In­crease in statins dose ‘would save thou­sands of lives’

New study sug­gests 12,000 heart at­tacks and strokes could be avoided

The Scotsman - - Front Page - By JEN­NIFER COCKERELL

Thou­sands of heart at­tacks and deaths from car­dio­vas­cu­lar dis­ease could be pre­vented by pa­tients tak­ing higher doses of statins and tak­ing the drugs as ad­vised by doc­tors, a study has sug­gested.

Re­searchers at Im­pe­rial Col­lege Lon­don and the Univer­sity of Le­ices­ter es­ti­mate the mea­sures could lead to 12,000 car­dio­vas­cu­lar events – such as a heart at­tack or stroke – be­ing averted among high­risk pa­tients in the UK.

The pa­per, pub­lished in the jour­nal JAMA Net­work Open, is the first to look at the com­bined ef­fect of high in­ten­sity statin treat­ment and ad­her­ence in pa­tients who have al­ready had a car­dio­vas­cu­lar event and who are at in­creased risk of it hap­pen­ing again, com­pared to the gen­eral pub­lic.

It found that those tak­ing the high­est doses of statins to re­duce their low-den­sity lipopro­tein (LDL) choles­terol lev­els – the “bad” choles­terol which builds up in the ar­ter­ies – and, cru­cially, who take the med­i­ca­tion as ad­vised by their doc­tor, saw the big­gest

re­duc­tions in risk for fu­ture car­dio­vas­cu­lar events.

Pa­tient ad­her­ence de­scribes the de­gree to which a pa­tient fol­lows med­i­cal ad­vice and takes med­i­ca­tion cor­rectly.

It can sig­nif­i­cantly af­fect how suc­cess­ful a treat­ment is, as pa­tients may not take a drug reg­u­larly, skip days, or stop the med­i­ca­tion al­to­gether – es­pe­cially if they see or feel no im­me­di­ate ben­e­fit.

Re­searchers said this is par­tic­u­larly im­por­tant as high choles­terol lev­els in the blood may not cause any no­tice­able symp­toms.

Lead au­thor Pro­fes­sor Kausik Ray, of Im­pe­rial Col­lege Lon­don, said: “The ba­sic mes­sage here is that long-term ad­her­ence achieves bet­ter long-term choles­terol re­duc­tions, and in turn, achieves bet­ter long-term out­comes for pa­tients.

“In terms of risk re­duc­tion, we can see the peo­ple who do the best are those who are ad­her­ing to the rec­om­mended dosage and are on more po­tent drug reg­i­mens.

“But if some­one is not go­ing to take a treat­ment as rec­om­mended, they may ac­tu­ally be bet­ter off on higher doses of statins.”

The study saw the team an­a­lyse pa­tient data from the Clin­i­cal Prac­tice Re­search Datalink (CPRD), which in­cludes more than five mil­lion records from more than 450 GP prac­tices.

They fo­cused on three groups of pa­tients at high risk of car­dio­vas­cu­lar events – those with es­tab­lished heart dis­ease, those with di­a­betes but no his­tory of heart dis­ease, and those with chronic kid­ney dis­ease but no prior heart at­tack or stroke.

Al­most 30,000 pa­tients re­cently started on choles­terol low­er­ing med­i­ca­tions were scored us­ing a mea­sure which com­bined the in­ten­sity of treat­ment they re­ceived (statins alone or com­bined with an­other choles­terol-low­er­ing drug called eze­tim­ibe) and their ad­her­ence – with those who took their med­i­ca­tion as pre­scribed 80 per cent of the time classed as “ad­her­ent”.

When re­searchers mea­sured the rel­a­tive risk re­duc­tion com­pared to un­treated pa­tients an av­er­age of three years after treat­ment, they found those pa­tients with the high­est score (who were on the high­est in­ten­sity treat­ment and had the high­est ad­her­ence) had the great­est re­duc­tion in LDL choles­terol lev­els and car­dio­vas­cu­lar risk, with a 40 per cent drop in their risk of car­dio­vas­cu­lar events.

By com­par­i­son, those pa­tients on the low­est in­ten­sity treat­ment and with poor ad­her­ence had a risk re­duc­tion of just 5 per cent com­pared to those not on med­i­ca­tion.

To im­prove ad­her­ence, the re­searchers ad­vise that doc­tors spend more time with pa­tients to ex­plain the ben­e­fits and risks of the drugs, so they are able to make bet­ter de­ci­sions about their own health.

They add that ad­her­ence could be im­proved with new de­liv­ery meth­ods, such as slow re­lease drugs which pa­tients take less fre­quently.

Prof Ray said there is a lot of con­fu­sion around di­etary choles­terol and med­i­ca­tions that lower choles­terol.

He added: “While chang­ing your diet is a good thing, it may not be enough for those pa­tients who are al­ready in the high-risk groups – such as those with heart dis­ease. Here, statins pro­vide ad­di­tional ben­e­fits over and above life­style.

“It doesn’t mat­ter how pa­tients get to this point – through obe­sity, smok­ing, ge­netic risk fac­tors – what we know is that once you have one heart at­tack or other car­dio­vas­cu­lar event, you are at much higher risk of more events in fu­ture and that low­er­ing your LDL choles­terol lev­els is key to im­prov­ing out­comes.

“For these pa­tients, tak­ing the right med­i­ca­tion, at the right dose, at the right time – and stick­ing to this reg­i­men – is crit­i­cal in low­er­ing their risk of fu­ture car­dio­vas­cu­lar events.”

Kausik Ray said long-term ad­her­ence can save lives

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