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Statins cannot erode heart attack risks caused
by low levels of good cholesterol
Data released at the 2009 AHA Scientific Sessions demonstrate that the danger of low levels of HDL is not reduced by statin treatment
Boston, MA (November 17, 2009) - Data released today at the American Heart Association (AHA) Scientific Sessions 2009 define the increased risk of heart attacks and cardiovascular disease in patients with low levels of HDL-C (known as “good cholesterol”). The data also determine that statins are unable to significantly impact the heart attack or cardiovascular disease risks associated with low HDL-C.
"Because there has been little data exploring the impact of low levels of HDL-C on heart attack risk in statin-treated patients, we believe most clinicians will be surprised to see the magnitude of the effect of low HDL-C on heart attack risk and how little statins impact the risk associated with low HDL-C," said Richard Karas, MD, PhD, Professor of Medicine, Tufts University School of Medicine and Associate Director, Molecular Cardiology Research Institute, Tufts Medical Center, who led this study.
"While statins overall prevent 4 heart attacks per 1,000 patient-years, these new findings demonstrate that a 10 point higher HDL-C level could save an additional 8 heart attacks per 1,000 patient-years, which indicates that, even if patients are on a statin, if they have low HDL-C, they may need more than just statins to significantly reduce their risks" added Dr. Karas. Furthermore, this reduction of 8 heart attacks per 1000 patient-years for every 10 mg/dl change in HDL-C is the same whether patients are or are not treated with a statin.
The study led by Dr. Karas, titled "Statin Therapy Does Not Reduce the Increased Cardiovascular Risk Associated with Low Levels of High-Density Lipoprotein Cholesterol: Evidence from Randomized Controlled Trials," show that every 10 point decrease (10 mg/dL reduction) in HDL-C was associated with 7.8 more heart attacks per 1,000 person-years in the non-statin group (95% CI 2.8-13.0) and 7.6 more heart attacks per 1,000 person-years in statin-treated patients (95% CI 3.9-11.3) (P = 0.45 for comparing the effect of HDL-C on MI risk in controls versus statin-treated patients).
In addition to heart attack risk, the study also explored the association of HDL-C and cardiovascular disease (CVD) as a secondary analysis, as well as the outcomes of coronary heart disease death, CVD death, and all-cause death. In all cases, findings indicated that the risks increased as the levels of HDL-C decreased, and there were minimal differences between the groups with and without the statin. These findings also support that the low levels of HDL-C may contribute importantly to the unacceptably high residual risk of CVD events even in statin-treated patients.
The study also found that, overall, statin treatment reduced heart attacks by a median of 4.4 incidents per 1,000 person-years, indicating its significant impact on LDL-C (known as "bad cholesterol").
"With the ongoing cholesterol debates among lipidologists and cardiologists, these outcomes, coupled with the ARBITER6 data, will be extremely valuable for physicians treating patients with low levels of HDL today," continued Dr. Karas.
Methodology
The data were derived from a meta-analysis examining the results of 20 related randomized-controlled trials involving 543,210 person-years of follow-up and 7,838 heart attacks. With the results of the much-anticipated AIM-HIGH (3,500 patients) still years away, this study was designed to offer physicians a more immediate understanding of the extent to which HDL-C is a risk-factor for heart attacks, and the impact statins can have on patient treatment.
About Tufts Medical Center and Floating Hospital for Children
Tufts Medical Center is an exceptional, not-for-profit, 451-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Founded in 1796 as the Boston Dispensary, Tufts Medical Center is the oldest permanent medical facility in New England and one of the first hospitals in the nation. For more than 200 years, Tufts Medical Center has pioneered innovative programs in clinical care and research and is a recognized leader in cancer care, cardiology, neurosciences, organ transplantation and pediatrics. More information is available at www.tuftsmedicalcenter.org.
Media Contact
Julie Jette
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jjette@tuftsmedicalcenter.org
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