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Higher dose statins could prolong lives of CVD patients

Benefits of reduced mortality were seen in over-75s as well as younger patients

Ingrid Torjesen

Thursday, 10 November 2016

More intense statin therapy reduces the risk of death, researchers have found in a study* of more than 500,000 patients with atherosclerotic cardiovascular disease, published in JAMA Cardiology.

Researchers at Stanford University in the US examined data on 509,766 adults in the Veterans Affairs health care system who had atherosclerotic cardiovascular disease (ASCVD) and were aged 21 to 84 years (average 69 years). At the start of the study, 30% were receiving high-intensity statin therapy, 46% receiving moderate-intensity statin therapy, 6.7% receiving low-intensity statin and 18% no statins. 

High-intensity statins were considered to be atorvastatin, 40 to 80 mg, rosuvastatin, 20 to 40 mg, or simvastatin, 80 mg. Moderate-intensity statin therapy was atorvastatin, 10 to 20 mg, fluvastatin, 40 mg twice a day or 80 mg once a day (extended-release formulation), lovastatin, 40 mg, pitavastatin, 2 to 4 mg, pravastatin, 40 to 80 mg, rosuvastatin, 5 to 10 mg, or simvastatin, 20 to 40 mg. Low-intensity therapy was fluvastatin, 20 to 40 mg, lovastatin, 20 mg, simvastatin, 10 mg, pitavastatin, 1 mg, or pravastatin, 10 to 20 mg.

During an average follow-up of 492 days, there was a graded association between intensity of statin therapy and mortality. One-year mortality rates were 4% for those receiving high-intensity statin therapy, 4.8% for those receiving moderate-intensity statin therapy, 5.7% for those receiving low-intensity statin therapy, and 6.6% for those receiving no statin. The researchers also found that the maximal doses of high-intensity statins (atorvastatin, 80 mg, and rosuvastatin, 40 mg) conferred the greatest survival advantage compared with submaximal doses of high-intensity statins. The same benefits of high-intensity statins were seen in patients older than 75 years as well as younger patients.

Dr Paul A Heidenreich, of Stanford University, California, said: "We evaluated the real-world practice of statin use by intensity and its association with all-cause mortality in a national sample of patients with ASCVD in the VA health system. We found an inverse graded association between intensity of statin therapy and mortality. These findings suggest there is a substantial opportunity for improvement in the secondary prevention of ASCVD through optimisation of intensity of statin therapy."

* Rodriguez F, Maron DJ, Knowles JW, et al. Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online November 9, 2016. doi:10.1001/jamacardio.2016.4052

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