Do statins (HMG-CoA reductase inhibitors) prevent heart attacks?

From the Guidelines

Yes, statins do prevent heart attacks in many people, as evidenced by a recent meta-analysis of twenty-eight trials including 186,854 participants, which showed a 21% drop in major vascular events for every 1 mM drop in LDL-cholesterol 1.

Key Points to Consider

• Statins reduce the risk of heart attacks by lowering LDL cholesterol levels in the blood, and are most beneficial for people with established cardiovascular disease, diabetes, high cholesterol levels, or multiple risk factors for heart disease.
• The typical starting doses range from 10-40mg daily depending on the specific statin, with adjustments based on cholesterol response and side effect tolerance.
• Statins work by inhibiting HMG-CoA reductase, an enzyme crucial for cholesterol production in the liver, which leads to increased removal of LDL cholesterol from the bloodstream.
• Beyond cholesterol lowering, statins also have anti-inflammatory effects and help stabilize arterial plaques, further reducing heart attack risk.
• While generally safe, some patients may experience muscle pain, and rarely, more serious side effects, so discussing individual risk factors with a healthcare provider is essential before starting treatment.

Important Considerations

• The USPSTF found adequate evidence that use of low- to moderate-dose statins reduces the probability of CVD events (MI or ischemic stroke) and mortality by at least a moderate amount in adults aged 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 10% or greater 1.
• A study found that statin use can modestly retard the progression of asymptomatic carotid atherosclerosis, and trials using these agents have demonstrated consistent benefits in reduction of stroke risk among individuals with coronary artery disease and elevated cholesterol levels 1.

From the FDA Drug Label

To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD Simvastatin significantly reduced the risk for the secondary composite endpoint (time to first occurrence of CHD death, definite or probable hospital verified non-fatal MI, silent MI verified by ECG, or resuscitated cardiac arrest) by 34% The risk of having a hospital-verified non-fatal MI was reduced by 37% Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD.

Statins prevent heart attacks by reducing the risk of myocardial infarction (MI) in adults with multiple risk factors for coronary heart disease (CHD).

• The risk of having a hospital-verified non-fatal MI was reduced by 37% in patients treated with simvastatin.
• Simvastatin significantly reduced the risk for the secondary composite endpoint, including non-fatal MI, by 34%.
• Atorvastatin is indicated to reduce the risk of MI, stroke, revascularization procedures, and angina in adults with multiple risk factors for CHD. 2 3

From the Research

Statins and Heart Attack Prevention

• Statins, also known as HMG-CoA reductase inhibitors, are a class of drugs commonly used to lower cholesterol levels in the blood 4.
• The primary cause of global morbidity and mortality is cardiovascular disease (CVD), which includes conditions such as myocardial infarction, stroke, and peripheral arterial diseases 4.
• Atherosclerosis plays a principal role in the pathogenesis of these conditions, and statins are used to reduce plasma cholesterol levels, thereby reducing the risk of heart attacks 4, 5.

Mechanism of Action

• Statins work by inhibiting the synthesis of cholesterol in the liver, which in turn reduces the amount of low-density lipoprotein (LDL) cholesterol in the blood 6, 7.
• Ezetimibe, a cholesterol absorption inhibitor, can be used in combination with statins to further reduce LDL cholesterol levels 5, 6.
• The combination of statins and ezetimibe has been shown to reduce remnant cholesterol and improve the ratio of high-density to low-density lipoproteins, which can help prevent heart attacks 5, 8.

Clinical Evidence

• Studies have demonstrated that statins can reduce the risk of cardiovascular events, including heart attacks, in patients with high cholesterol levels 4, 5.
• The addition of ezetimibe to statin therapy has been shown to provide additional reduction in cardiovascular events, particularly in patients with type 2 diabetes mellitus 5.
• Clinical trials have consistently shown that statins, alone or in combination with ezetimibe, can reduce the risk of heart attacks and other cardiovascular events 5, 7, 8.