Smoking diminishes the beneficial effect of statins: Observations from thelandmark trials

The landmark statin trials showed a significant reduction in morbidity and mortality associated with ischemic heart disease. However, it may not be wi dely appreciated that smoking had a marked adverse effect on outcome in the se trials. In both the primary and secondary prevention setting, the effect of smoking was broadly similar. Smoking markedly increased the risk of eve nts in the placebo and treatment groups. For example, in the primary preven tion trials, this risk was 74-86% higher when smokers were compared with no nsmokers in the placebo groups. The corresponding figures for the secondary prevention trials were 23-61%. The risk of events in untreated nonsmokers was of a similar order to that seen in smokers taking statins. Although sta tin treatment was associated with a significant reduction in events in smok ers, the best outcome was observed in nonsmokers treated with statins (prim ary prevention: lovastatin or pravastatin; secondary prevention: pravastati n or simvastatin). The highest risk of events in any group was in the smoke rs on placebo. This information may increase clinician and patient awarenes s as to the marked harmful effect of smoking relative to effective, evidenc e-based treatment (ie, the use of statins).