HKUMed demonstrates that statins can lower the risk of cardiovascular disease without increasing major adverse events, providing guidance for future clinical practice in managing high cholesterol. The research is led by Professor Eric Wan Yuk-fai (third left).
A multidisciplinary team from the LKS Faculty of Medicine at the University of Hong Kong (HKUMed), has conducted a series of landmark studies demonstrating that statins can lower the risk of cardiovascular disease (CVD) without increasing the incidence of major adverse events. These studies were conducted in several patient groups, including individuals with type 1 diabetes mellitus (T1DM), patients with kidney failure, and the elderly patients with chronic kidney disease. The findings strengthen the evidence base for the statin use in populations historically excluded from randomised controlled trials (RCTs), and guide future clinical practice in managing high cholesterol.
The findings were published in prestigious journals including the Journal of the American College of Cardiology, the Journal of the American Society of Nephrology, Nature Communications, Journal of Internal Medicine, and The Lancet Healthy Longevity. More recent findings were featured in Annals of Internal Medicine [link to the publication].
Hypercholesterolemia, commonly referred to as high cholesterol, has become a significant global public health challenge. In Hong Kong, its prevalence among individuals aged 15 to 84 reached 51.9% between 2020 and 2022. Statins are commonly used for primary lipid-lowering treatment, with well-established benefits in preventing CVD. However, existing clinical guidelines and research lack solid evidence in several key areas, such as underrepresented populations in RCTs, safety and side effects, and the best timing for starting statin therapy.
Underrepresented populations in randomised controlled trials
Professor Eric Wan Yuk-fai, Associate Professor and Chief of Research in the Department of Family Medicine and Primary Care, School of Clinical Medicine, and the Department of Pharmacology and Pharmacy, HKUMed, said, 'RCTs often exclude elderly individuals and contain only a small number of participants with rare health conditions like T1DM or kidney failure. Our team comprising clinicians, pharmacists, pharmacoepidemiologists, and data scientists, leveraged real-world big data from Hong Kong and the UK to provide strong evidence for improving lipid-lowering treatment for cardiovascular prevention.'
'The research findings highlight that the benefits of statin therapy outweigh the associated risks in these specific populations,' added Professor Wan.
Risk of myasthenia gravis observed
The research team examined data from Hong Kong, the UK and Japan to evaluate the associations between long-term statin use and the risks of cancer and myasthenia gravis. Over a ten-year follow-up period, the initiation of statin therapy showed no link to increased cancer incidence, but it was associated with a significant increase in the risk of myasthenia gravis within the first year, particularly at higher doses. This highlights the importance of close monitoring during the first year of treatment, especially for patients receiving medium-to-high doses of statins.
Early initiation of statins benefits type 2 diabetes mellitus (T2DM) patients
The research team also evaluated the timing of statin initiation in patients with T2DM in Hong Kong and the UK. The findings from the Hong Kong database revealed that starting statins at lower baseline cholesterol levels significantly reduces the risk of CVD and all-cause mortality without increasing the incidence of major adverse events, even among patients aged 75 and above. Corresponding UK data showed that statin use for primary prevention effectively decreases all-cause mortality and major CVD across various cardiovascular risk levels. Both studies provide compelling evidence to support the benefits of early statin initiation in T2DM patients.
'This series of big data studies addresses clinical uncertainties surrounding statin therapy that conventional RCTs have not resolved,' said Professor Wan, 'providing valuable guidance for clinicians, strengthening their confidence in individualised statin therapy, and contributing to CVD reductions with evidence-informed decisions.'
About the research team
The research project was led by Professor Eric Wan Yuk-fai, Associate Professor, Department of Family Medicine and Primary Care, School of Clinical Medicine, and the Department of Pharmacology and Pharmacy, HKUMed. The work brought together experts in clinical medicine, pharmacy, epidemiology, and data science.
