Pravastatin reduces long-term cardiovascular mortality by more a quarter, even in men with markedly raised low density lipoprotein cholesterol (LDL-C) levels, according to a new analysis of the West Of Scotland Coronary Prevention Study (WOSCOPS), published in Circulation.

Researchers stratified 5,529 men without evidence of vascular disease into two groups: LDL-C under 190mg/dL (about 4.9mmol/L) and at least 190mg/dL. Over the 4.9-year randomised-controlled phase, pravastatin reduced the risk of coronary heart disease (CHD) and major adverse cardiovascular events (MACE) by 27 and 25 per cent respectively among those with and without LDL-C ≥190 mg/dL compared to placebo.

Among men with LDL-C ≥190mg/dL, pravastatin reduced the risk of CHD by 27 per cent and MACE by 25 per cent during the initial trial phase, while the risk of CHD death, cardiovascular death and all-cause mortality declined by 28, 25 and 18 per cent respectively in those who originally received pravastatin during the 20 years’ follow-up.

“For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy except for very high LDL levels. This legitimises current guidelines which recommend treating this population with statins,” says author Kausik Ray, professor of public health at Imperial College London.

“Our findings provide the first trial-based evidence to support the guidelines for treating patients with LDL above 190mg/dL and no signs of heart disease. They also suggest that we should consider prescribing statins more readily for those with elevated cholesterol levels above 155mg/dL and who also appear otherwise healthy.”

DOI: 10.1161/CIRCULATIONAHA.117.027966

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