Stopping statin treatment early could substantially reduce lifetime protection against heart disease, according to a new study.
Researchers suggest this is because the benefit of taking the cholesterol-lowering drugs is seen later in life. Statins are one of the most commonly prescribed drugs in the UK, with millions taking them to cut their chance of a heart attack or stroke.
Lead author Dr Runguo Wu, of Queen Mary University, London, 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.”
The study suggests that people who started taking statins in their 50s but stopped at 80 saw a reduction in the benefit. Heart disease is the most common cause of ill-health and death worldwide, and high cholesterol is a key modifiable risk factor. Research suggests that lowering cholesterol with statins can reduce the risk of heart disease and stroke by up to 25%. However, there is some uncertainty about when to start and how long to persist with statin therapy to get the most benefit.
In the new study, researchers estimated the accumulation of benefit with statins according to age at the start of the therapy. They used a model developed using data on 118,000 people in large international statin trials from the Cholesterol Treatment Trialists’ (CTT) Collaboration and 500,000 people in the UK Biobank study.
Treatment with a standard dose of statin (40mg daily) was used to estimate the effect of therapy versus no therapy in a number of different scenarios. These were lifelong therapy, therapy stopped at 80 years of age, and delayed initiation of therapy by five years in people aged under 45. The benefit of statins was measured in quality-adjusted life years (QALYs), which is the length of life adjusted by health to reflect quality of life.
One QALY is equal to a year of perfect health.
Benefits were also reported separately according to the likelihood of having a heart attack or stroke in the next 10 years, and is based on age, blood pressure, cholesterol levels, smoking status, and medical conditions.
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% of the QALY benefit if they are at relatively low cardiovascular risk and 36% 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.”
In people aged under 45 who had less than 5% likelihood of heart attack or stroke in the next 10 years, a five-year delay in taking statins had little impact. However, the impact was larger in people under 45 years who had more than 20% likelihood of heart attack or stroke in the next 10 years – they lost 7% of the potential QALY benefit from lifelong therapy.
Dr Wu said: “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.”
The findings of the modelling study will be presented at the European Society of Cardiology Congress 2022.
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