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Oct. 10, 2007 -- Men who took statins for five years had fewer heart deaths and heart attacks 10 years later -- even though most had stopped taking the cholesterol-lowering drugs.
The intriguing finding suggests that relatively small, early reductions in bad LDL cholesterol can have very large benefits later in life.
Study investigator Stuart Cobbe, MD, professor of medical cardiology at the University of Glasgow, Scotland, says the finding was something of an accident.
"Almost by chance we had the opportunity to look at the long-term effect of a five-year period of treatment with statins -- without further ongoing treatment -- to see how that altered the trajectory of heart disease," Cobbe tells WebMD.
What happened?
"The very interesting finding is the five-year treatment had a beneficial effect that was clear 10 years later," Cobbe says. "We put the clock back on coronary disease in the people who received treatment."
These results, taken together with other recent findings, are very exciting to Michael Domanski, MD, chief of the atherothrombosis and coronary artery disease branch of the National Institutes of Health. Domanski's editorial comments accompany the study by Cobbe and colleagues in the Oct. 11 issue of the New England Journal of Medicine.
"If you start early, and keep LDL cholesterol down over a lifetime, you may be able to prevent heart disease," Domanski tells WebMD.
The study by Cobbe and colleagues, called?the West of Scotland Coronary Prevention study, enrolled 6,595 middle-aged men with high cholesterol from 1989 through 1991. None of the men in the study had a previous heart attack.
It was supposed to test a then-new idea: that Pravachol, one of the cholesterol-lowering statin class of drugs, might prevent heart disease (other statins currently available in the U.S. are Crestor, Lescol, Lipitor, Mevacor, and Zocor). At the time, statins were prescribed only for patients who already had heart disease.
Pravachol treatment cut their average LDL cholesterol levels by 26% -- from 192 mg/dL to 142 mg/dL. Over the five-year study period, these men had 31% fewer heart attacks or deaths from heart disease.
Because most doctors still though statins should be prescribed for men with existing heart disease, fewer than 40% of the men used statin drugs after the study ended. Nevertheless, the researchers kept tabs on the men for another 10 years.
This gave them the chance to see whether statin treatment had any lasting benefit. It did. Men who got inactive placebo pills during the study had a 15.5% chance of heart attack or heart death 10 years after the study ended. Those who got five years of statin treatment had only an 11.8% chance of heart attack or heart death. They also had a lower risk of heart disease.
This doesn't mean that the men should have stopped taking statins. Although five years of treatment offered a long-lasting benefit, the men's heart attack and heart death rates were much lower during the time they were taking their medicine.
"This suggests to us that although the benefit of those years was not lost, one would continue to get benefit from taking the statins," Cobbe says.
The study eased concern that statin treatment might increase cancer risk.
"There has been a long-running controversy over whether statins increase other diseases. The one that has generated the most discussion is whether these drugs increase the risk of cancer," Cobbe says. "Here we have a chance to see the effect on cancer a decade after treatments were finished. And we saw no evidence at all of a cancer effect."