People in their forties should start taking statins if they are at risk of heart problems, according to new research.
Anyone with existing heart disease, no matter what age, should also begin taking the cholesterol-lowering treatment, say scientists.
The new study found people who stop taking statins early are significantly less likely to be well-protected against heart conditions later in life.
A research team from Queen Mary University of London looked at the effects of treatment with a standard 40mg daily dose of statin.
They estimated the effect of therapy versus no therapy in three scenarios- lifelong therapy, therapy that stopped when people turned 80 and therapy that began five years late among under-45s.
The benefit of statins was measured in quality-adjusted life years (QALYs) which is the length of life adjusted by health to reflect the quality of life. One QALY is equal to one year of life in perfect health.
Benefits were also reported separately according to baseline cardiovascular risk, which refers to the likelihood of having a heart attack or stroke in the next 10 years. It is based on age, blood pressure, cholesterol levels, smoking status, and medical conditions.
The team found a large part of the QALYs gained with statin therapy occurred later in life.
The higher someone’s risk of heart problems over 10 years, the bigger and earlier the gains from statins were.
Stopping therapy at the age of 80 erased much of the benefit from the fat-busting drugs, particularly among people at relatively low risk from heart conditions.
People who began taking statins at 50 and quit them at 80 lost 73 percent of the benefit in QALYs if they were at low risk and 36 percent of benefit in QALYs if they were at high risk.
The team said that the surprising finding can be explained by the fact people at high risk start taking the drugs earlier, ensuring they feel more of the benefits.
Women’s risk of heart conditions was found to be lower than men’s, which means women are more likely than men to suffer if the therapy is withdrawn early.
People under 45 with a high risk of heart problems lost seven percent of the potential QALY benefit from taking statins if they started the treatment five years late.
Under 45s at a lower risk lost two percent of the potential benefit from statins.
Heart disease is the world’s biggest killer and cause of ill health, and high cholesterol is a risk factor that can be changed by human behavior and medication.
There is strong evidence that cutting cholesterol with statins can slash the risk of coronary heart disease and stroke by a quarter.
Statins are the most commonly used fat-busting drug and it is estimated that they were taken by more than 145 million people in 2018.
The research team said that exaggerated claims about their side effects might mean that not enough people at risk of heart problems are taking them.
It is not yet known exactly when in life is the best time to start taking statins and how long people should keep taking them.
For the study, the researchers used computer models to estimate how beneficial statins are for people of different ages when they began taking them.
The team used data on 118,000 people who took part in large international statin trials from Cholesterol Treatment Trialists’ (CTT) Collaboration and 500,000 British people whose health data is stored in the UK Biobank.
The model used individual characteristics such as age, sex and disease history to simulate people’s annual risk from heart attacks, strokes, diabetes, cancer, vascular (blood vessel) death, nonvascular death and needing coronary revascularisation- a treatment that can restore blood flow to blocked veins and arteries.
Study lead author Dr. Runguo Wu said: “The study indicates that people in their forties 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. "
Dr. Wu added: “People at higher cardiovascular risk start to accrue benefits early on and have more to lose by delaying statin therapy than those at low risk.”
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