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Dates: 2008 -
Funding: British Heart Foundation (BHF) 2008 - 2010, NIHR HTA 2019 -

Clinical Trial Service Unit (CTSU), University of Oxford

Centre for Primary Care and Public Health, Queen Mary University of London

Further Information: Boby Mihaylova

Cholesterol lowering statin therapy reduces heart attacks and strokes, saves lives, and is considered good value for people at high risk. In our work on the Heart Protection Study we showed that lifelong treatment of people at much lower cardiovascular risk than 2% per annum recommended for treatment at the time may still be cost-effective (see the Heart Protection Study).  In these further projects we use data from large statin trials, from the Cholesterol Treatment Trialists' Collaboration (CTT), to produce evidence about the effectiveness and cost-effectiveness of statin regimens for categories of people by age, sex and risk of cardiovascular disease. We reported clear evidence for reduction in cardiovascular risk in people at relatively low-risk of cardiovascular disease with LDL-cholesterol lowering with statins (Lancet 2012, 380:581-90), in women (Lancet 2015, 385:1397-405), in people with reduced kidney function (Lancet Diabetes and Endocrinology 2016, 4: 829–39) and in older people (Lancet 2019, 393: 407–15). These results have had substantial impact on widening recommendations for the use of statins to people at much lower risk than previously recommended and strengthening evidence and recommendations in other categories of people.

Work is underway at present to evaluate the lifetime cost-effectiveness of LDL-cholesterol reduction with statin regimen of different intensity in different categories of people. The study will use the Cholesterol Treatment Trialists’ (CTT) Collaboration database, the UK Biobank study and the Whitehall II study to develop a reliable computer model that will predict future heart attacks, strokes and deaths and effects of statins on these and other disease events in categories of people. We will use this model to calculate people’s life expectancy, their quality of life, and the costs of healthcare, with and without use of statin therapy. We expect our findings to directly inform future statin guidance.


Cholesterol Treatment Trialists’ (CTT) Collaboration (Writing committee: Fulcher, J, Mihaylova, B, O'Connell, R, Emberson, J, Blackwell, L, Reith, C, Koren, M, Tonkin, A, Ridker PM, Barnes,  VE,  Ford, I, Packard, CJ, Lonn, E, Wanner, C, Koenig, W, Gotto, AM, Kjekshus, J, Yusuf, S, Collins, R,  Simes, J, Baigent, C,  Keech, A) (2019). Efficacy and safety of statin therapy in older people: meta-analysis of individual participant data from 28 randomised controlled trials. Lancet, 393: 407–15

Cholesterol Treatment Trialists’ (CTT) Collaboration (Writing committee: Herrington, W, Emberson, J, Mihaylova, B, Blackwell, L, Reith, C, Solbu, MD, Mark, PB, Fellström, B, Jardine, AG, Wanner, C,  Holdaas, H, Fulcher, J, Haynes, R, Landray, MJ, Keech, A, Simes, J, Collins, R, Baigent, C) (2016). Impact of renal function on the effects of reducing LDL cholesterol with statin-based regimens: meta-analysis of individual data from 28 randomised trials. Lancet Diabetes and Endocrinology, 4: 829–39.

Reith C, Blackwell L, Emberson J, Mihaylova B, Armitage J, Fulcher J, Keech A, Simes J, Baigent C, Collins,R (2016). Protocol for analyses of adverse event data from randomized controlled trials of statin therapy. American Heart Journal, 176:63-9.

Cholesterol Treatment Trialists’ (CTT) Collaboration (Writing Committee), Fulcher, J, O'Connell, R, Voysey, M, Emberson, J, Blackwell, L, Mihaylova, B, Simes, J, Collins, R, Kirby, A, Colhoun, H, Braunwald, E, La Rosa, J, Pedersen, T, Tonkin, A, Davis, B, Sleight, P, Franzosi, M, Baigent, C, and Keech, A (2015). Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials. Lancet (doi:10.1016/S0140-6736(14)61368-4).

Cholesterol Treatment Trialists’ (CTT) collaborators (Writing committee: Mihaylova, B, Emberson, J, Blackwell, L, Keech, A, Simes, J, Barnes, EH, Voysey, M, Gray, A, Collins, R, and Baigent, C) (2012). The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet, 380(9841):581-90.