Stopping statin treatment early could substantially reduce lifetime protection against heart disease because most of the benefit occurs late in life, a major conference is to hear.
A modelling study carried out by a team at Queen Mary University of London, UK, and presented at ESC Congress 2022 in Barcelona, Spain, suggests that people who start taking statins in their 50s but stop at 80 years of age will lose 73% of the quality-adjusted life years (QALY) benefit if they are at relatively low cardiovascular risk and 36% if they are at high cardiovascular risk.
Lead author Dr Runguo 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. Stopping treatment, unless advised by a doctor, does not appear to be a wise choice.”
There is strong evidence that reducing low-density lipoprotein cholesterol by 1 mmol/L with statins reduces the risks of ischaemic heart disease and stroke by 24%-25%.
Statins are the most commonly used lipid-modifying drug, but delayed treatment initiation and poor adherence are common, which, say the authors, could be caused by exaggerated claims about side-effects.
This study used a microsimulation model to estimate the accumulation of benefit with statins according to age at therapy initiation, examining details of 118,000 participants from the Cholesterol Treatment Trialists’ (CTT) collaboration and 500,000 individuals in the UK Biobank.
The model used individual characteristics and disease histories to simulate the annual risk of heart attack, stroke, coronary revascularisation, diabetes, cancer, vascular death and nonvascular death for each participant.
Treatment with a standard 40mg dose of statin was used to estimate the effect of therapy compared with no therapy in lifelong therapy, used until death or 110 years of age if earlier); therapy stopped at 80 years of age; and delayed initiation of therapy by five years in participants under 45 years of age.
The benefit of statins was measured in QALYs and benefits were also reported separately according to baseline cardiovascular risk.
The researchers found that a large part of QALYs gained with statin therapy accrued later in life, with the higher the participants’ 10-year cardiovascular risk, the larger and earlier the statin benefit accrued.
Compared with lifelong statins, stopping therapy at 80 years of age erased a large share of the potential benefit, especially for people with relatively low cardiovascular risk.
Dr Wu said: “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.”
In individuals under 45 years with low cardiovascular risk, a five-year delay in taking statins had little impact, losing 2% of the potential QALY benefit from lifelong therapy.
However, under 45s at high cardiovascular risk they lost 7% of the potential QALY benefit from lifelong therapy.
Dr Wu added: “Again, this is because 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.”
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