In 2003, Law and others reported in the British Medical Journal the remarkable effects of low dose Statins on both LDL cholesterol and ischemic heart disease reduction in an impressive study reported in BMJ.
One would have thought this comprehensive meta-analysis would have shaken the very foundation of the medical community with respect to dosing strategy of the statin drugs, yet all that was heard was an inaudible "ho-hum" as if nothing had registered.
The authors of this impressive ( to me ) study reported that reductions in LDL cholesterol ( in the 164 trials observed ) were 2.8 mmol/L ( 60% ) with rosuvastatin ( Crestor ) 80 mg/day, compared with 1.8 mmol/L ( 40% ) with rosuvastatin 5 mg/day, all from pretreatment LDL cholesterol concentrations of 4.8 mmol/L. In my world, cholesterol reductions are of negligible importance but it was the effect of 5 mg Crestor on reduction of ischemic heart disease that caught my full attention.
In the 58 trials where the effect of Statins on ischemic heart disease was studied, Law reported that for every LDL cholesterol reduction of 1.0 mmol/L, the risk of IHD events was reduced by 11% in the first year of treatment, 24% in the second year, 33% in year three to five, and by 36% thereafter. Law worded his report as if to suggest the reduction of LDL cholesterol was somehow causative of the IHD risk reduction, which it is not. He just as easily and far more accurately could have worded his report to read, "The risks of IHD events were reduced substantially by the use of 5 mg of Crestor daily."
Law predicted that after several years a reduction of 1.8 mmol/L of LDL cholesterol would reduce IHD events by an estimated 61%, which according to his data is the same as saying that, "the dosage of five mg of Crestor would after several years reduce IHD events by an astounding 61%."
His results from the same 58 trials, corroborated by results from the nine cohort studies, showed that lowering LDL cholesterol decreases all strokes by 10% for a 1 mmol/L reduction and 17% for a 1.8 mmol/L reduction or that 5 mg Crestor decreases all strokes by a factor of 17%. These are extraordinarily impressive results especially to me with my repository of thousands of reports from statin damaged people and more coming in every day. Why in the world are high doses of Statins being used with their terrible legacy of side effects ( and cost ) when doses of one-sixteenth the amount can achieve 60% of the benefit and the highly desirable benefit of very few significant side effects?
Although the medical community may have "ho-hummed" Law's BMJ paper, the results astounded me. I am very impressed that rosuvastatin 5 mg daily, one sixteenth the size of the 80 mg dose, can give 61% of the ischemic heart disease risk reduction and 17% of the stroke risk reduction. I can think of no stronger case for the consideration of low dose statins by primary care physicians, than this paper by Law. Obviously further studies are needed to define low dose response relationships but this is an excellent start.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
