Long Term Safety and Efficacy of Lowering LDL Cholesterol With Statin Therapy: 20-Year Follow-Up of West of Scotland Coronary Prevention Study
Background—Extended follow up of statin-based low density lipoprotein (LDL) cholesterol lowering trials improves understanding of statin safety and efficacy. Examining cumulative cardiovascular events (total burden of disease) gives a better appreciation of the clinical value of statins. This paper evaluates the long-term impact of therapy on mortality and cumulative morbidity in a high risk cohort of men.
Methods and Results—The West of Scotland Coronary Prevention Study was a primary prevention trial in 45-64 year old men with high LDL cholesterol. 6595 men were randomized to receive pravastatin 40mg once daily or placebo for an average of 4.9 years. Subsequent linkage to electronic health records permitted analysis of major incident events over 20 years. Post-trial statin use was recorded for 5 years post-trial, but not the last 10. Men allocated to pravastatin had reduced all-cause mortality; hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.80-0.94, p=0.0007, mainly attributable to a 21% decrease in cardiovascular death; HR 0.79 (CI 0.69-0.90), p=0.0004. There was no difference in non-cardiovascular or cancer death rates between groups. Cumulative hospitalisation event rates were lower in the statin treated arm: by 18% for any coronary event (p=0.002), 24% for myocardial infarction (p=0.01) and 35% for heart failure (p=0.002). There were no significant differences between groups in hospitalization for non-cardiovascular causes.
Conclusions—Statin treatment for five years was associated with a legacy benefit with improved survival and a substantial reduction in cardiovascular disease outcomes over a 20-year period, supporting the wider adoption of primary prevention strategies.
- Received August 19, 2015.
- Revision received January 18, 2016.
- Accepted January 28, 2016.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.