MONDAY, Feb. 9 (HealthDay News) -- A massive Israeli study finds that people with high cholesterol levels who faithfully take statins are less likely to die over four to five years than those who neglect the therapy.

But that finding is not necessarily a tribute to the effectiveness of the cholesterol-lowering therapy, American experts said. Previous studies have shown that people who follow doctors orders about taking drugs are more likely to follow other rules of good health, they said.

The Israeli study of almost 230,000 middle-aged people enrolled in a health maintenance organization found a 45 percent lower death rate among those who took the drugs at least 90 percent of the time, compared to those taking the statins less than 10 percent of the time, according to a report in the Feb. 9 issue of the Archives of Internal Medicine by researchers at Maccabi Healthcare Services in Tel Aviv.

The risk reduction was true for both people who were prescribed a statin for secondary prevention, because they already had heart disease, and for primary prevention, to reduce the chance of having a first coronary event.

"The observed benefits from statins were greater than expected from randomized clinical trials, emphasizing the importance of promoting statin therapy and increasing its continuation over time for both primary and secondary prevention," the researchers wrote.

But it's not necessarily the statins that were responsible for all of the benefit, said Dr. Mark A. Hlatky, a professor of health research policy and medicine at Stanford University. He cited the Coronary Drug Project, done more than three decades ago, which showed an apparent benefit from faithfully taking a placebo.

"People who took placebo did much better than people who didn't take placebo," Hlatky said. They also did just about as well as people who took active drugs in the study.

For example, the five-year death rate for study participants who took the lipid-lowering drug clofibrate at least 80 percent of the time was 15 percent, compared to 24.6 percent of those who didn't follow orders.

But the numbers were virtually identical for those taking what they didn't know was a placebo -- a 15.1 percent mortality rate for those following the rules about taking the pill regularly, 28.3 percent for those not taking the pills as recommended, Hlatky said.

"It is definitely a very important observation that people who take their drugs always do better than people who don't, even if the drug is not terribly effective, because they tend to take better care of themselves better in a lot of ways," Hlatky said.

"While guidelines support the use of lipid-lowering medication in people with diabetes and other risk factors for coronary heart disease, they fall short in stipulating which class of lipid-lowering medication to use," said Dr. Erica Spatz, a fellow in the Robert Wood Johnson Clinical Scholars Program at Yale University.

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