Friday, January 18, 2008


I have long been intrigued by the role of statins in the management of CAD. This must arguably be one of the most studied drug in the history of medicine. Since the beginning of this new year, two more big studies have emerged. In the Jan 1 issue of Journal of American College of Cardiology, Dr Jonathan Afilalo from McGills Uni, Montreal Canada, published a meta-analysis of 9 big statin trials with a combined population of about 20,000 patients. I am certain that with such a large cohort, even if it is a meta-analysis, some conclusions can be derived. They included in their population, patients within the age group of 65-82 years, as they wanted to see if statins given to the elderly confer any benefit. Well, it did. There was a 22% reduction in all cause mortality. Of course all the cardiac indices were also better, including reductions in cardiac mortality, need for revascularisation, fatal and non-fatal MI, and even strokes. All the reductions were in the 22-30% range. Of course, not to be outdone, the workers across the big pond form ed a group called the " Cholesterol Treatment Trialist ( CTT ) collaboration. I suppose it is not unlike the Aspirin Trialist collaboration of the 80s, to pull together all the cholesterol trials, so that the data can be re-analyse with certain endpoints in mind. In the case of the CTT collaboration, they have just published their meta-analysis of 14 large cholesterol trials, on the use of Statins in the diabetic population, to see if it is of any benefit. Well such a large number ( 18,686 patients ) in their cohort, any benefit becomes very obvious. Their results were published in the Jan 11 issue of Lancet. Of course it showed that statins benefitted diabetics, be it type 1 or type 2. The benefits ranged from 9% ( reduction in all cause mortality ) to 13% ( reduction in all the usual cardiac indices including strokes ). Well there you are. 2008 brings with it more good news. That statins help patients with heart disease, even the elderly ( those above 70yrs ) and also diabetics. I suppose soon we will see some meta-analysis on the benefits of statins in those without CAD, as I believe that there are enough statin trials in primary prevention, to give us those numbers. Another point worth mention, as an observation, is that looks like there will no longer be prospective statin trials, partly because many statins are off patent, and partly because the benefits of stains are so obvious and significant that it have become unethical to run statin trials with some patients on placebo. So for very many reasons, we will see large meta-analysis with endpoints defined by the research group. I suppose by doing that, we also save some R&D money, and products can remain competitive in pricing.

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