A study presented at the European Society of Cardiology congress 2022 has suggested that stopping statin therapy too early in life could reduce lifetime protection against heart disease.
Cardiovascular disease is the most common cause of illness and death worldwide, and high cholesterol is a key modifiable risk factor. Evidence suggests that reducing low-density lipoprotein cholesterol by one mmol/L with statin therapy can reduce the risk of ischaemic heart disease and stroke by 24%-25%.
“The study indicates that people in their 40s with a high likelihood of developing cardiovascular disease, and people of all ages with existing heart disease, should be considered for immediate initiation of cholesterol-lowering treatment. Stopping treatment, unless advised by a doctor, does not appear to be a wise choice,” said lead author Dr Rungo Wong of the Queen Mary University of London.
145 million people using statins
It is estimated that in 2018, 145 million people worldwide were undergoing statin therapy, making statins the most used lipid-modifying drug in the world. Unfortunately, delayed treatment initiation and poor adherence are common. It is believed that exaggerated claims about the side effects of statins may be responsible for the low usage of statin therapy among some individuals.
There is some debate about when to start, and how long to persist with statin therapy to achieve optimal effects. The study estimated the accumulation of statin therapy benefits according to age at therapy. Results were found using a microsimulation model, made up of data from 118,000 participants of large international statin therapy trials and 500,000 individuals in the UK Biobank population.
The model considered the individual characteristics of each participant such as age and sex, as well as disease histories. Using this information, the model was able to simulate the risk of heart attack, stroke, coronary revascularisation, diabetes, cancer, vascular death, and nonvascular death for each participant.
Treatment with a standard daily 40 mg dose of statin was used to estimate the effect of therapy versus no therapy in the following scenarios: (1) lifelong therapy (used until death or 110 years of age if earlier), (2) therapy stopped at 80 years of age, and (3) delayed initiation of therapy by five years in participants under 45 years of age.
The benefits of statin therapy were measured in quality-adjusted life years (QALYs), meaning the length of life adjusted by health to reflect the individual’s quality of life. One QALY is equal to one year of life with perfect health. Benefits were also reported according to baseline cardiovascular risk, which measures the risk of heart attack or stroke in the next ten years based on
Benefits of statin therapy clear to see
The benefit of statins was measured in quality-adjusted life years (QALYs), which is the length of life adjusted by health to reflect the quality of life. One QALY is equal to one year of life in perfect health. Benefits were also reported separately according to baseline cardiovascular risk, which refers to the likelihood of having a heart attack or stroke, based on age, blood pressure, cholesterol levels, smoking status, and medical conditions.
The researchers discovered that QALY’s tended to improve with statin therapy later in life. The study found that the higher the participant’s ten-year cardiovascular risk, the larger and earlier the benefits of statin therapy were. Results showed that stopping statin therapy at 80 years of age undid a large share of the potential benefits, especially for people with relatively low cardiovascular risk.
“Our study suggests that people who start taking statins in their 50s but stop at 80 years of age instead of continuing lifelong will lose 73% of the QALY benefit if they are at relatively low cardiovascular risk and 36% if they are at high cardiovascular risk,” concluded Wong.