Statins for Long-Term Primary Prevention

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The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
• Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
• Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
• Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

The guidelines have made statin therapy easier to initiate now, in Robinson’s opinion, because there is no number to remember; all you have to do is remember “high-intensity statin.” And when statin therapy is used for 5 years, as was the case in the West of Scotland Coronary Prevention Study (WOSCOPS), its primary prevention benefits can persist for 20 years, with long-term prevention of heart attack, stroke, and death. Robinson said, “That’s pretty darn exciting because we’re taking people who otherwise probably would have been dead because these people had high cholesterol…who are still alive and we really reduced their risk.”

Aside from lowering LDL levels, Watson said that, as in WOSCOPS, statin therapy has many other beneficial effects, such as lowering C-reactive protein levels, so it is “not just a cholesterol-lowering drug, but a really all-around good atherosclerotic treatment.” It is directly causal in the atherosclerotic pathway, lowering cholesterol, stabilizing plaque, making the endothelium healthier, and serving as an anti-thrombotic. Ballantyne added that statins lower atherogenic lipoproteins, apoB, and they raise HDL levels. He posited that lowering LDL is the most compelling theory about how statins work, since events increase with an increase in LDL and decrease with a decrease in LDL.