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Statin Users Risk Heart Attacks by Stopping Treatment
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And a lot of people do stop taking statins, which are prescribed to lower cholesterol in individuals at risk of coronary heart disease. More than half of the nearly 60,000 people followed in the study gave up on the drugs within two years, and only one-third were persistent users, taking a high or intermediate dose.
Hospital admissions for heart attacks fell by 30 percent among persistent users of the drugs. That finding is entirely understandable, said Ron Herings, director of the PHARMO Institute in Amsterdam, and an author of the report.
"You have a high risk when you start using these drugs," Herings said. "When you stop, your risk increases to baseline, and that is a 30 to 40 percent increase."
The reduction in risk was affected by how persistent people were in taking a statin and the dose they took, the study found. For example, the incidence of hospital admissions for people who took the drugs on a non-regular basis was reduced from 0.52 per 100 patient years to 0.42 per 100 patient years.
Among people using high or intermediate doses, the risk reduction was as high as 40 percent, while a low dose reduced the risk by only 20 percent.
The study is published in the Dec. 7 online edition of the European Heart Journal.
The findings support the recently adopted view that intensive statin therapy pays benefits, said Dr. Stephen Nicholls, a cardiologist who is director of the intravascular ultrasound laboratory at the Cleveland Clinic.
"We need intensive therapy to get LDL cholesterol levels as low as possible," Nicholls said. LDL cholesterol is the bad kind that clogs arteries.
But the study also illustrates a continuing problem in achieving that goal, Nicholls said. "Despite the fact that we have a large body of evidence that taking statins lowers LDL levels and is beneficial, in the real world, there seems to be a discord in getting this into clinical practice," he said.
One reason people stop taking statins is that they feel no immediate improvement, Herings said. "You do not find a benefit if your lipids are controlled," he said. "Also, it is difficult to take a drug for many years, especially when you have to take many drugs."
Another factor is a widespread fear of adverse side effects, Hering said. "Even a mild drug reaction can make patients stop," he said.
That fear goes against the clinical evidence indicating that statins are "the most rigorously tested class of drugs in terms of the number of patients enrolled in clinical trials," Nicholls said. Those trials show "statins are tolerated by the overwhelming majority of patients with no problems at all," he said.
As the Dutch study shows, "statins will remain an integral part of any strategy to reduce heart disease," Nicholls said.
SOURCES: Ron Herings, Pharm.D., director, PHARMO Institute, Amsterdam, the Netherlands; Stephen Nicholls, MBBS, Ph.D., cardiologsit, Cleveland Clinic; Dec. 7, 2006, European Heart Journal, online
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