Four in five high risk patients on statins still have high cholesterol

Four in five high-risk patients taking statins for cardiovascular disease still have high cholesterol and may need higher doses or new injectable treatments, study finds

  • Researchers examined data on thousands of European cardiovascular patients
  • They found just one in five high-risk patients on statins had lower cholesterol 
  • A combination of new cholesterol treatments and lifestyle changes can help 

About 80 per cent of high-risk patients taking statins for cardiovascular disease still have high cholesterol and may need higher doses of the medication, a study finds. 

Researchers from Imperial College London analysed the findings of a major study of cardiovascular patients in 18 European countries including the UK.

Those at the highest risk of cardiovascular ‘events’ – such as a heart attack or stroke – may benefit from higher doses or injectable versions of cholesterol therapies. 

Scientists say although statins are a ‘first line treatment’, when used alone they will not help the majority of European patients achieve their cholesterol goals. 

They found that if high-risk patients take a combination of cholesterol drugs can cut the risk of heart attacks by 11 per cent and the risk of death by 5 per cent. 

Researchers from Imperial College London analysed the findings of a major study of cardiovascular patients in 18 European countries including the UK. Stock image

Lead study author Professor Kausik Ray, of Imperial College London, said a global approach was needed to tackle the burden of cardiovascular disease.

‘After diet and lifestyle, cholesterol lowering with medications is a key approach to lowering risk of heart disease and strokes,’ Ray explained.

‘Based on trial data we have compelling evidence that lower cholesterol levels benefit those at highest risk particularly.’

The findings show a gap between current clinical guidelines and clinical practice for cholesterol management across Europe.

The researchers explained that even among patients who are already receiving optimal doses of statins, greater use of other non-stain cholesterol-lowering drugs could help to further reduce cholesterol levels. 

‘Though statins are first line treatment, it is clear from our contemporary study that statins alone even when optimally used will not help the majority of patients achieve European Society of Cardiology cholesterol goals,’ Ray said.

‘Only one in five very-high risk patients achieve 2019 recommended goals and to improve this will require use of combination therapy of more than one drug.

‘Currently less than ten per cent of very-high risk patients in Europe receive some form of combination therapy, nine per cent with ezetimibe and one per cent with PCSK9 inhibitors.’

Scientists say although statins are ‘first line treatment’, when used alone they will not help the majority of European patients achieve their cholesterol goals. Stock image

High levels of so-called ‘bad’ cholesterol in the blood, or low-density lipoprotein (LDL) cholesterol, are a known risk factor for cardiovascular disease.

CHOLESTEROL: A FATTY SUBSTANCE VITAL TO THE FUNCTIONING OF THE HUMAN BODY 

Cholesterol is a fatty substance that is vital for the normal functioning of the body.

But too much can cause it to build up in the arteries, restricting blood flow to the heart, brain and rest of the body.

This raises the risk of angina, heart attacks, stroke and blood clots. 

Cholesterol is made in the liver and is carried in the blood by proteins.

The first – high-density lipoprotein (HDL) – carries cholesterol from cells to the liver where it is broken down or passed as waste. This is ‘good cholesterol’.

‘Bad cholesterol’ – low-density lipoprotein (LDL) – carries cholesterol to cells, with excessive amounts then building in the artery walls.

High cholesterol can be genetic but it is also linked to a diet rich in saturated fat, as well as smoking, diabetes, high blood pressure and a family history of stroke or heart disease. 

Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.

A healthy adult’s overall level should be 5mmol/L or less, while their LDL level should be no more than 3mmol/L. An ideal level of HDL is above 1mmol/L.

Cholesterol can be lowered by eating a healthy, low-fat diet; not smoking; and exercising regularly.

If these do not help, cholesterol-lowering medication like statins may be prescribed.

Source: NHS   

While diet and lifestyle are important factors in reducing ‘bad’ cholesterol, many patients are at increased risk.

