The Pharmaceutical Journal Vol 267 No 7174 p701-706
17 November 2001

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Trial heralds statins as the new aspirin

Cholesterol lowering with statins reduces the risk of heart attacks and strokes in all people at risk of vascular disease by at least a third, said Professor Rory Collins of Oxford University, lead researcher of the Heart Protection Study. "These results are at least as important as previous findings for aspirin's effects on heart attacks and strokes. Those findings changed medical practice and we expect these to have the same effect. In fact, statins are the new aspirin."

Professor Collins and colleagues randomly assigned 20,536 patients, who were aged between 40 and 80 years and at high risk of coronary heart disease, to receive either simvastatin 40mg daily or placebo. The study targeted patients for whom there is little evidence of the benefit of cholesterol-lowering therapy and included women, those over 70 years of age, people with diabetes, those with non-coronary vascular disease and those with average or below average cholesterol levels. The study was carried out in 69 hospitals in the United Kingdom. Treatment and follow-up were continued for an average of five and a half years.

The researchers found that statin treatment for about five years prevented heart attacks, strokes and other vascular events in 100 out of every 1,000 patients who had previously had a heart attack, 80 out of 1,000 patients with angina or some other evidence of coronary heart disease, and in 70 out of 1,000 patients who had previously had a stroke. There were also 30 fewer admissions to hospital for worsening angina per 1,000 patients being treated with simvastatin for five years. The researchers said that the benefits of simvastatin increased over the five year period and were additional to other treatments used to prevent heart attacks and strokes.

Professor Richard Peto, Oxford University, also involved in the study, said: "Irrespective of the blood cholesterol level, a statin should now be considered for anybody with a history of heart disease, stroke, other occlusive vascular disease or diabetes". The researchers also found no support for previous concerns about possible adverse effects of lowering cholesterol on particular non-vascular causes of death, cancers or on strokes due to bleeding.

The study also assessed the effects of antioxidants in these patients. Patients were assigned to receive vitamin E 600mg, vitamin C 250mg and beta-carotene 20mg daily, or placebo. Professor Collins says: "We found no excess risk of strokes due to bleeding or of cancers at any site. This contradicts the apparent adverse trends in some previous smaller studies of vitamin E and of beta-carotene".

The study was presented at the American Heart Association's annual congress in Anaheim, California, earlier this week.

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