Statins aren’t the only way to lower cholesterol and reduce risk for heart events, according to a recent analysis that found similar cardiovascular benefits among statins, non-statin therapies and even lifestyle changes.
Published in the Journal of the American Medical Association, this study looked at the association between various cholesterol-lowering therapies and cardiovascular risk.
Low-density lipoprotein, often referred to as LDL or “bad” cholesterol, is a well-known risk factor for heart disease. Reducing LDL is critical to good health and cholesterol-lowering statins are often the go-to choice for most patients. Not only have they been around for decades, statins are extremely effective in reducing cholesterol and cardiovascular risk. The 2013 guidelines from the American College of Cardiology and American Heart Association emphasize the use of statins to lower LDL cholesterol. However, with new research on cholesterol-lowering therapies, experts wonder if we should consider other therapies for lowering cholesterol and risk for heart disease.
To learn more, researchers analyzed data from 49 clinical trials that included more than 312,000 participants with high cholesterol. These studies tested various cholesterol-lowering therapies, ranging from a heart-healthy diet to statins, other cholesterol-lowering drugs like ezetimibe and bile acid sequestrants and even ileal bypass surgery which shortens the length of the intestine to help reduce cholesterol levels. Each trial followed participants for a minimum of six months, collecting data on cholesterol levels and heart events like heart attack and stroke.
After analysis, researchers found that it’s not how patients achieve lower cholesterol levels but whether the cholesterol is lowered that really matters. For patients on statins, every 1 millimole per liter (mmol/L) decrease in LDL cholesterol levels was associated with 25% lower risk for heart events. Similarly, every 1 mmol/L reduction among patients on non-statin therapies was associated with 23% lower risk for heart events.
The take-home message, according to authors, is that statins are not the only option for lowering cholesterol levels. Regardless of the method used, reductions in LDL cholesterol were significantly associated with decreased risk for heart events. So rather than pushing one therapy over another, experts explain that the focus should be reducing LDL cholesterol with the best-possible method for each patient.
Of course, authors also acknowledge that additional research is needed to confirm recent findings before updating to guidelines. But a recent statement from the American College of Cardiology recommended considering adding non-statin therapies to lower LDL cholesterol, rather than focusing on statins alone. With additional research, it’s likely that future guidelines may incorporate different strategies to help patients lower cholesterol and reduce risk for heart disease.