This includes those with diabetes, inherited conditions or who have previously had heart attack or stroke and are prescribed cholesterol-lowering drugs, like statins, to reduce their cholesterol.

But a number of other classes of cholesterol-lowering drugs are available, which act on different elements of the body’s cholesterol-metabolism.

‘These treatments, such as ezetimibe, bempedoic acid, or PCSK9 inhibitors, can be used in combination with statins to further reduce LDL-cholesterol levels,’ Ray said.

In the new study, researchers looked at 5,888 patients across Europe who were prescribed lipid-lowering therapies and provided information about themselves.

Information included lifestyle factors, previous cardiovascular events such as heart attack or stroke, measures of their current LDL cholesterol levels and any current lipid-lowering medications.

Guidelines recommend statins as first-line treatment for lowering LDL cholesterol.

The guidance also recommends goals based on risk groupings, such as a target of 50 per cent reduction in LDL-C levels in very-high risk patients.

In the new study, the team reviewed how lipid-lowering therapies were used in primary and secondary care.

They found more than four in five patients received statins as their primary lipid-lowering therapy only – with no other medication. 

Overall, less than half of patients were achieving the most recent cholesterol-lowering goals set out by guidelines. 

The findings highlight the potential for combinations of lipid lowering drugs to help close the gap and reduce the risk for millions of patients across Europe.

Professor Ray added: ‘Over the last 15 years we have seen improvements in guideline implementation and control of cardiovascular risk factors.

‘These were based on better first line treatment such as statins.

‘Now, with lowering of cholesterol goals, our data suggest this will not be enough and we need to think about cholesterol in the same way as we look at blood pressure where often combinations of treatments are needed to optimise targets.’  

The findings are due to be presented at the virtual meeting of the European Society of Cardiology.  

High blood pressure can ruin your love life – but new study shows taking hypertension pills can put it back on track 

Taking medication to treat high blood pressure doesn’t reduce blood flow to the penis, a new study found.

However, men with untreated hypertension do have poorer blood flow and reduced sexual performance, according to the European Society of Cardiology study.

The new research examined the impact of hypertension medication on penile performance to find out just how big of an impact it has.

It comes after studies found men were not taking their pills due to a perceived ‘reduced performance’ side effect in the bedroom.

Men with untreated hypertension do have poorer blood flow and reduced sexual performance, according to the European Society of Cardiology study. Stock image

The results provide reassurance to men concerned about the effects of blood pressure-lowering medications.

Hypertension affects more than one billion people worldwide and is the leading cause of premature death.

Doctors advise a healthy lifestyle including reduces salt and alcohol, exercise, weight loss and no smoking – most also require medication.

Around half of patients do not take their pills, researchers claim, with many saying the risk of sexual dysfunction causing them to stop.

Men with hypertension are almost twice as likely to have erectile dysfunction compared to men with normal blood pressure, the team found.

Erectile dysfunction is a warning sign of damaged blood vessels.

However, previous studies have shown that erectile dysfunction is more common in treated, than untreated, men with high blood pressure.  

This study examined the association between blood pressure level and penile blood flow, and whether blood pressure-lowering medication had an effect on the relationship.  

Among men not receiving anti-hypertensive medication, penile blood flow velocity progressively decreased with rising blood pressure.   

Professor Charalambos Vlachopoulos of the National and Kapodistrian University of Athens, Greece led the new study that included more than 300 volunteers with hypertension.

He said: ‘These results imply that hypertensive patients already have significant structural damage in the penile arteries and adding antihypertensive drugs does not further reduce penile blood flow.’

He urged men with concerns about sexual dysfunction to discuss it with their doctor before stopping medication.

Professor Vlachopoulos noted that changing hypertensive medications in men with erectile dysfunction must be handled with caution.  

Professor Vlachopoulos concluded: ‘Our study shows that high blood pressure can be treated without causing erectile dysfunction.

‘Patients and doctors need to have open discussions to find the best treatment option.’

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