Do statins reduce the risk of myocardial infarction or stroke compared to placebo?

From the Guidelines

Statins significantly reduce the risk of myocardial infarction and stroke compared to placebo, with a approximately 21% reduction in cardiovascular disease events per 1-mmol/L LDL-C reduction. This is based on the strongest and most recent evidence from the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1. The benefits of statins are seen in both primary and secondary prevention, with reductions in major coronary events, nonfatal myocardial infarction, and total mortality. Key points to consider when prescribing statins include:

• The dose of statins can range from 10 to 80 mg daily, depending on the specific medication and patient factors
• Treatment is usually long-term, often lifelong, to maintain cardiovascular risk reduction
• Statins should be taken consistently, usually in the evening for most types
• Regular lipid panel monitoring (every 3-12 months) is recommended to assess efficacy and adjust dosage if needed
• Statins work by inhibiting HMG-CoA reductase, leading to decreased LDL cholesterol production and increased LDL receptor expression, resulting in lower circulating LDL levels
• Pleiotropic effects of statins, including improving endothelial function and reducing inflammation, contribute to their cardiovascular protective effects beyond just lowering cholesterol. The evidence from the 2013 ACC/AHA guideline 1 supports the use of statins in reducing the risk of myocardial infarction and stroke, with a significant reduction in cardiovascular disease events. In adults with and without cardiovascular disease, statin therapy reduces the risk of cardiovascular events, including myocardial infarction and stroke, with approximately 22% reductions in cardiovascular disease risk across baseline LDL-C levels 1. Overall, the use of statins is a crucial component of cardiovascular disease prevention and treatment, and their benefits in reducing the risk of myocardial infarction and stroke are well established.

From the FDA Drug Label

Rosuvastatin significantly reduced the risk of major CV events (252 events in the placebo group vs. 142 events in the rosuvastatin group) with a statistically significant (p<0. 001) relative risk reduction of 44% and absolute risk reduction of 1. 2% Rosuvastatin significantly reduced the risk of nonfatal myocardial infarction, nonfatal stroke, and arterial revascularization procedures. Rosuvastatin significantly reduced the risk of myocardial infarction (6 fatal events and 62 nonfatal events in placebo-treated subjects vs. 9 fatal events and 22 nonfatal events in rosuvastatin-treated subjects) and the risk of stroke (6 fatal events and 58 nonfatal events in placebo-treated subjects vs. 3 fatal events and 30 nonfatal events in rosuvastatin-treated subjects)

Key Findings:

• Rosuvastatin reduces the risk of myocardial infarction and stroke compared to placebo.
• The relative risk reduction for major CV events was 44% and the absolute risk reduction was 1.2%.
• The risk reduction for nonfatal myocardial infarction and nonfatal stroke was statistically significant. 2

From the Research

Statin Efficacy in Reducing Myocardial Infarction and Stroke Risk

• Statins have been shown to reduce the risk of myocardial infarction (MI) in patients with heart failure, with a hazard ratio of 0.81 (95% confidence interval 0.66-0.99, P < 0.05) compared to placebo 3.
• In patients with cerebrovascular disease, statins may increase the risk of hemorrhagic stroke, but they clearly produce a greater reduction in the risk of atherothrombotic stroke and thus total stroke, as well as other cardiovascular events 4.
• Atorvastatin has been found to reduce the relative risk of primary coronary heart disease events by 36% (p = 0.0005) compared with placebo in patients with hypertension, and has also demonstrated secondary preventive benefits in various clinical settings 5.
• High-intensity statin therapy has been associated with a non-significant decrease in major adverse cardiovascular events (death, stroke or recurrent myocardial infarction) at 5 years in the overall population, but with lower mortality only in high-risk patients (hazard ratio 0.79,95% confidence interval 0.64-0.97; P = 0.02) 6.

Comparison to Placebo

• Rosuvastatin decreased the risk for myocardial infarction among patients with ischemic heart failure randomized to rosuvastatin vs. placebo, with no significant differences in risks for stroke or death from other causes 3.
• Atorvastatin reduced the risk of nonfatal myocardial infarction by 17-22% (p < or = 0.02) compared to simvastatin or low-dosage atorvastatin in patients with stable coronary heart disease 5.
• High-intensity statin therapy was associated with a decrease in major adverse cardiovascular events at 5 years compared to intermediate- or low-intensity statins or without a statin prescription, although the difference was not significant (hazard ratio 0.94,95% confidence interval 0.81-1.09; P = 0.42) 6.

Patient Subgroups

• Patients with ischemic heart failure may benefit from statin therapy, with a decreased risk of myocardial infarction (hazard ratio 0.81,95% confidence interval 0.66-0.99, P < 0.05) 3.
• High-risk patients, as defined by the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P), may derive the greatest benefit from high-intensity statin therapy, with a lower mortality rate (hazard ratio 0.79,95% confidence interval 0.64-0.97; P = 0.02) 6.
• Patients with cerebrovascular disease may require careful consideration of the benefits and risks of statin therapy, as they may be at increased risk of hemorrhagic stroke 4.