PARIS, Aug 29 (Benin News) –
According to a model study presented at the European Society of Cardiology ESC 2022, stopping statin therapy early could significantly reduce lifelong protection against heart disease, with much of the benefit occurring later in life.
The lead author of the study, Dr. Runguo Wu, from Queen Mary University of London (UK), points out that “the study shows that people in their forties have a high likelihood of developing cardiovascular disease, and people of all ages who already have heart disease should start cholesterol-lowering therapy immediately. Discontinuing treatment unless recommended by a doctor does not seem like a wise option.
Cardiovascular disease is the leading cause of disease and death worldwide, and high cholesterol is a major modifiable risk factor. There is strong evidence that lowering low-density lipoprotein cholesterol by 1 mmol/L with statins reduces the risk of ischemic heart disease and stroke by 24% to 25%.
Statins are the most widely used lipid-modifying drug: it is estimated that more than 145 million people took them in 2018. However, late treatment initiation and poor adherence to therapy are common. Exaggerated claims about side effects of statins may also account for their underuse in people at increased risk of cardiovascular events.
There is some uncertainty about when to start statin therapy and how long to continue it to maximize its effects. This study estimated the accumulation of statin benefits as a function of age at treatment initiation using a microsimulation model developed from data from 118,000 participants in large international statin studies conducted by the Cholesterol Treatment Trialists’ (CTT) Collaboration and 500,000 subjects from the Cholesterol Treatment Trialists’ (CTT) Collaboration UK Biobank were conducted population cohort.
The model used individual characteristics (eg, age, gender) and medical history to simulate each participant’s annual risk of myocardial infarction, stroke, coronary artery revascularization, diabetes, cancer, vascular death, and non-vascular death.
Treatment with a standard statin dose (40 mg daily) was used to assess the effect of treatment compared to no treatment in the following scenarios: (1) Lifelong treatment (administered until death or until age 110, if earlier ), (2) stopping treatment at age 80, and (3) delaying treatment initiation by five years in elderly participants under 45 years of age.
Statin benefit was measured in quality-adjusted life-years (QALYs), which is a health-adjusted lifespan to reflect quality of life. One QALY is equivalent to one year of life in perfect health. Benefits were also broken down by baseline cardiovascular risk, which refers to the likelihood of having a heart attack or stroke within the next 10 years and is based on age, blood pressure, cholesterol levels, smoking and medical conditions.
The researchers found that a large fraction of the QALYs gained from statin treatment occurred later in life. The higher the participants’ 10-year cardiovascular risk, the greater and earlier the benefit of statins.
Compared to lifelong statins, stopping treatment by age 80 eliminated much of the potential benefit, particularly for people at relatively low cardiovascular risk.
“Our study suggests that people who start taking statins at age 50 but stop taking them at age 80, rather than continuing for life, lose 73% of the QALY benefit if they are at relatively low cardiovascular risk and 36% if they are at high cardiovascular risk, because high-risk people benefit earlier,” notes Dr. Wu.
Women’s cardiovascular risk is generally lower than men’s,” he continues. This means that for women, most of the lifelong benefits of statins occur later in life, and stopping treatment prematurely is likely to be more harmful than for men.
For people under 45 with low cardiovascular risk, meaning less than 5% chance of having a myocardial infarction or stroke in the next 10 years, delaying statin use by five years had little effect: they just lost 2% the potential QALY benefit of lifetime treatment.
However, the impact was greater in people under 45 years of age at high cardiovascular risk, ie more than 20% chance of having a heart attack or stroke within the next 10 years: they lost 7% of the potential benefit in terms of lifetime QALYs Treatment.
dr Wu points out that “again, this is because people at high cardiovascular risk start to see benefits very early and have more to lose by delaying statin therapy than people at low risk.”
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