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Newswise New research suggests that widely used statin therapy provides the most benefit to patients with the highest genetic risk of heart attack. Using a relatively straightforward genetic analysis, the researchers assessed heart attack risk independently of traditional risk factors such as age, sex, so-called good and bad cholesterol levels, smoking history, family history and whether the patient has diabetes.

Patients in intermediate and low-risk categories still benefit from statin therapy, but that benefit is progressively smaller because theyre starting at lower baseline risk, according to the investigators.

The research, from Washington University School of Medicine in St. Louis, Brigham and Womens Hospital, Massachusetts General Hospital and Harvard Medical School appears March 4 in The Lancet.

For patients at risk of heart disease, doctors routinely prescribe statins, known for their cholesterol-lowering effect. In 2013, the American College of Cardiology and the American Heart Association changed the guidelines for statin therapy, dramatically increasing the number of patients recommended to take it. The move has stirred debate over whether these drugs are overused, especially in light of increasing health-care costs.

There is ongoing debate over which individuals should be allocated statin therapy to prevent a first heart attack, said co-first author Nathan O. Stitziel, MD, a Washington University cardiologist and human geneticist. Some have said we should be treating more people, while others say we need to treat fewer. As an example of precision medicine, another approach is to identify people at high risk and preferentially prescribe statin therapy to those individuals. Genetics appears to be one way to identify high-risk patients.

Stitziel noted that this genetic analysis is not available to patients right now. More research is needed to validate the findings before such a test could be developed for clinical use.

Using statistical methods to combine data on 49,000 people enrolled in five studies, the researchers reported that individuals in the high-risk category have a 70 percent higher risk of heart attacks compared with those at lowest genetic risk. They went on to show that statin therapy results in a 13 percent reduction in risk in the low genetic-risk group, a 29 percent reduction in the intermediate group and a 48 percent reduction in the high-risk group.

Stitziel said the new results differ from past research that consistently has shown statins provide about the same relative risk reduction 30-45 percent depending on dose across all categories of patients.

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Study Shows Who Benefits Most From Statins