[Treatment with statins: further data from the Heart Protection Study]

Statins have been shown to reduce cardiovascular disease in subjects with coronary heart disease, in men with high cholesterol levels and in men and postmenopausal women with low high-density lipoprotein cholesterol levels. In meta-analysis, reduction in events is associated with reduction in serum low-density lipoprotein (LDL) cholesterol levels, however, some studies have proposed a threshold level for the effect.

A clinician and a statistician reviewed the Heart Protection Study in the context of previous similar studies.

High-risk men and women (n = 20,536) aged 40-80 years with coronary heart disease, peripheral artery disease or diabetes and a cholesterol level of at least 3.5 mmol/l were randomised to simvastatin 40 mg or placebo. After 5.5 years, the incidence of nonfatal myocardial infarction or coronary death was reduced from 11.8% in the placebo group to 8.7% in the simvastatin group, and a similar reduction was seen in subjects with diabetes but no cardiovascular disease. There was no threshold of LDL cholesterol below which lowering it did not reduce risk.

The study adds to the body of evidence indicating that cholesterol lowering with statins is indicated for subjects with high risk and that LDL cholesterol reduction explains the reduction in events.