Modeling Study Sheds Light on Benefits on Lifelong Statin Therapy

Runguo Wu, MSc, PhD

New research presented at the European Society of Cardiology (ESC) 2022 Congress is underlining the potential benefits accrued from long-term statin therapy in individuals with increased cardiovascular disease risk.

Results of the modeling study, which leveraged a newly developed microsimulation model using data from the UK Biobank and Cholesterol Treatment Trialists’ (CTT) Collaboration cohorts, provide insight into the benefits of lifelong statin therapy, impact of discontinuation at 80 years of age, and the impact of delayed initiation in those aged 45 years of age.

“The study indicates that people in their 40s with a high likelihood of developing cardiovascular disease, and people of all ages with existing heart disease, should be considered for immediate initiation of cholesterol-lowering treatment. Stopping treatment, unless advised by a doctor, does not appear to be a wise choice,” said lead investigator Runguo Wu, MSc, PhD, a health economist at the Wolfson Institute of Population Health at Queen Mary University of London, in a statement from the ESC.

Due to their low cost, heightened availability, and proven risk reduction benefit, the emphasis on statin use for primary prevention has ballooned in recent years. Citing a lack of conclusive research outlining optimal strategies for initiation and duration of statin therapy, Wu and a team of colleagues sought to explore the accrual of benefits with statin use using a microsimulation model.

The microsimulation model, named the UKB-CTT model, was developed using data from the UK Biobank and CTT cohorts and used individual characteristics and disease histories to simulate the annual risk of heart attack, stroke, coronary revascularization, diabetes, cancer, vascular death, and nonvascular death for each participant. Using the model, investigators planned to estimate the effects of statin use among 44,412 individuals without previous cardiovascular disease and 13,061 individuals with a history of cardiovascular disease from the UK Biobank cohort. Investigators pointed out a 40 mg daily dose of atorvastatin was used to assess the effect of use against nonuse for lifelong therapy, if therapy was discontinued at 80 years of age, and if statin use was delayed by 5 years among those aged 45 years of age. Investigators also noted the benefits of statin therapy were measured in quality-adjusted life years (QALYs).

Upon analysis, results provide evidence demonstrating the incremental accrual of benefits from statin use over time, with the majority of benefits accruing later in life. Results suggested men accumulated larger benefits and earlier the women. Further analysis indicated the pattern of benefits actual was similar among individuals with and without a history of cardiovascular disease. When assessing the impact of early discontinuation, results indicated discontinuation at 80 years of age resulted in a notable reduction in overall benefits from statin therapy, particularly among women and those with a lower cardiovascular disease risk.

In their abstract, investigators highlighted the potential losses of QALYs benefit observed in their analyses among people with no history of cardiovascular who initiate therapy in their 50s and discontinue therapy in their 80s compared to lifelong statin use, with a 47% loss in QALYs benefit among men, a 66% loss among women, a 73% loss among those with a 10-year cardiovascular disease risk of 5% or less, and a 35% loss among those with a 10-year risk of 20% or greater. Investigators also pointed out each 5-year delay in initiation beyond in patients less than 45 years of age was associated with a 4% reduction in benefits, with this loss greater among those with higher cardiovascular disease risk.

“Our study suggests that people who start taking statins in their 50s but stop at 80 years of age instead of continuing lifelong will lose 73% of the QALY benefit if they are at relatively low cardiovascular risk and 36% if they are at high cardiovascular risk – since those at elevated risk start to benefit earlier. Women’s cardiovascular risk is generally lower than men’s,” Wu added, in the aforementioned statement. “This means that for women, most of the lifelong benefit from statins occurs later in life and stopping therapy prematurely is likely more detrimental than for men.”

This study, “Benefit accrual with cardiovascular disease prevention and effects of discontinuation: a modelling study,” was presented at ESC Congress 2022.