Long-term use of statin therapy is safe and provides maintained survival benefit in follow-up LIPID trialHague WE et al., Circulation. 2016
Long-Term Effectiveness and Safety of Pravastatin in Patients With Coronary Heart Disease: Sixteen Years of Follow-Up of the LIPID Study
Hague WE, Simes J, Kirby A, et al.
BackgroundThe LIPID (Long-term Intervention with Pravastatin in Ischemic Disease) trial, showed that 6 years of pravastatin treatment resulted in better survival, in line with other statin trials [1-4]. However, there are concerns about the long-term use of statins regarding non-CV mortality and increased incidence of cancer [5-8], although large statin trials with an average follow-up of 5 years demonstrated safety .
In this study, the long-term effects of statins on cancer incidence and mortality, as well as the mortality from other causes was evaluated, based on a 16-years follow-up of the LIPID trial, including 7721 patients with a history of CHD.
Main resultsType of statin treatment:
- pravastatin prescription was initially (first 6 years) 49%, and decreased to 25% (last 10 years),
- simvastatin prescription increased from 27% to 32%
- atorvastatin prescription increased from 19% to 31%
- other statins prescription increased from 3% to 11%
- CHD; RR: 0.89; 95% CI: 0.81−0.97; P=0.009
- CV disease; RR: 0.88; 95% CI: 0.81−0.95; P=0.002
- any cause; RR: 0.91; 95% CI: 0.85−0.97; absolute RR: 2.6%; P=0.003
- 26 fewer deaths (31 over 6 years)
- 25 fewer CVD deaths (23 over 6 years)
- 18 fewer CHD deaths (19 over 6 years)
- the double-blind period; RR: 0.94; 95% CI: 0.82–1.08; P=0.41
- later follow-up; RR: 1.02; 95% CI: 0.91–1.14; P=0.74
- overall; RR: 0.99; 95% CI: 0.91–1.08; P=0.83
ConclusionIn 7721 patients with a history of CHD who participated in the extended follow-up of the LIPID study, the absolute survival benefit from 6 years of pravastatin treatment appeared to be maintained over another 10 years. The survival benefit was primarily related to CV-deaths and treatment with statins did not influence cancer incidence/death nor death from other non-CV causes during long-term follow-up. These results support the long-term use of statin therapy in patients at risk of CV events.
Find this article online at Circulation
1. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301–1307.
2. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001–1009.
3. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7–22.
4. LIPID Study Group, Tonkin A, Simes RJ. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1347–1357.
5. Law MR, Thompson SG. Low serum cholesterol and the risk of cancer: an analysis of the published prospective studies. Cancer Causes Control. 1991;2:253–261.
6. Davey Smith G, Pekkanen J. Should there be a moratorium on the use of cholesterol lowering drugs? BMJ. 1992;304:431–434.
7. Poynter JN, Gruber SB, Higgins PD, et al. Statins and the risk of colorectal cancer. N Engl J Med. 2005;352:2184–2192.
8. Shannon J, Tewoderos S, Garzotto M, et al. Statins and prostate cancer risk: a case-control study. Am J Epidemiol. 2005;162:318–325.
9. Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267–1278.