Statins appear to improve mortality in patients with high BP but no other CVD, diabetes
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Key takeaways:
- Statin therapy may reduce risk for all-cause and CV death among patients with hypertension and no other CVD or diabetes.
- Statins lowered heart attack risk for women but not men.
Statin use for primary prevention was associated with reduced risk for all-cause and CV death among patients with hypertension and no other CVD or diabetes vs. matched controls not on statin therapy, researchers reported.
In addition, the researchers reported a reduced risk for MI among women on statin therapy for primary prevention, an interaction not observed among men, according to data published in the European Journal of Preventive Cardiology.
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“In Sweden, the prevalence of hypertension has been estimated to 27%, and a recent publication reported an increased proportion of individuals with hypertension reaching the < 140/90 mm Hg target from 39% to 49% between 2010 and 2017,” Tobias Andersson, MD, PhD, research affiliate in primary health care at the school of public health and community medicine, institute of medicine, at Sahlgrenska Academy, University of Gothenburg in Gothenburg, Sweden, and colleagues wrote. “The decision to initiate statin therapy as primary prevention involves assessing the individual’s cardiovascular risk from objective clinical data ... but also patients’ and doctors’ individual preferences and beliefs. Hence, as there is no strong policy to initiate primary prevention statin treatment in individuals with hypertension but without other cardiovascular disease or diabetes, some of these individuals will receive treatment whereas others with the same level of risk will not, thus resulting in the set-up of a natural experiment.”
Andersson and colleagues used the Swedish primary care quality assurance register, QregPV, to evaluate the effect of statins on all-cause mortality, CV mortality, MI and stroke among 13,193 patients with hypertension and no other CVDs or diabetes (mean age, 61 years; 53% women) compared with matched controls not on a statin.
The mean LDL was 4.57 mmol/L and mean systolic BP was 141.7 mm Hg.
During a median follow-up of 4.2 years, the researchers reported significantly reduced risk for all-cause mortality (HR = 0.83; 95% CI, 0.74-0.93) and CV mortality (HR = 0.85; 95% CI, 0.72-0.998) among statin-treated patients with hypertension compared with matched controls.
Andersson and colleagues observed no significant impact of statins on risk for MI or stroke; however, they did report a significant interaction by sex (P = .008), with a lower risk for MI observed among women and not men (HR for women = 0.66; 95% CI, 0.49-0.88; HR for men = 1.09; 95% CI, 0.86-1.38; P for interaction = .008).
From study inclusion to 7 years follow-up, patient adherence to statin therapy decreased from approximately 84.1% to 61.9%
“Our study suggests that statin use in a hypertensive primary care population without CVD or diabetes is beneficial to reduce the risk of all-cause and cardiovascular mortality, and in women myocardial infarction. Given the low yearly cost of treating one person with a statin in Sweden ... even a high [number needed to treat] would result in a relatively low cost to prevent one clinical outcome,” the researchers wrote. “Poor adherence to statins has been well-documented despite its positive effects on reducing the burden of cardiovascular disease. To address this, the balance between benefits vs. potential harm need to be discussed in the doctor-patient meeting before starting primary prevention with statins.”
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