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Who should have statins

Who should have statins. 18 th March 2013. STATIN VS CONTROL – Proportional effects on MAJOR VASCULAR EVENTS per mmol/L LDL-C reduction. No. of events (% pa). Relative risk (CI) per mmol/L LDL-C reduction. Statin. Control. 2310 (0.9%). 3213 (1.2%). 0.74 (0.69 - 0.78). Nonfatal MI.

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Who should have statins

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  1. Who should have statins 18th March 2013

  2. STATIN VS CONTROL – Proportional effects on MAJOR VASCULAR EVENTS per mmol/L LDL-C reduction No. of events (% pa) Relative risk (CI) per mmol/L LDL-C reduction Statin Control 2310 (0.9%) 3213 (1.2%) 0.74 (0.69 - 0.78) Nonfatal MI 1242 (0.5%) 1587 (0.6%) 0.80 (0.73 - 0.86) CHD death Any major coronary event 3380 (1.3%) 4539 (1.7%) 0.76 (0.73 - 0.79) 816 (0.3%) 1126 (0.4%) 0.76 (0.69 - 0.83) CABG 601 (0.2%) 775 (0.3%) 0.78 (0.69 - 0.89) PTCA Unspecified 1686 (0.6%) 2165 (0.8%) 0.76 (0.70 - 0.83) Any coronary revascularisation 3103 (1.2%) 4066 (1.6%) 0.76 (0.73 - 0.80) 987 (0.4%) 1225 (0.5%) 0.80 (0.73 - 0.88) Ischaemic stroke Haemorrhagic stroke 188 (0.1%) 163 (0.1%) 1.10 (0.86 - 1.42) 555 (0.2%) 629 (0.2%) 0.88 (0.76 - 1.02) Unknown stroke Any stroke 1730 (0.7%) 2017 (0.8%) 0.85 (0.80 - 0.90) 99% or 95% CI Any major vascular event 7136 (2.8%) 8934 (3.6%) 0.79 (0.77 - 0.81) 0.4 0.6 0.8 1 1.2 1.4 Statin better Control better

  3. Proportional effects on MAJOR VASCULAR EVENTS per mmol/L LDL-C reduction, by baseline prognostic factors No. of patients (% pa) Relative risk (CI) per mmol/l LDL-C reduction Statin/more Control/less Treated hypertension: Yes 6176 (3.7%) 7350 (4.5%) 0.80 (0.76 - 0.84) 4543 (2.7%) 5707 (3.5%) 0.76 (0.72 - 0.80) No Systolic blood pressure (mm Hg): <140 5470 (3.2%) 6500 (3.8%) 0.80 (0.77 - 0.85) ³140,< 160 3145 (3.0%) 4049 (3.9%) 0.75 (0.70 - 0.80) ³160 2067 (3.6%) 2473 (4.5%) 0.79 (0.73 - 0.85) Diastolic blood pressure (mm Hg): <80 4558 (3.5%) 5306 (4.2%) 0.81 (0.76 - 0.85) ³80,< 90 3670 (3.0%) 4587 (3.8%) 0.77 (0.73 - 0.82) ³90 2452 (3.0%) 3128 (3.9%) 0.77 (0.72 - 0.82) Estimated GFR (mL/min/1.73m2): 2712 (4.1%) 3354 (5.1%) 0.77 (0.72 - 0.83) < 60 ³60, < 90 6161 (3.2%) 7540 (4.0%) 0.78 (0.75 - 0.82) ³90 1315 (2.5%) 1571 (3.0%) 0.77 (0.69 - 0.85) HDL-C (mmol/L): £1.0 5032 (4.0%) 6165 (5.0%) 0.78 (0.75 - 0.82) >1.0, £1.3 3656 (3.1%) 4452 (3.9%) 0.77 (0.73 - 0.82) >1.3 2199 (2.4%) 2633 (2.9%) 0.80 (0.74 - 0.87) 10973 (13.0%) 13350 (15.8%) 0.78 (0.76 - 0.80) Total 0.4 0.6 0.8 1.2 1.4 1 99% or 95% CI Statin/more better Control/less better

  4. Proportional effects on SITE SPECIFIC CANCER per mmol/L LDL-C reduction No. of first cancers (% pa) Relative risk (CI) per mmol/L LDL-C reduction Statin/more Control/less 1166 (0.3%) 1194 (0.3%) 0.97 (0.87 - 1.09) Gastrointestinal Genitourinary 1596 (0.5%) 1645 (0.5%) 0.97 (0.88 - 1.06) Respiratory 813 (0.2%) 814 (0.2%) 1.00 (0.88 - 1.15) 267 (0.3%) 241 (0.3%) 1.07 (0.84 - 1.38) Female breast Haematological 305 (0.1%) 291 (0.1%) 1.04 (0.84 - 1.30) Melanoma 159 (0.0%) 142 (0.0%) 1.14 (0.83 - 1.56) 754 (0.2%) 737 (0.2%) Other/unknown 1.04 (0.89 - 1.21) Any 5060 (1.4%) 5064 (1.4%) 1.00 (0.96 - 1.04) 99% or 95% CI 0.4 0.6 0.8 1 1.2 1.4 Statin/more better Control/less better

  5. My brief • Who should be on statins? • hypertensives • diabetics • IHD patient • peripheral vascular disease patients • If yes, should they be treated irrespective of their cholesterol level or only if it's abnormal. • Familial Hypercholesterolaemia. Diagnosis & treatment. • Why do we measure total cholesterol in some groups of patients and Chol:HDL ratio in others. YES to all YES

  6. Total Cholesterol or HDL:Chol ratio Ratio for risk assessment Total cholesterol for medicine management Framingham – men remaining IHD free in first 16 years of study

  7. Literature • Cochrane Library of Systematic Reviews has 14 reviews on statins and vascular disease • Medline (search on words in title) • Cholesterol AND heart 1257 • Statin AND coronary 449 • Statin AND heart 192 • Statin AND cholesterol 309 • Medline Reviews • Statin AND Systematic Review 1230 • Statin AND Meta-analysis 376

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