Long-term findings from a major statins trial have bewildered experts, showing that while they reduce all-cause mortality, they fail to significantly reduce cardiovascular deaths.
The findings from the Anglo-Scandinavian Cardiac Outcomes Trial - Lipid Lowering Arm (ASCOT-LLA) were presented at the European Society of Cardiology Congress 2011 meeting in Paris this week.
Jointly published in the European Heart Journal, they showed that patients randomised to atorvastatin (Lipitor) 10mg daily had a significant 14% reduction in all-cause mortality compared with those on placebo after an average of 11 years follow-up.
However, while atorvastatin was linked with 11% fewer cardiovascular deaths than placebo, this was not statistically significant.
The reduction in all-cause mortality was driven by a significant 15% reduction in non-cardiovascular related deaths in favour of atorvastatin, through fewer infections and respiratory illness.
However, an editorial conceded that an explanation for these long-term benefits on non-cardiovascular deaths was “not available.”
“Results from observational studies... suggest that statins may have a therapeutic role through pleiotrophic effects in the management of pneumonia and sepsis, although an explanation for a long-term carry-over effect has not been established,” the editorial said.
The ASCOT-LLA trial included more than 10,000 UK hypertensive patients with cholesterol levels less than 6.5mmol/L. It was stopped after 3.3 years due to a 36% relative risk reduction in non-fatal MI and fatal coronary heart disease in favour of atorvastatin.
Among patients originally assigned to atorvastatin, 84% were still taking statins after three years, however this was reduced to 67% at 5.5 years.
The editorialist said the finding that event rates in the atorvastatin group continued to decline after 5-years suggested “an important carry-over effect”.
European Heart Journal 2011; doi: 10.1093/eurheartj/ehr333
http://eurheartj.oxfordjournals.org/content/early/2011/08/26/eurheartj.ehr333.abstract
http://eurheartj.oxfordjournals.org/content/early/2011/08/26/eurheartj.ehr303.full.pdf+html