guidelines on these drugs.

Researchers reviewed data from 22 statin-versus-control trials and five trials of more-versus-less statin, involving approximately 175,000 people in total. The analysis found that statins reduced the risk of serious vascular events by 21 percent for each 1 mmol/L reduction in LDL cholesterol in each of the five risk groups the researchers identified, including those at lowest risk for vascular disease. This lowest risk group includes those with a five-year risk of a major vascular event lower than 10 percent, meaning “people who would typically not be judged suitable for statin treatment.” Since most statins can reduce LDL by much more than 1 mmol/L, there could be even larger absolute reductions in serious vascular events if statins were used more widely, the researchers noted.

Co-author Colin Baigent calculated that lowering the threshold for prescribing statins to a 10-percent risk of cardiovascular disease within a decade would lead to five million more people taking the drugs. In turn, he noted that this would save 2,000 lives and prevent 10,000 heart attacks or strokes every year. “Half of [these] deaths come out of the blue in people who were previously healthy…If we are going to prevent that half of cardiac or stroke deaths, then we’ve got to consider treating healthy people,” he said.

In the analysis, there was no evidence that reduction of LDL cholesterol with a statin increased cancer incidence, cancer mortality or other non-vascular mortality. The FDA recently required label changes to statins, to warn of certain problems associated with the therapies, including diabetes risk and memory problems. “Statins may produce small increased risks of haemorrhagic strokes and in diagnoses of diabetes, but the definite benefits of statins greatly outweigh these potential hazards,” the authors concluded.

Current US and European guidelines restrict statin use to people with at least a 20 percent risk of having a major vascular event within 10 years. However, the researchers noted that the data suggest that treating patients with a risk as low as 1 percent was likely to prove cost-effective. The National Institute for Health and Clinical Excellence has indicated that it will update its guidelines, noting that “new evidence on statin treatment thresholds that has become available since publication of the original NICE guideline, including the study reported in The Lancet, will be considered as part of our review.” The agency’s conclusions will be published towards the end of 2013.

In an accompanying commentary, Shah Ebrahim noted that “this research provides further evidence that statins are an effective and safe way of reducing the risk of heart attacks and strokes even among people at quite low risk of these conditions.” He added that “the benefits of giving statins to everyone over the age of 50 would probably save the NHS money in the long run, owing to the savings in health care costs from the heart attacks and strokes prevented.”