September 27, 2016

expert reaction to study looking at heart disease risk reduction of statins and other cholesterol-lowering methods

A review published in JAMA investigated the effect of statin and non-statin therapies on LDL cholesterol and cardiovascular risk, and reported that both statin and non-statin therapies (including diet, surgery and other drugs) can contribute to lower LDL-cholesterol and a reduction in heart disease risk.

Dr Tim Chico, Reader in Cardiovascular Medicine / consultant cardiologist, University of Sheffield, said:

“This review has not performed any new trials but compares results from previous studies that looked at whether lowering LDL cholesterol reduces risk of heart disease. This included studies that lowered cholesterol by various means, such as by diet, surgery, statins or other drugs. Overall it is a well conducted analysis that is in accordance with the majority of evidence and medical opinion.

“The important message of this study is that someone’s risk of heart disease is definitely reduced by lowering their LDL cholesterol, and the more you lower someone’s cholesterol, the lower their risk of suffering a stroke or heart attack. Either diet or statins reduce heart disease by around the same extent for a given reduction in cholesterol, but as statins reduce the cholesterol more than diet they do provide a greater benefit overall.

“Although the current debate is often portrayed as whether or not we should use diet or statins to reduce risk of heart disease, this is a false choice that does real damage. The best way to reduce a person’s risk of heart disease is by combining a healthy lifestyle (for everyone) with drugs such in statins in certain types of patients that we know benefit from this treatment. However, whether or not to go on any treatment is the choice of the patient; the doctor’s job is to give someone the right information without bias.”

Prof. George Davey Smith, Professor of Clinical Epidemiology, University of Bristol, said:

“This definitive overview of randomised controlled trails shows that lowering LDL cholesterol reduces risk of serious cardiovascular disease events, such as heart attacks and ischaemic strokes.  Importantly it also shows that this is due to the cholesterol reduction itself, and is not some additional effect of any specific treatment, for example statins, as has sometimes been claimed.

“In addition to statins, other approaches which can lower cholesterol levels produce the same reduction in cardiovascular disease risk for a given reduction in cholesterol. Diet is generally not as effective because it produces smaller reductions in cholesterol. This provides support for a dual-pronged attack on the cardiovascular disease problem: population-based dietary changes – optimally achieved through changes in food policy rather than haranguing individuals about their poor diet – and for those at high risk, cholesterol lowering drug treatment.”

Prof. Peter Weissberg, Medical Director at the British Heart Foundation, said:

“High cholesterol is a major risk factor for heart disease and reducing your cholesterol level is an effective way of reducing your risk of a future heart attack or stroke.

“This analysis supports previous findings that it’s the lowering of ‘bad cholesterol’ – or LDL cholesterol – that really matters when it comes to preventing heart attacks, and not the means by which it is achieved. Statins are a safe and effective way of lowering cholesterol, and this study helps to dispel the notion that statins work in ways that are unrelated to lowering cholesterol.

“The vast majority of patients in this analysis were taking statins and several of the non-statin approaches included in the study, such as bowel surgery, are not viable options for patients today. Patients on statins should be reassured that by lowering their cholesterol levels they are helping to protect themselves from future heart attacks and strokes.”

‘Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: A systematic review and meta-analysis’ by Michael G. Silverman et al. published in JAMA on Tuesday 27 September 2016. 

Declared interests

Dr Tim Chico: “I am a committee member and Treasurer of the British Atherosclerosis Society, a charity established in 1999 to promote UK atherosclerosis research.”

Prof. Peter Weissberg: “No interests to declare.”

Prof. George Davey Smith: “No COIs.”