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Published on: November 10, 2017
The comparative effectiveness of statin therapy in selected chronic diseases compared with the remaining population
Xia Sheng1, Michael J Murphy, Thomas M MacDonald
1Medicines Monitoring Unit, Division of Medical Sciences, Ninewells Hospital & Medical School, University of Dundee, Dundee, DD1 9SY, UK.
Insights
Statins effectively lower total cholesterol (TC) but show varied effectiveness in reducing cardiovascular events and mortality across different chronic diseases. Statin efficacy in patients with chronic conditions, except diabetes, was generally lower than in the general population.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Public Health
Background:
- Total cholesterol (TC) is a key marker for statin efficacy in the UK.
- Evaluating statin effectiveness in chronic diseases is crucial for patient outcomes.
Purpose of the Study:
- To assess statin effectiveness in lowering TC, cardiovascular events, and mortality in patients with common chronic diseases (COPD, OA, RA, CKD, DM).
- To compare statin effectiveness between individuals with chronic diseases and the general population.
Main Methods:
- Population-based cohort study in Tayside with individuals having at least two TC measurements (1993-2007).
- Included 12,140 patients with chronic diseases and 9,481 controls.
- Primary outcomes: TC change, cardiovascular events, and all-cause mortality.
Main Results:
- Statin-induced TC reductions ranged from 7% to 28% depending on disease and prevention status (primary/secondary).
- TC reductions were generally lower in chronic disease patients compared to the general population.
- A 0.5 mmol/L TC reduction predicted variable cardiovascular event reductions across diseases, with notable differences compared to the general population.
Conclusions:
- Statin effectiveness in managing chronic diseases varies, often being less pronounced than in the general population, with diabetes as a partial exception.
- The correlation between TC reduction and improvements in cardiovascular events and mortality is not consistently strong across all chronic disease groups.
Background:
Total cholesterol (TC) concentration is the most commonly used measure of statin efficacy in the UK. This study aimed to evaluate the effectiveness of statins in lowering TC, cardiovascular events (CV) and mortality five common chronic diseases (chronic obstructive pulmonary disease (COPD), osteoarthritis (OA), rheumatoid arthritis (RA), chronic kidney disease (CKD), and diabetes mellitus (DM)) and to compare effectiveness with the rest of the population not recorded as having these diseases.
Methods:
A population-based cohort study was conducted in Tayside population who had at least two TC measurements between 1993 and 2007. There were 12,140 patients with chronic diseases and 9,481 patients in the rest of the population not recorded as having these chronic diseases. The main outcomes were TC change from baseline, CV events and all-cause mortality.
Results:
Statin-associated TC reductions varied from 15% to 28% with baseline value of between 5.1 and 5.9 mmol/L in the primary prevention (PP) and from 7% to 23% with baseline value of 4.5 to 5.2 mmol/L in the secondary prevention (SP) among chronic diseases patients. In the rest of the population, TC reductions with statins were 31% in PP and 28% in SP with baselines of 6.3 mmol/L and 5.3 mmol/L, respectively (test of heterogeneity with chronic disease groups: p < 0.001). A notional reduction of 0.5 mmol/L in TC predicted variable reductions in incident CV events of 30% in RA, 19% in CKD, and 20% in DM, and recurrent CV events by 62% in COPD, 16% in CKD, and 19% in DM. The corresponding figures for the rest of population were 12% for incident CV events and 17% for the recurrent CV events, respectively. Risk reductions for all-cause mortality varied from 20% to 36% in PP and from 18% to 40% in SP, except in OA or RA patients in the chronic diseases and 11% in PP and 16% in the rest of population (test of heterogeneity: p > 0.05).
Conclusions:
The effectiveness of statins in common chronic diseases varied. With the exception of diabetes, statins tends to be less effective in patients with the chronic diseases compared with the rest of the study population. Changes in TC with statins appear not to correlate well with the changes in cardiovascular events and all-cause mortality.
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