Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Statin users risk heart attacks by dropping treatment or taking low doses

07.12.2006
Doctors must emphasise importance of complying with treatment say researchers

Thousands of statin users worldwide are suffering preventable heart attacks, simply because they are not complying with their treatment or are taking too low a dose, according to new research published on-line today (Thursday 7 December) in European Heart Journal[1].

These life-saving drugs, used to lower cholesterol levels in people at risk of coronary heart disease (CHD), can only be optimally effective if patients use them properly – and many are not.

That is the conclusion by the research team, who followed the prescription records of nearly 60,000 patients in the Netherlands for up to 14 years.

Dr Fernie Penning-van Beest and colleagues from the PHARMO Institute[2], the Utrecht Institute of Pharmaceutical Sciences and the Academic Hospital in Amsterdam, analysed 548,084 prescriptions of statin treatment issued over the first two years of treatment[3] in 59,094 new users in the period January 1991-December 2004, and followed the patients until their first hospital admission for heart attack, death, or the end of the study in December 2004.

The aim was to see how effective robust statin treatment was for primary and secondary CHD in the ‘real world’ – as opposed to in clinical trials. Their results enabled them to calculate the absolute number of avoidable heart attacks that occurred because patients had stopped taking their drugs or were not taking them consistently. They were also able to compare the preventive effects of different doses and types of statins.

Patients were divided into two groups – those at high risk of heart attack and those at intermediate or low risk, with over a fifth of patients (12,762) considered high risk.

They found more than half of all patients (31,557) stopped taking statins within two years and only just over a third (20,883) were persistent users on a high or intermediate dose.

Among persistent users, hospital admission for heart attacks fell by nearly a third (30%) compared to non-persistent users, in both primary and secondary prevention groups. In the primary prevention group, admission was down from 0.52 per 100 patient years among non-persistent users to 0.42 per 100 patient years in persistent users. In the secondary prevention group it was down from 0.86 to 0.62.

Among patients using the high or intermediate doses the risk reduction was as high as 40%, while a low dose reduced the risk by only 20%.

The researchers calculated that, every year, around 300 to 400 statin users in the Netherlands have an avoidable heart attack because of sub-optimal doses or discontinuing treatment. They believe the results are likely to be typical of Europe as a whole and of the USA, which means 7,000 to 9,000 Europeans and 5,000 to 7,000 Americans a year are suffering unnecessary heart attacks.

“What this clearly tells us,” said lead researcher Dr Penning-van Beest, a research associate at the PHARMO Institute, “is that our observational study supports robust cholesterol lowering, as recommended on the basis of clinical trials. But, drugs are only really effective if they are used properly and persistently. Unfortunately, statins are not being used optimally, so thousands of people are having unnecessary heart attacks. Getting users to stay on statins and to use them persistently saves lives, and doctors must get over to patients the message that complying with treatment is essential.”

Different types of statins are used in different doses, so the researchers dealt with these differences by grading the five statins they assessed for equipotency (the dose of one type of statin needed to achieve the same effect as another type).

They found that as well as the largest reduction in heart attacks needing hospital admission being among patients consistently taking the drugs over the whole two-year period at persistently high or intermediate equipotent doses, these patients were also relatively more likely to be using second generation statins i.e. atorvastatin or rosuvastatin, rather than the first generation types, pravastatin, fulvastatin or simvastatin. Higher doses of first generation statins were being prescribed, but increasing the dose of these older statins is limited by the maximum safe dose.

Co-author Dr Ron Herings, scientific director of the PHARMO Institute and associate professor of pharmacoepidemiology at Utrecht University, said: “It is preferable to achieve a high equipotent dose by using the new, highly potent statins. But, the new statins have considerable economic impact on pharmaceutical budgets and the opposite trend is being encouraged in the Netherlands and Germany, where reimbursement measures promote the use of relatively inexpensive generic older types.”

He said: “This is fine, as long as guidelines for higher doses of these older statins are implemented, and bearing in mind that there may be limitations to giving the highest doses. But, restricting the use of older generic statins to standard low doses will make the problems worse.

