Statins provide lasting protection against MI
Statins appear to provide protection against heart attacks for many years
after patients stop taking them, according to long-term follow up data
from the West of Scotland Coronary Prevention Study.
In the original trial, middle-aged men with high cholesterol levels but
no history of myocardial infarction (MI) were randomly assigned to receive
pravastatin or placebo for an average of five years. At the end of the
trial, the risk of death from heart attack or of suffering a heart attack
was reduced from 7.9 per cent to 5.5 per cent (P<0.001) for those
in the pravastatin group. Five years after the end of the trial, approximately
37 per cent of participants in both groups were being treated with a
statin.
The latest analysis, which included more than 90 per cent of the original
trial survivors, shows that, after a further follow up of 10 years, the
risk of death from coronary heart disease or non-fatal MI was 10.3 per
cent in the placebo group and 8.6 per cent in the pravastatin group (P=0.02).
“
This result was presumably due to stabilisation of existing plaque and
a slowing of the progression of coronary artery disease,” the researchers
conclude.
They also report that there was no excess fatal or incident cancers associated
with pravastatin, although there was a trend towards increased risk for
prostate cancer (New England Journal of Medicine 2007;357:1477).
The author of an accompanying editorial (ibid, p1543) writes: “That
the group originally assigned to pravastatin had better outcomes, even
after years of similar statin treatment of the placebo group during the
post-trial period, suggests the importance of duration of therapy in
determining outcome. Earlier initiation of therapy appears to have durably
mitigated the atherosclerotic process.”
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