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A photograph of a packet of statin tablets in a packet.

Researchers at Oxford Population Health have found that taking statins may be a cost-effective way to help prevent heart attacks and strokes in a wider group of people than previously thought. The study is published in The Lancet Regional Health - Europe.

Heart disease and strokes are leading causes of death and disability around the world. Statins can reduce the risk of heart attacks and strokes by lowering the levels of low-density lipid (LDL) or ‘bad’ cholesterol in the blood. Previous studies have shown that statins can safely reduce the risk of heart attacks and strokes by up to 25% for every 1mmol/L reduction in LDL cholesterol. Many health services around the world now recommend treatment with statins for people with a history of heart disease, people who are at high risk of developing heart disease, and people with high levels of LDL cholesterol.  

This study aimed to find out whether or not treatment with statins could also benefit a wider group of people who may not currently be considered for treatment. The study also looked at whether or not treating more people would be cost-effective. To find this out, the researchers used an analysis model that they had created using data from every participant in 16 large statins vs placebo trials that are part of the Cholesterol Treatment Trialists’ Collaboration.

The model works by taking into account each of the participants’ characteristics and predicts the influence of statin therapy on their risk of heart disease, their health-related quality of life, and an estimate of their health-related care costs over their lifetimes. The model also assesses the cost-effectiveness of treatment with statins for different groups of people.

The researchers assessed the value of treatment with statins for different groups of people. They applied the model to data from the over 500,000 UK Biobank participants. All of the participants were aged between 40 and 70 years old when their data and blood samples were collected.

Key findings:

  • Statins were found to improve health-related quality of life and were cost-effective for all people aged between 40 and 70 years old, even if they were at low-risk of heart disease;
  • People who are at low risk of heart disease but have high levels of LDL-cholesterol and do not currently take statins could see benefits from statins that are comparable to those seen by people who are currently recommended for treatment and this would be cost-effective;
  • Higher doses of statins were found to increase the benefits further and were cost-effective in people who are at an increased risk of heart disease or have higher levels of LDL cholesterol;
  • The highest benefits were seen in people who started taking statins sooner and more consistently.

Borislava Mihaylova, Associate Professor and Senior Health Economist at Oxford Population Health, said ‘Many people around the world are suffering from preventable heart disease due to lack of access to proven, low-cost treatments such as statins. The results of our study demonstrate that strengthening and widening access to statins could cost-effectively improve overall health for more people than those who are currently recommended to receive treatment. This evidence will be highly informative not only for future guidelines for prescribing statins but also in shared decision-making consultations between clinicians and patients where treatment effectiveness, adverse effects, and the patient’s preferences are discussed.’

The researchers note that while the results show that statins can be beneficial and cost-effective for treating a wider group of people, it is unclear whether or not current health services would be able to expand provision of statins and still maintain the current costs of starting and monitoring treatment. They also suggest that future research may shed more light on the effects of statins in both older and younger populations.

This study was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment funding portfolio.