Statins provide 'limited use unless you stay on them for life'

Article By: Laura Donnelly

New study finds stopping treatment early cuts the benefits by as much as three quarters - even for those who stayed on them until their 80s

Statins provide limited use unless patients stay on them for life, research suggests.

The British study found that stopping treatment early cut the benefits by as much as three quarters - even among those who stayed on the drugs until they reached their 80s.

Researchers from Oxford University and Queen Mary University of London found most of the gains from taking cholesterol-busting drugs occur in later life, when the risk of heart disease is greatest.

Some people stop taking statins because they dislike being on long-term medication or because they suspect side-effects.

However, lead author Dr Runguo Wu, from Queen Mary University of London, said: “Stopping treatment, unless advised by a doctor, does not appear to be a wise choice.”

Modellers estimated the benefit of taking a standard 40mg daily dose of statins for 57,473 people selected from the UK Biobank, using detailed information about their medical history, as well as age and sex.

The benefit was measured in quality-adjusted life years (QALYs), which is the length of life adjusted to reflect the impact of poor health on quality of life.

One QALY is equal to one year of life in perfect health.

Researchers found that compared with lifelong use, stopping therapy at 80 years of age erased a large share of the potential benefit.

The trend was particularly strong among women, whose overall risk of heart disease is lower.

'Those at elevated risk start to benefit earlier'
Dr Wu said: “Our study suggests that people who start taking statins in their 50s but stop at 80 years of age instead of continuing lifelong will lose 73 per cent of the QALY benefit if they are at relatively low cardiovascular risk and 36 per cent if they are at high cardiovascular risk – since those at elevated risk start to benefit earlier.

‘Women’s cardiovascular risk is generally lower than men’s.

“This means that for women, most of the lifelong benefit from statins occurs later in life and stopping therapy prematurely is likely more detrimental than for men.”

The research also found that younger people at high risk of heart attacks and strokes lost a significant chunk of life spent in good health if they delayed starting on statins.

Participants who were under 45 with a 20 per cent chance of heart attacks and strokes within a decade lost 7 per cent of the potential benefits of lifelong therapy, by delaying medication for five years. For those at low risk, the delay had little impact.

Some people 'have more to lose' by delaying statins
Dr Wu said: “People at higher cardiovascular risk start to accrue benefit early on and have more to lose by delaying statin therapy than those at low risk.”

Cardiovascular disease is the most common cause of ill-health and death worldwide, and high cholesterol is a key modifiable risk factor.

Around 8 million people in the UK take statins, which cost only a few pence a day.

Around four in 10 adults - including most men over the age of 60, and women over 65, are eligible for the drugs, under NHS guidance, which says they should be offered to anyone with a one in five chance of developing cardiovascular disease within a decade.

Reducing LDL, or “bad”, cholesterol by 1 mmol/L with statins reduces the risks of ischaemic heart disease and stroke by around a quarter.

But poor adherence is common, with many put off by concerns about side-effects.

Dr Wu said: “The study indicates that people in their 40s with a high likelihood of developing cardiovascular disease, and people of all ages with existing heart disease, should be considered for immediate initiation of cholesterol lowering treatment.”

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “This large analysis adds to the already extensive evidence that statins help people to live for longer in good health by reducing their risk of having a heart attack or stroke. It shows that the benefits accumulate with time. This means the earlier the treatment is started the more effective it is and shows that the benefits persist into old age. Therefore, statins should not be stopped simply because someone is elderly."


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