Wider prescription of cholesterol-lowering drugs could reduce the rate of heart attack and stroke by at least a third, according to major research published today.
The group of drugs, called statins, are usually only given to people who have established heart disease and raised blood cholesterol.
New findings from the heart protection study, published in The Lancet, show that statins also reduce the risk of heart attack and stroke in people who have diabetes, arterial disease and in individuals who have previously had a stroke. Significantly, the benefits were seen even among these high- risk patients considered to have "normal" or "low" blood cholesterol levels.
The report says there should be new treatment guidelines because of the statins' effects.
Researchers, led by Dr Rory Collins from the University of Oxford's Clinical Trial Service Unit, studied over 20,000 adults aged 40-80 across Britain. The patients, who had diabetes or arterial disease, were randomly allocated to receive daily doses of 40 mg Simvastatin or a "dummy pill" (placebo) for five years.
Those who received the statin had a 25 per cent reduction in the risk of both fatal and non-fatal heart attacks, with a similar reduction in the risk of stroke. The treated group also required less curative procedures such as coronary angioplasty and cardiac bypass.
When the researchers made allowance for patients who were non-compliant with treatment, they estimated the statin regime would reduce the risk of heart attack and stroke by one third.
The study found that Simvastatin was well tolerated with no major side effects, and its benefits were additional to other cardiac preventive treatments such as aspirin, beta blockers and ACE inhibitors.
In the Republic, statins are available free to medical card holders; for others, the monthly cost of 40 mg of Simvastatin daily, before the chemist's fee, is about €40.
A separate arm of the heart protection study assessed the effects of using antioxidant vitamin supplements in people at high risk of vascular disease. Neither 600 mg of vitamin E, 250mg of vitamin C or 20 mg of beta-carotene, taken daily, produced any significant reduction in the five-year risk of heart attack or stroke. Cancer outcomes were also unaffected by vitamin consumption.
Commenting on the results, Dr Collins said: "The Heart Protection Study shows unequivocally that statins can produce substantial benefit in a very much wider range of high-risk people than had previously been thought. These new findings are relevant to the treatment of hundreds of millions of people worldwide."
He noted that among the many types of high-risk individuals treated, five years of therapy with Simvastatin would prevent 70 to 100 people per 1,000 from having a heart attack or stroke.
The editor of the Lancet, Dr Richard Horton, said: "These findings should tear up the rule-book on statin prescribing. They are the most important and far reaching results for the treatment and prevention of heart disease and stroke and should result in a dramatic change in clinical practice around the world."