High statin therapy may not significantly cut heart disease risks, study reveals

An Israeli-led research has found that taking high levels of statin drugs have modest benefits for reducing cardiovascular risks.
The study findings, published in the online Journal JAMA Internal Medicine, revealed that lowering cholesterol beyond a certain point made no difference in protecting patients from heart attacks, angina or strokes.
Researchers from the Clalit Research Institute in Tel Aviv, along with scientists from the US and Canada, examined the association between aggressiveness of treatment and the evolution of cardiovascular risks in more than 31,000 patients with pre-existing heart disease.
They looked specifically at the participants’ levels of low-density lipoprotein cholesterol (LDL-C) – a surrogate marker for cardiovascular disease – and to what extent different degrees of statin-induced reductions in LDL-C improved their risk profile.
The results showed that there was a substantial decrease in risk between patients with high LDL cholesterol and moderate LDL cholesterol levels.
However, those with the lowest LDL cholesterol levels, below 1.8 mmol/l (70 mg/dL), had the same statistical chances of suffering from serious adverse event of heart disease than the group with moderate LDL cholesterol levels.
Out of 31,619 patients with ischemic heart disease (IHD) followed by the research team, 16,782 (53 per cent) had moderate LDL-C levels.
According to this paper, all patients are at greater risk when they have more LDL cholesterol particles, but recent lipidology studies questioned whether the size of LDL particles could in fact represent a greater risk.
Evidence from other large clinical trials show that a smaller LDL particle is more pathologic than a large one, the so-called pattern A versus pattern B. Statin drugs improve outcomes by reducing small dense LDL. But it doesn’t eliminate it completely, which could explain the modest improvement in cardiovascular disease risks.
At any rate, the conclusions reached by this population-based study suggest that current treatment guidelines set by the European Society of Cardiology recommending very low target LDL-C levels (below 70 mg/dL) for patients with predispositions to heart disease – such as people with type 2 diabetes and prediabetes – are misguided.
Within the UK, however, statins are not prescribed by cholesterol levels alone but by a formula that takes into account a variety of cardiovascular risk factors including age, BMI and blood pressure in addition to cholesterol levels.