Long-term statin safety and efficacy in secondary prevention: can combination therapy improve outcomes?

The use of statins has been associated with substantial reductions in vascular morbidity and mortality. The Prospective Pravastatin Pooling Project (PPP) looked at the long-term safety and efficacy of statins in secondary prevention, based on pooled results from three key statin trials. PPP revealed a highly significant relative risk reduction in total mortality, and demonstrated that pravastatin has a similar incidence of muscle-related side effects as placebo. It has been speculated that treatment with statins in combination with other cardiovascular drugs may have a synergistic effect on reduction of cardiovascular complications. However, for ethical reasons, evidence can only ever be sought from sub-group analyses or meta-analyses of existing studies. Recent studies have focused on statins plus acetyl- salicylic acid (ASA, aspirin). Evidence suggests that a combination of statins with ASA provides a cardiovascular risk reduction that is superior to the respective monotherapy. Thus, statins effectively reduce further cardiovascular morbidity and mortality as well as total mortality in patients with manifest coronary artery disease (CAD) or at high risk, also they act in synergy with ASA and they are safe.