I am continually asked by patients if they REALLY should take statins that for elevations in their LDL levels.
My answer is YES, for a couple of reasons:
Statins significantly reduce cardiovascular morbidity and mortality.
Patients. A total of 1221 patients aged 30–70 years who received a new prescription for a statin drug between 1994 and 2001, within 1 year of their first cardiovascular event (i.e., myocardial infarction, unstable angina, ischemic stroke, percutaneous transluminal coronary angioplasty [PTCA], or coronary artery bypass graft [CABG]).
Measurements and Main Results. Adherence was measured by the fill frequency (number of prescriptions filled during the observation period divided by months of observation). Patients with a fill frequency of 80% or greater were classified as adherent (661 patients); those with a fill frequency of 60% or less were classified as nonadherent (395 patients). The remaining 165 patients who had adherence rates of 61–79% were excluded from the analysis. The primary end point included a composite of myocardial infarction, unstable angina, PTCA, CABG, and death. Among 1056 patients, adherence was not associated with a reduction of the primary end point. However, patients in the adherent group were half as likely to experience a subsequent myocardial infarction as the patients in the nonadherent group (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.20–0.99, p=0.047). In patients younger than 65 years (both adherent and not), the associated reduction in myocardial infarction was even more profound (HR 0.14, 95% CI 0.04–0.46, p=0.001) and was accompanied by a trend for a lower frequency of unstable angina (HR 0.37, 95% CI 0.13–1.03, p=0.06). In patients 65 years or older (301 patients), adherence was not associated with significant changes in cardiovascular end points.
Conclusion. A detectable excess of cardiovascular morbidity appears to be associated with nonadherence to statin therapy. Our analysis suggests that many occurrences of myocardial infarction could be prevented with improvements in adherence. Larger studies are necessary to determine the association between adherence and other cardiovascular end points.
Pre-treatment with Statins Improves pneumonia outcome.
Reimar Thomsen, MD, PhD, of Aarhus University and Aalborg Hospital in Aalborg, Denmark, and colleagues, reviewed data from 29,900 adults hospitalized with pneumonia between 1997 and 2004. Of those, 1,371, or 4.6%, were taking statins at the time.
"Mortality among statin users was lower than among non-users," researchers write in their report, which appears in the Oct. 27 issue of Archives of Internal Medicine.
The death rate for statin users was 10.3% after 30 days, compared to 15.7% for non-users. And after 90 days, the death rate for statin users was 16.8%, compared to 22.4% of those not on statins.
"The differences became apparent during the first few weeks of hospitalization, a period associated with a high number of pneumonia-related deaths, and they increased only minimally between 30 and 90 days after admission, which suggests that statin use is beneficial, primarily in the early phase of infection," the authors write.
Former use of statins was not linked to decreased death rate from pneumonia.
The researchers said that other studies have indicated that statins may benefit patients with sepsis or bacteremia, or infection of the bloodstream, possibly because of the anti-clotting, anti-inflammatory, or immune-modifying properties of statins.
Pneumonia remains a major health problem. Hospitalization rates in the United States and Europe have increased 20% to 50% in the last 10 years, researchers say, and about 10% to 15% of patients die of the disease.
The report is important because it suggests another potential advantage of taking statins.
The scientists say statins change the immune response and inhibit dysfunction in blood vessels, effects that may especially benefit patients with sepsis and bacteremia, which are associated with early death from pneumonia.
"Our study adds to the accumulating evidence that statin use is associated with improved prognosis after severe infections," the authors write. "The decrease in mortality associated with statin use seems to be substantial in patients with pneumonia requiring hospital admission."
Nothing is perfect but the data strongly favor statin therapy. Internet shibboleths to the contrary, the class of drugs seem to be both safe and effective.
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