The cardiovascular benefit of the cholesterol-lowering statin drugs has been firmly established for quite some time.
But, a twenty-year follow up of the West of Scotland Coronary Prevention Study (WOSCOPS) may have raised a few eyebrows. These drugs work better than expected even long after they have been stopped.
Dr. Chris Packard of The University of Glasgow, Scotland, presented the follow up study at last week s American Heart Association meeting in Chicago, which demonstrated that even a five year course of pravastatin (Pravachol) provided a "persistent reduction in cardiovascular disease outcomes" over the course of 2 decades.
Dr. Packhard also noted that, that the study shows a remarkable persistence in terms of cardiovascular risk reduction over such a long period of time, suggesting that statin treatment alters the natural history of the disease in some way by lowering LDL cholesterol."
To which, ACSH s Dr. Josh Bloom comments, Wow. Mechanistically, it is pretty straightforward to be able to understand why statins work. They inhibit cholesterol biosynthesis in the liver, and this in turn is responsible for secondary effects, one of which is the upregulation of receptors on liver cells, which then bind to more LDL (bad cholesterol), eventually resulting in its metabolism and excretion.
He adds, But it seems that some of these effects are long-lasting (permanent?), which effectively changes the physiology of the liver. Back in 1987 when Mevacor the first statin was approved, I very much doubt that anyone would have predicted this.
Some other findings from the study:
- Use of pravastatin for 5 years significantly reduced the risk of nonfatal heart attacks or death from cardiovascular causes by 31%.
- Men who were treated with pravastatin were significantly less likely to be hospitalized over the twenty year period.
- There was no difference in the cancer rate in the treated and control groups.
ACSH s Dr. Gil Ross had this to say: This is an amazing extra benefit to people who take statins. Perhaps they can stop taking the medication after a reasonable time frame but given their current inexpensive cost and their general safety, it may be wiser to keep on the drugs. I was comforted by the lack of increased cancer risk, since there have been occasional studies seeming to show an increased risk, while the overwhelming consensus has not shown that. However, reliable studies have shown a minor increase in risk of diabetes among statin patients. I wonder if that adverse effect was measured?