Japan: are statins still good for everybody?

摘要

Use of statins has become almost mandatory in a range of disorders, from coronary heart disease to ischaemic cerebrovascular disease, and several other high-risk conditions, such as diabetes and hypertension.1-3 Although the guidelines for risk assessment have been somewhat softened-eg, the coronary heart disease risk equivalence of diabetes4-the tendency to widen statin indications still remains.Despite the widened indications, some questions about primary risk prevention remain open. Women are poorly represented in most studies and generally achieve a lower risk-reduction than men, frequently not reaching statistical significance.5 Another example is individuals at low risk-eg, Japanese, in whom the need for cholesterol-lowering drugs might possibly seem overstated.A formal answer from Japan comes from the MEGA trial in today's Lancet.6 Haruo Nakamura and colleagues did a randomised open-label study, investigating pravastatin (10-20 mg per day) added to a low-lipid diet in primary prevention in individuals with moderate hypercholesterolemia (5-69-6-98 mmol/L). Of about 8000 participants, 70% were women. The study provided overall positive results, reaching the gold standard of about 30% reduction in the diet plus pravastatin group versus the diet only group, with a coronary heart disease endpoint. This risk reduction occurred despite modest total and LDL cholesterol lowering by attributable reductions of 9-4% and 14-8% respectively, after drug treatment.