August 8, 1997

Cholesterol-lowering drugs also fight off stroke: study

Cholesterol-lowering drugs also fight off stroke: study

The newest class of cholesterol-lowering drugs, called statins, significantly lowers cholesterol levels and protects against stroke and overall mortality, a review of published research has found.

The review of 10 years of data – encompassing 29,000 patients in 16 studies – was recently reported in the Journal of the American Medical Association.

Lead author of the article is Patricia R. Hebert, Ph.D., associate professor of Preventive Medicine and Medicine, Ki Sau Chan is a co-author. The review was conducted while Hebert and Chan were at Brigham and Women's Hospital in Boston, prior to Hebert joining the Vanderbilt faculty last December and Chan joining the Vanderbilt staff in June.

In addition to finding that the statin drugs have clear cardiovascular health benefits, the researchers found no evidence to suggest increases in death from non-cardiovascular causes, including cancer.

"Our results are very encouraging and reassuring," Hebert said. "While everyone had recognized the benefit of cholesterol-lowering medications in preventing coronary deaths, there has long been a concern that they may increase deaths from other causes as well as the incidence of cancer.

"With this study, the concern about these possible risks appears to be abating. However, the longest follow-up of the patients in these studies was five years. These patients are likely to be on these drugs for many years, so we would certainly endorse long-term monitoring for any side effects that might occur 10 or 15 years later."

Statins, scientifically known as 3-hydroxy-3 methylglytaryl coenzyme A (HMG-CoA) reductase inhibitors, produce larger reductions of cholesterol than previously available drugs, the review found.

That reduction may be the explanation for the 29 percent reduction in stroke, Hebert said.

"These drugs produced a 22 percent lowering of cholesterol levels, while previous studies of drugs and diet resulted in a reduction of cholesterol of about 10 percent," she said.

"Statin drugs essentially provide a two-fold increase in reduction of cholesterol levels. That's a major breakthrough, especially considering that statin drugs are particularly good at lowering LDL, the so-called bad cholesterol."

The study found that statin drugs provided a 22 percent reduction in the overall risk of death, largely from a reduction in deaths due to cardiovascular disease.

The findings suggest that more patients should be considered for treatment with statin drugs, especially patients with a history of coronary artery disease and those with high cholesterol levels who also have other risk factors, such as a family history of coronary disease at an early age, Hebert said.

However, she cautioned that "statin drugs aren't for everyone."

"About 25 percent of people have elevated cholesterol levels," she said. "Many can successfully control their cholesterol with diet and exercise. That should be the first-line therapy. And even patients who are on drug therapy should still be watching their diet and getting regular exercise."