“Ideally, to improve the population effectiveness of statin treatment, persistent drug use and the use of new, potent statins, should be encouraged.” he concluded.

The research was funded by an unrestricted grant from Nefarma – the Dutch association of pharmaceutical industries. But, the study was designed, conducted and analysed entirely independently of the funders.

(ends)

[1]Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40%: a cohort study. European Heart Journal. doi:10.1093/eurheartj/ehl391.

[2]PHARMO Institute: an independent scientific research organisation dedicated to studying drug use and outcomes in daily practice.

[3]The reduction of serum cholesterol levels is associated with a considerably lower risk of coronary heart disease (CHD) among high-risk patients and individuals without cardiovascular risk factors. The benefits of reducing cholesterol levels are obtained early, the major part after two years of treatment and the full benefit only after five years.

Margaret Willson | alfa
Further information:
http://www.oxfordjournals.org

More articles from Health and Medicine:

nachricht Biofilm discovery suggests new way to prevent dangerous infections
23.05.2017 | University of Texas at Austin

nachricht Another reason to exercise: Burning bone fat -- a key to better bone health
19.05.2017 | University of North Carolina Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Strathclyde-led research develops world's highest gain high-power laser amplifier

The world's highest gain high power laser amplifier - by many orders of magnitude - has been developed in research led at the University of Strathclyde.

The researchers demonstrated the feasibility of using plasma to amplify short laser pulses of picojoule-level energy up to 100 millijoules, which is a 'gain'...

Im Focus: Can the immune system be boosted against Staphylococcus aureus by delivery of messenger RNA?

Staphylococcus aureus is a feared pathogen (MRSA, multi-resistant S. aureus) due to frequent resistances against many antibiotics, especially in hospital infections. Researchers at the Paul-Ehrlich-Institut have identified immunological processes that prevent a successful immune response directed against the pathogenic agent. The delivery of bacterial proteins with RNA adjuvant or messenger RNA (mRNA) into immune cells allows the re-direction of the immune response towards an active defense against S. aureus. This could be of significant importance for the development of an effective vaccine. PLOS Pathogens has published these research results online on 25 May 2017.

Staphylococcus aureus (S. aureus) is a bacterium that colonizes by far more than half of the skin and the mucosa of adults, usually without causing infections....

Im Focus: A quantum walk of photons

Physicists from the University of Würzburg are capable of generating identical looking single light particles at the push of a button. Two new studies now demonstrate the potential this method holds.

The quantum computer has fuelled the imagination of scientists for decades: It is based on fundamentally different phenomena than a conventional computer....

Im Focus: Turmoil in sluggish electrons’ existence

An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.

We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...

Im Focus: Wafer-thin Magnetic Materials Developed for Future Quantum Technologies

Two-dimensional magnetic structures are regarded as a promising material for new types of data storage, since the magnetic properties of individual molecular building blocks can be investigated and modified. For the first time, researchers have now produced a wafer-thin ferrimagnet, in which molecules with different magnetic centers arrange themselves on a gold surface to form a checkerboard pattern. Scientists at the Swiss Nanoscience Institute at the University of Basel and the Paul Scherrer Institute published their findings in the journal Nature Communications.

Ferrimagnets are composed of two centers which are magnetized at different strengths and point in opposing directions. Two-dimensional, quasi-flat ferrimagnets...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Marine Conservation: IASS Contributes to UN Ocean Conference in New York on 5-9 June

24.05.2017 | Event News

AWK Aachen Machine Tool Colloquium 2017: Internet of Production for Agile Enterprises

23.05.2017 | Event News

Dortmund MST Conference presents Individualized Healthcare Solutions with micro and nanotechnology

22.05.2017 | Event News

 
Latest News

New insights into the ancestors of all complex life

29.05.2017 | Earth Sciences

New photocatalyst speeds up the conversion of carbon dioxide into chemical resources

29.05.2017 | Life Sciences

NASA's SDO sees partial eclipse in space

29.05.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>