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Tuesday, 13 November, 2001, 16:47 GMT
Q&A: Heart drugs study
A major study of the impact of cholesterol-lowering statin drugs has found they could save the lives of thousands of heart patients a week.

What is the main finding of the study?

Cholesterol-lowering with statin treatment reduces the risk of heart attacks and of strokes by at least one-third, as well as reducing the need for arterial surgery, angioplasty and amputations.

How important are these findings?

Very important. These new findings show that cholesterol-lowering therapy should now be considered for a very much wider range of people than had previously been thought to benefit.

How big was this study compared with others done in the past?

With 20,536 participants, it is by far the largest trial of cholesterol-lowering therapy ever conducted.

What has this study told us that we did not know before?

Cholesterol-lowering with statins has now been shown to be effective for a much wider range of people at increased risk of vascular disease because of their past medical history.

Which new groups may benefit?

It is not just those who've had a heart attack or have angina who will benefit, but also those who've had a stroke or have peripheral arterial disease or diabetes mellitus.

Women as well as men, and those aged over 70 as well as middle-aged people.

In addition, those whose cholesterol levels might previously have been considered low, as well as those considered to have elevated cholesterol levels may benefit.

Which people should consider statins who may not have considered them before?

People with a history of heart attack or angina who are aged over 70, and those who have blood total cholesterol levels below 5.0mmol/l or LDL (bad) cholesterol levels below 3.0mmol/l.

People with a history of stroke, other occlusive vascular diseases, or diabetes, regardless of their age, sex or cholesterol level.

What would be the effect on the risk of a heart attack or stroke if a person is already receiving other treatments to lower risk?

The benefits of cholesterol-lowering with statins are additional to those of other effective treatments for vascular disease (such as aspirin and blood-pressure lowering drugs).

Should every person now having vascular surgery consider statins? Does this include people who, for example, have surgery for vascular injury, as opposed to disease?

All patients who have had surgery (or other procedures) on coronary or non-coronary arteries to bypass or remove narrowings due to atherosclerosis should now be considered for cholesterol-lowering with statins, regardless of their cholesterol levels.

Evidence in women was sketchy before. Now it looks as if women benefit in the same way as men? How important is this finding for women?

This is the biggest study of cholesterol-lowering in women, and these results are definitive.

Cholesterol-lowering has now been shown to reduce the risk of vascular disease to about the same extent in women as in men.

Women tend to develop vascular disease at older ages than men, so the evidence of benefit in this study among people aged over 70 is also of great relevance to improving the health of women.

How many vascular events have these findings the potential to prevent?

About 70-100 fewer heart attacks, strokes or revascularisation operations for every 1,000 patients treated for 5 years.

Given the very much wider range of people now shown to benefit, there could be 70-100,000 fewer such major vascular events in every million extra that are treated.

How many deaths do these findings have the potential to prevent?

About 20-30 fewer deaths per 1,000 - or 20-30,000 fewer per million - treated for 5 years.

For how many people are these results relevant?

It is estimated that about 25m people worldwide are currently being treated with a statin.

World Health Organization statistics indicate that there are about 200m people worldwide with CHD, stroke, other occlusive vascular disease or diabetes mellitus.

Consequently, the present findings are directly relevant to starting statin treatment in some tens of millions of people at increased risk of heart attacks and strokes.

Source: Heart Protection Study

See also:

13 Nov 01 | Health
Heart drugs could save thousands
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