- Findings of new review published in Canadian Journal of Cardiology -
MONTREAL, April 10 /CNW/ - An expert review - conducted by a panel of
Canadian healthcare professionals - concludes that statins effectively lower
LDL cholesterol ("bad cholesterol") levels, and reduce the incidence of
cardiovascular events and death in primary prevention. The greatest benefits
are observed in high-risk subjects, such as patients with diabetes or
hypertension(1).
"With more than 10 years of scientific and clinical experience around the
world, statins have become a cornerstone for effective cholesterol management,
dramatically improving our ability to prevent and manage heart disease," says
Dr. David Miller, Division of Endocrinology, Vancouver Island Health
Authority, British Columbia and one of the review authors. "Not only do
statins effectively lower cholesterol levels, but our analysis also shows that
the benefits of statins translate into a reduction in cardiovascular death,
even in primary prevention. Nevertheless, the beneficial effect is greater in
populations who are at highest risk of cardiovascular disease."
The expert review entitled, "Clinical and public health assessment of
benefit and risk of statins in the primary prevention of coronary
events: Resolved and unresolved issues", is published in the April issue of
Canadian Journal of Cardiology.
Review: Statins Extremely Effective Medications
Based on the present review of evidence, the authors recommend that
statins are appropriate in the primary prevention (the prevention of the
development of cardiovascular disease (CVD) in patients who are at high risk
of developing the disease, but who have not yet experienced a cardiovascular
disease event) of CVD events(1), with benefits outweighing the risks. The
greatest benefits are observed in high-risk subjects, such as patients with
diabetes or hypertension (high blood pressure)(1).
Evidence-Based Assessment
The narrative review of published randomized controlled trials and
meta-analyses was conducted to critically appraise the benefits and risks of
statins in primary prevention; a total of seven independent clinical trials
and a separate meta-analysis were included in the review (AFCAPS/TexCAPs,
ALLHAT-LLT, ASCOT-LLT, CARDS, HPS, PROSPER and WOSCOPS).
"Since peer reviewed, evidence-based recommendations for statin use in
primary prevention are limited, this analysis of published data is
particularly critical," says Dr. Yola Moride, Ph.D., Faculty of Pharmacy,
University of Montreal and Centre of Clinical Epidemiology, Sir Mortimer
B. Davis Jewish General Hospital, Montreal, Quebec. "Such review is critical
in the setting of primary prevention since large numbers of individuals must
be treated to observe measurable treatment effects, such as preventing
cardiovascular disease related events. Hence, the issue must be examined from
a public health perspective with emphasis both on effectiveness and safety. In
the primary prevention of high-risk patients, potential benefits appear to
outweigh the risks, provided that adequate treatment adherence is achieved."
This review supports the findings from numerous landmark trials, which
have shown that statins improve cardiovascular outcomes(2),(3), while the use
of statins in various at-risk populations is supported by major medical
guidelines in Canada and abroad(4),(5),(6).
About High Cholesterol and Cardiovascular Disease
High cholesterol, an asymptomatic condition which affects millions of
Canadians, is one of the major risk factors for heart disease and stroke(7).
In fact, almost 40 per cent of Canadians have high cholesterol(8). Medical
research continues to show that lowering LDL cholesterol reduces the risk of
developing heart disease and stroke.
Cardiovascular disease is the leading cause of death in Canada(9). It is
estimated that there are more than 70,000 heart attacks in Canada each
year. In 2003, more than 18,500 (18,662) Canadians died from heart
attacks(10). Stroke is the fourth most common cause of death in Canada and
accounts for seven per cent of all deaths each year(11).
Cardiovascular diseases have a significant economic impact. Health Canada
estimates that the total cost of cardiovascular diseases to the Canadian
economy in 1998 was $18.5 billion, which includes a direct cost of
$6.8 billion and an indirect cost of $11.7 billion(12).
The review was made possible via a grant from Pfizer Canada Inc.References:
-------------------------
(1) Y Moride, RA Hegele, A Langer, R. McPherson, DB Miller, S.
Rinfret. Clinical and public health assessment of benefits and
risks of statins in primary prevention of coronary events:
Resolved and unresolved issues. Can J Cardiol 2008; 24: 6.
(2) Sever PS, Dahlof B, Poulter NR et al. Prevention of coronary and
stroke events with atorvastatin in hypertensive patients who have
average or lower-than-average cholesterol concentrations, in the
Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm
(ASCOT-LLA): a multicentre randomised controlled trial.
(see comment). Lancet 361(9364):1149-58. 2003.
(3) Ford I, Murray H, Packard CJ et al. Long-Term Follow-up of the
West of Scotland Coronary Prevention Study The New England Journal
of Medicine. 2007;357:1477-1486.
(4) Hemmelgarn, B, McAlister FA, Grover, SA, Myers, MG, McKay, DW,
Bolli, P, Abbott, C, Schiffrin, EL, Honos, G, Burgees, E, Mann, K,
Wilson, T, Penner, B, Tremblay, G, Milot, A, Chockalingam, A,
Touyz, RM, Tobe, SW, and for the Canadian Hypertension Educatin
Program. The 2006 Canadian Hypertension Education Program
recommendations for the management of hypertension: Part I--Blood
pressure measurement diagnosis and assessment of risk.
Can J Cardiol 22(7), 573-581. 2006.
(5) Canadian Diabetes Association Clinical Practice Guidelines Expert
Committee. Canadian Diabetes Association 2003 Clinical Practice
Guidelines for the Prevention and Management of Diabetes in
Canada. Can J Diabetes. 2003;27.
(6) Anderson JL, Adams CD, Antman EM et al. ACC/AHA 2007 Guidelines
for the Management of Patients With Unstable Angina/Non ST-
Elevation Myocardial Infarction Executive Summary: A Report of the
American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Writing Committee to Revise the 2002
Guidelines for the Management of Patients With Unstable Angina/Non
ST-Elevation Myocardial Infarction) Developed in Collaboration
with the American College of Emergency Physicians, the Society for
Cardiovascular Angiography and Interventions, and the Society of
Thoracic Surgeons Endorsed by the American Association of
Cardiovascular and Pulmonary Rehabilitation and the Society for
Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:652-726.
(7) Heart and Stroke Foundation of Canada
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484027/k.5C04/
High_blood_cholesterol.htm. Accessed April 7, 2008
(8) Living with Cholesterol. Prepared by the Heart and Stroke
Foundation of Canada.
(9) Canadian Institute of Health Research
http://www.cihr-irsc.gc.ca/e/24939.html. Accessed April 7, 2008.
(10) Statistics Canada, Causes of Death 2003. Mortality, Summary List
of Causes, 2003.
(11) Heart and Stroke Foundation. Understanding Transient Ischemic
Attack (TIA). June 2006.
(12) Heart and Stroke Foundation. Growing Burden of Heart Disease and
Stroke. 2003.
For further information: or to speak to a Physician Expert in Vancouver,
Toronto, Ottawa or Montreal, please contact: Laura Espinoza, Carolyn
Santillan, Edelman (Toronto), (416) 979-1120, ext. 245, 351,
laura.espinoza@edelman.com, carolyn.santillan@edelman.com; Alexandra Menear,
Edelman (Montreal), (514) 844-6665, ext. 226, alexandra.menear@edelman.com
