Statin treatment in midlife of no benefit to patients with established coronary atherosclerosis

The use of statins to reduce low‐density lipoprotein cholesterol (LDL‐C) levels in middle-aged individuals with established coronary atherosclerosis does not appear to restore a low cardiovascular disease (CVD) risk state, according to a study.

The analysis included 5,687 MESA (Multi‐Ethnic Study of Atherosclerosis) participants aged ≥50 years without CVD at baseline. These patients were grouped according to Adult Treatment Panel III statin treatment recommendation, statin treatment status (untreated [reference] vs treated), LDL‐C level (<100 [reference] vs ≥100 mg/dL; <100 mg/dL as reference), and coronary artery calcium (CAC) score (0 [reference] vs >0 Agatston units).

Compared with untreated individuals with LDL‐C <100 mg/dL, those who received statins and had LDL‐C <100 mg/dL tended to be older, comprise White and fewer Black and Hispanic participants, and have diabetes mellitus and be receiving antihypertensive medication. Meanwhile, the untreated/treatment recommended group and the treated/uncontrolled group were more likely to have more Black participants and fewer White participants, higher body mass index and systolic blood pressure, and more diabetes mellitus than the reference (untreated with LDL‐C <100 mg/dL) group.

Over 15 years of follow-up, a total of 567 coronary heart disease and 848 CVD events were documented. Multivariable Cox regression analysis showed that relative to the reference, the group of patients with statin‐treated LDL‐C <100 mg/dL had hazard ratios (HRs) for coronary heart disease and CVD or 1.16 (95 percent confidence interval [CI], 0.85–1.58) and 1.02 (95 percent CI, 0.78–1.32), respectively.

However, in the group of treated individuals with LDL‐C <100 mg/dL, those with CAC >0 Agatston units had even greater risks of coronary heart disease (HR, 2.6, 95 percent CI, 1.7–4.2) and CVD (HR, 1.8, 95 percent CI, 1.2–2.6).