Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Prof Colin Baigent discusses how the benefits outweigh the hazards of Cholesterol-lowering drugs.

Introduction to The Cholesterol Treatment Trialists Collaboration

Over the last decade or two, we have been very successful in reducing mortality from heart disease and strokes and part of that has been because we gradually developed better drugs and one of those drugs has been the statin class of drugs, which lowers cholesterol. Now, currently statins are used very widely in people with heart disease, and who have had a stroke. And they're also offered typically to people who are known to be at increased risk of heart attack or stroke. Typically, the threshold level is greater than 20% risk over about 10 years. And so that is the policy that we currently have. But the problem that we have is that over half of deaths from coronary disease silica in people who've had no previous problems and so it comes out of the blue. So if we're going to do better with that type of person, then we have to consider offering drugs for prevention to healthy people, and that was what we were aiming to look into with the current project.

The Study

We over the last 20 years have accumulated data from around 27 trials involving about 175,000 people and we have an unparalleled level of detail on each of the patients in these trials. What we were able to do was use that information to predict their risk of having a heart disease or stroke, within the trials. What we thought we would do with this particular project would be to try to look at the people with a very lowest risk of heart disease and stroke. So, we did some statistical calculations and subdivided people into those who are very lowest risk, those were slightly highest risk, and so forth until we got to the very highest risk people. All in all, there were five categories of people. What we then did was calculate how effective statin therapy was in each of those groups of people. So obviously, the very lowest risk people had no previous history of any heart disease or stroke and the very highest risk people had a history of vascular disease. What we discovered was that in the very lowest risk people statins were clearly effective, and possibly even more effective than they were in the highest risk people. And what we also discovered was that the benefits of statin therapy in those really lowest risk people was still very much bigger than any known hazards of therapy.

Outcomes from the Study

We think there has been quite a bit of confusion about whether statins are effective in people who are healthy. These data are incontrovertible evidence that statins are effective and they are safe, even at the very lowest risk people. It is very important to realise that somebody can be at increased risk of heart disease or stroke but actually have average cholesterol. And what we know from the trials is that people with average cholesterol, who are increased risk will be better off with lower cholesterol. So one very important piece of our research is the finding that reducing cholesterol is still effective in people with average cholesterol, if they are at increased risk for other reasons. And that has major implications for the way in which we use statin therapy in populations. Doctors are very fixated as are patients on the cholesterol number, but that's not where the action is. Actually, we need to be looking at somebody as risk, and treating risk by lowering cholesterol, irrespective or largely irrespective of what their cholesterol is. If we were to use statins more widely and offer them when people have a predictive risk of more than about 10% over 10 years so at 1% per year then that would bring into treatment around 5 million people aged 40 or over in the UK. And that could prevent each year, about 10,000, heart attacks and strokes, among which there will be around 2000 deaths. So it's really very beneficial treatment. We now know that these drugs are very safe. They increase the risk of muscle problems, of liver problems, but these problems go away when you stop taking treatment, and the risks are very small. We also know that rarely, very rarely, they cause bleeding into the brain, and they may cause an increased risk of diabetes, when compared to the benefits of taking statins these hazards are much much smaller than the benefits, even in people who are low risk of heart disease.

Conclusion

If we were to treat a wider range of people, then this evidence demonstrates really clearly that we could prevent more heart attacks and strokes in people who are currently healthy. We can stop many of these events that come out of the blue, and wreck lives, simply by using a cheap and effective and safe pill. And so we think it's very important that these results are taken seriously and considered widely not just in the UK, but around the world. Ultimately, our aim as researchers is to try to make a difference to public health. So I think the important message is not pride but the conviction that this type of research needs to happen and it needs to happen on a wider scale collaboration between doctors really does have the potential to make a difference to public health and we need to ensure that is possible. So the question now is what should public policy be? We think it's time for NICE and other organisations to review their guidelines and to think about whether it's appropriate for a wider range of people who are at increased risk of heart disease and stroke to be offered statin therapy.

Colin Baigent: Cholesterol-lowering drugs

Prof Colin Baigent discusses how the benefits outweigh the hazards of Cholesterol-lowering drugs.

This podcast presents the research done by Professor Colin Baigent whilst working in the Nuffield Department of Medicine. Professor Baigent now works at the Nuffield Department of Population Health.

The largest and most reliable study ever to examine the effect of statins has found them to reduce the risk of heart attacks, strokes and premature deaths among a wide range of apparently healthy people. The benefits greatly exceed any known risks associated with taking these drugs.

Read more in this BBC News article: NHS 'should consider giving statins to healthy people'

Read the press release

More podcasts related to Ex-faculty podcasts

Raghib Ali: INDOX Cancer Research Network

INDOX is a collaboration between Oxford and twelve leading cancer centres in India. It aims to develop effective and affordable cancer treatments in low and middle income countries, to improve the early detection of cancer, and to reduce the incidence of cancer by establishing the population specific risk factors.

Richard Antrobus: Universal Flu Vaccine

A Universal Flu Vaccine would protect against a wide range of strains of the virus. Universal vaccines target the parts of the virus that stay relatively stable and are the same between different strains of flu. The ultimate goal is to produce a vaccine that will eventually replace the normal seasonal flu jab.

Colin Baigent: Lowering cholesterol in chronic kidney disease

The SHARP study involved almost 9,500 volunteers aged 40 or over with chronic kidney disease recruited from 380 hospitals in 18 countries. Volunteers were randomly allocated to take either cholesterol-lowering therapy with a tablet containing ezetimibe 10mg daily and simvastatin 20mg daily, or matching dummy "placebo" tablets for an average of 5 years.

Paul Bowness: Spondyloarthritis

Spondyloarthritis describes a group of arthritic illnesses where there is inflammation of the joints of the lower back. Joints become painful and stiff, and inflammation ultimately fuses the spine. A better understanding of the role of various immune components might help us better prevent it and perhaps cure it.

Vincenzo Cerundolo: Cancer immunology

The development of therapeutic vaccines is more challenging. Current lines of research include the development of antibodies blocking inhibitory T cell signals, and the characterisation of adjuvants.

Hal Drakesmith: Iron and Infection

Pathogens can escape recognition by the immune system, but they require iron from their host to grow and spread. If iron availability is high, infection can progress more rapidly. Diverting iron away from invading microbes slows their growth, giving time for our immune mechanisms to clear the infection. Manipulating iron transport might lead to new strategies to combat infections.

Christian Eggeling: Nano-immunology

Super-resolution optical microscopy allows us to study immunological processes on the molecular level. We can get new insights into how our body reacts to viral or bacterial attacks. This has the potential to help us design new drugs and developing new ways of treating diseases.

Barbara Fielding: Metabolism of Fatty Acids

Obesity puts a huge strain on health care services in the UK, with 61% of people in England being overweight. By tracing fats containing heavy atoms from meals into the blood, her aim is to learn more about fat metabolism and target treatments for the complications associated with obesity and diabetes.

Alexander Finlayson: MedicineAfrica

This podcast presents the research done by Dr Alexander Finlayson whilst working in the Nuffield Department of Medicine. Dr Finlayson now works at the Nuffield Department of Population Health.

Jonathan Flint: Psychiatric Genetics

Every psychiatric disorder has a genetic contribution. Although anxiety and depression are very common diseases, current treatments are not very good. A better understanding of the contribution of genetic variants might help us better diagnose as well as develop new therapies.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.