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Senior Citizen Health & Medicine
Statins Reduce Risk of Heart Attack and Stroke in
Seniors Without Heart Disease
But not coronary heart disease or overall risk of
death
 November
27, 2006 Statins are now frequently prescribed for senior citizens to
prevent future cardiovascular disease. But, among individuals without
cardiovascular disease, taking statins regularly may reduce the risk of
major heart and cerebrovascular problems (blood vessels that supply the
brain), such as heart attack and stroke, but not coronary heart disease
(disease of the coronary arteries and veins), or overall risk of death,
according to an analysis reported todays issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.
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Statins have been shown to reduce death and other
negative outcomes associated with heart and cerebrovascular disease
among those who already have these conditions, according to background
information in the article.
It is less clear whether these medications benefit
those without cardiovascular disease. Current national treatment
guidelines recommend the use of statins in these patients based on their
cardiovascular risk profile and LDL-C or "bad cholesterol" level.
For patients without cardiovascular disease and
with normal LDL-C levels, statins are recommended only for individuals
with diabetes or with two or more other cardiac risk factors that raise
their 10-year risk of a heart attack or other heart event to at least 10
percent.
Paaladinesh Thavendiranathan, M.D., M.Sc.,
University of Toronto, Ontario, and colleagues analyzed the results of
seven previously published clinical trials that assessed the benefits of
statins in a total of 42,848 patients, 90 percent of whom had no history
of cardiovascular disease.
In each study, patients were randomly assigned to
receive either statins or another form of care and were followed for at
least one year, at least 100 major cardiovascular events occurred and 80
percent or more of the participants did not have cardiovascular disease.
In total, 21,409 patients in the trials took
statins and 21,439 were assigned to placebo. The average follow-up
period for the studies ranged from 3.2 to 5.2 years; average age of the
participants ranged from 55.1 to 75.4 years; and the proportion of men
included ranged from 42 percent to 100 percent.
In patients on statin therapy, there were 924 major
coronary events such as heart attack compared with 1,219 among those in
control groupsa 29.2 percent reduction in risk.
Major cerebrovascular events, including stroke,
occurred in 440 patients taking statins and 517 controls, a 14.4 percent
lower risk.
Statin treatment was also associated with a 31.7
percent reduction in risk for non-fatal heart attacks and a 33.8 percent
reduction in the number of revascularization procedures, which restore
blood flow and include angioplasty and bypass surgery.
There were no statistically significant differences
between the statin and control groups in the rates of patients who died
from cardiovascular disease or from all causes.
Assuming that individuals not taking statins have a
5.7 percent chance of having a major heart event over a 4.3-year period,
statins can reduce that risk to 4 percent, the authors write.
"Therefore, 60 patients would need to be treated
for an average of 4.3 years to prevent one major coronary event."
Similarly, 268 patients would need to be treated to
prevent one stroke or other major cerebrovascular event; 61 to prevent
one non-fatal heart attack; and 93 to prevent one revascularization
procedure.
Statins are expensive and other therapies also may
work to reduce risk, the authors conclude. "Therefore, even though
universal lipid-lowering therapy appears attractive, especially in an
intermediate-risk primary prevention population, further studies are
needed to clarify the cost-effectiveness of therapy in this group."
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