Renewed calls for statin prescribing guidelines to be revised after
new trial
Cardiology experts have once again called for statins to be prescribed
to patients who are at risk of major cardiac events, regardless of their
cholesterol level, following new results from a major clinical trial.
Initial results from the Anglo-Scandinavian cardiac outcomes trial (ASCOT)
show that giving statins to hypertensive patients, who had a blood cholesterol
level of 6.5mmol/L or less, decreased their risk of heart attack and stroke
by about a third.
The trial involved over 10,000 hypertensive patients from seven countries,
including the United Kingdom and Ireland, who had been randomised to receive
either atorvastatin (Lipitor) 10mg daily or placebo.
Full results are not expected until early next year, but because of the
benefit seen in patients given atorvastatin, the ASCOT Data Safety Monitoring
Board recommended premature termination of the trial earlier this month.
The National Service Framework for Coronary Heart Disease says statins
should be prescribed to people who have a cholesterol level over 5mmol/L
if they have already had a myocardial infarction or if they have a 30
per cent 10-year risk of having an event. But the researchers say this
guidance needs to be revised urgently.
Professor Peter Sever, one of the trial investigators, said: “Statins
are safer than aspirin — they should be available over the counter.”
Professor Sir Charles George, medical director of the British Heart Foundation,
commented that the ASCOT results underlined previous conclusions from
the Heart Protection Study, reported earlier this year (PJ, 6 July, p4).
“The message continues to be ‘treat risk — not cholesterol
level’. Guidelines on the use of statins will need to be updated,”
Professor George said.
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