Taking a cholesterol-lowering drug for five years in middle age can lower heart and death risks for decades afterward, and the benefits seem to grow over time, a landmark study finds. Doctors say it’s the first evidence that early use of a statin can have a legacy effect, perhaps changing someone’s odds of disease for good.
“It might be a lifetime effect,” said one study leader, Chris Packard of the University of Glasgow in Scotland.
Not only did original benefits of statins continue into late life, but researchers were surprised to see new ones become evident over time, he said.
The results are from the West of Scotland Coronary Prevention Trial, the first study ever to show that statins could prevent heart problems in people who had not yet developed clogged arteries but had high LDL, the bad type of cholesterol.
Early results from the watershed trial led to these drugs — sold as Lipitor, Crestor, Zocor and related generics — becoming a mainstay of treatment and one of the most prescribed medicines in the world.
The long-term results were discussed last week at an American Heart Association conference in Chicago.
The study, which started in 1989, involved about 6,600 Scottish men, ages 45 to 64, with high LDL. Half were given the statin Pravachol; the others took dummy pills. Five years later, there were fewer heart attacks and 35 percent fewer heart-related deaths in the statin group.
Once the study ended, about one-third of both groups kept taking or started taking a statin. This means any differences seen years later probably is due to whether they took statins during the five-year study, Packard explained.
Scotland has national health care and good electronic medical records, so researchers were able to document what happened to more than 90 percent of the men.
Twenty years after the study began, the risk of heart-related deaths was 27 percent lower among the men who took Pravachol for those first five years rather than dummy pills.
The chance of dying from any cause was 13 percent lower in the statin group at the 20-year mark, a benefit not seen earlier on.
“The big surprise” was a 31 percent lower risk of heart failure in the group initially assigned to take the statin, Packard said. Heart failure occurs when a heart damaged from a heart attack or other cause weakens over time and can’t pump blood effectively.
Doctors have long suspected that the way statins work gives benefits beyond lowering cholesterol, and the heart failure result supports that theory, Packard said.
“This is another stone in the foundation supporting the value of preventive cardiology,” said Sidney C. Smith Jr., a former American Heart Association president from the University of North Carolina at Chapel Hill. Other factors might have played some role in how these men fared, but “nevertheless, a moderate-dose statin taken for primary prevention shows long-term benefit.”