17 May Before Initial Acute Coronary Syndrome: Study Finds Statin Therapy Reduced Heart Failure and Mortality
MedicalResearch.com Interview with:
Dr. Raffaele Bugiardini, UNIBO Professor & MD
Full Professor of Cardiology at the University of Bologna
MedicalResearch.com: What is the background for this study?
Response: Questions about the evidence base for primary prevention with statins continue to emerge from many quarters. It has been argued that prior estimates of statin effects were mainly based on information from both individuals with and without pre-existing cardiovascular disease, which may overestimate the true benefits of statins. Some investigators attempted to quantify the impact of statins on outcomes of women versus men and reported significantly different effect estimates.
Others have questioned the benefits of statins in adults 76 years and older as this age group was poorly represented in the randomized trials for primary prevention of cardiovascular disease.
There is little or no information on concomitant preventive medications in prior work. Thus, how large is the incremental benefit of statin, added to other standard preventive interventions? and is cholesterol a reliable surrogate endpoint to guide prevention of cardiovascular disease?
MedicalResearch.com: What are the main findings?
Response: Statin therapy given in a primary prevention setting led to a reduction in the number of patients suffering acute heart failure after an acute coronary syndrome as a first manifestation of cardiovascular disease.
Moreover, statin use predicted a lower risk of 30-day mortality in patients presenting with acute heart failure following an acute coronary syndrome.
When statin treatment was stratified based on conventional risk factors, statin use was associated with a substantially lower risk of presenting with acute heart failure following an acute coronary syndrome in patients who were current smokers or former smokers, and for those with hypercholesterolemia, diabetes and hypertension. In line with these findings, the benefit of statins was seen even in patients with no history of hypercholesterolemia.
Reductions in the risk of presenting with acute heart failure complicating an acute coronary syndrome were not attenuated when controlling for older age.
Benefits of statins were observed for adults whose 10-year cardiovascular risk exceeded 10%, but were not seen in the lower risk group. We used the American College of Cardiology calculator for estimating baseline risk.
As regards sex, the current study suggests that the benefit might be more pronounced in women and, therefore, reinforces the value of treating women with statins to reduce the burden of CV mortality.
MedicalResearch.com: What should readers take away from your report?
Response: On this background, people with a cardiovascular risk threshold exceeding 10% would be advised to start taking a statin unless there is a clear medical reason why they could not do it.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our findings underscore the need for shifting away from the practice of using statins only for treating lipid targets moving to a specific goal: prevention with statins of cardiovascular disease morbidity and mortality even in patients with normal cholesterol levels.
Our results also support the use of statins in the older populations, an issue that is still unsettled.
Differences between benefits and harms are likely to be razor thin, and balancing prevention of acute heart failure and mortality from acute heart failure against the risk of side effects is not straightforward. One of the most common complaints of people taking statins is muscle pain. Very rarely, statins can cause other side effects. Prospectively, we can’t predict which of those outcomes would apply to any given patient.
Our study was addressed to search benefits, not harms. Nevertheless, our findings may inform the potential role of cardiovascular risk in decision making. Broadening prophylaxis to include statin therapy for low-risk individuals unnecessarily exposes these people to the incidence of adverse effects without providing clear benefit.
MedicalResearch.com: Is there anything else you would like to add?
Response: Raffaele Bugiardini and the majority of the authors have none to disclose. Christopher Gale reports personal fees from AstraZeneca, Amgen, Bayer, and Daiichi Sankyo, grants from Abbott and BMS, all outside the submitted work. Lina Badimon reports personal fees from Bayer, SANOFI, ASTRAZENECA, PACE FICYE (FORUM TO STUDY BEER & LIFESTYLE), BMS/Pfizer and LILLY, grants from ASTRAZENECA, all outside the submitted work. In addition, Lina Badimon has a patent APOj-Gly licensed, a patent IV_STATIN pending, and a patent DJ1-F pending.
Bugiardini R, Yoon J, Mendieta G, et al. Reduced Heart Failure and Mortality in Patients Receiving Statin Therapy Before Initial Acute Coronary Syndrome. J Am Coll Cardiol. 2022 May, 79 (20) 2021–2033.https://doi.org/10.1016/j.jacc.2022.03.354
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