Should we all be on statins?

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This may be of interest:

Ralph Giarnella MD

Southington, CT

Should we all be on statins?

A drug that has been lowering cholesterol for 20 years

now appears to have dramatic benefits for other

conditions.

By Carlyle

Every so often, something very strange happens in the

world of medicine. A drug that is tested for one

disease turns out to cure another. And another. And

another. And the more rigorously it's tested, the

better it works. Until recently, aspirin had perhaps

the strongest claim to " wonder drug " status, but many

doctors believe it is about to be toppled by a rival

in the shape of statins.

These cholesterol-lowering drugs have been around

since the late 1980s but - for once - have been

severely under-hyped. Only in the past 18 months have

their incredible benefits been revealed, and they seem

to have fewer side effects than aspirin. Most

important, they dramatically cut the risk of heart

attacks and strokes, the biggest causes of death in

the West. It is also claimed that they reduce the risk

of dementia, could ease some symptoms of multiple

sclerosis and may even trigger the " suicide " of some

cancer cells.

Scientists both here and in the USA - where 15 million

people now take a statin tablet every day - have been

astounded. " Cardiologists have told me that statins

should be put in the water supply, " says American

neurologist Professor Drachman. They are joking,

of course, but only just. A British researcher

commented: " Pretty much every cardiologist I know over

50 is now taking their statin every day because the

results of the studies are so convincing. "

The story of statins began in Japan in 1971 when Dr

Akiro Endo started looking for a substance to stop the

body producing too much cholesterol. Cholesterol is a

type of fat made in the liver mainly from the

saturated fats we eat; it is vital for the functioning

of every cell in our bodies, but too much of it

contributes to heart disease because it furs up the

arteries. After three years of research, Dr Endo

finally isolated a mould related to penicillium which

seemed to do the trick. Following extensive trials and

further research, the first statins were approved for

use in America in 1987, but there was remarkably

little fanfare. It was not until more recently that

the mainstream medical community allowed itself to

believe it may have found the answer to heart disease,

the scourge of the fat-guzzling Western world.

The most exciting results came from Oxford

University's Heart Protection Study, the world's

largest study of cholesterol-lowering drugs, published

in July 2002. Researchers recruited 20,000 people with

an increased risk of cardiovascular disease - those

who had diabetes, angina or high blood pressure, plus

those who had already had heart attacks, strokes and

mini-strokes. Over seven years, they discovered that

taking a statin every day cut the risk of heart

disease and stroke by a third. But the remarkable

thing was that the drugs also worked on those whose

cholesterol levels were normal, as well as on people

with very high levels.

When the findings were published in the Lancet, the

editor described them as " the most far-reaching

results for the treatment and prevention of heart

disease and strokes that we have seen in a

generation " .

The study also included a group of over-75s (whose

average age was 80), and they gained every bit as much

from statins as the younger volunteers. " There used to

be a belief that cholesterol was less important in

older people, " says study co-ordinator Dr Jane

Armitage. " Many people thought if they'd reached the

age of 70 or 80 with raised cholesterol levels there

was no point in doing anything about it. But it's

never too late to cut your risk of having a heart

attack. "

If statins could help people at high risk of a heart

attack, how about those with high blood pressure? One

in three people over 45 has high blood pressure

(hypertension) and it is a major risk factor for heart

disease and strokes.

A huge Anglo-Scandinavian research programme was set

up to find out. Professor Sever at Imperial

College, London, leader of the British arm of the

study, recruited 9,000 patients with hypertension. But

the research was never concluded. It was suddenly

halted two years early, because the statin had such a

dramatic effect on cutting the risk that the

researchers decided it wasn't fair for half the group

to be taking a placebo.

Prof Sever commented: " There are eight million people

with high blood pressure in Britain. If our results

are correct, and I know no reason why they should not

be, we could be potentially preventing 20,000 to

30,000 strokes and heart attacks a year if they were

all taking statins. "

Scientists in other fields are getting equally

excited, although the research is at much earlier

stages. Preliminary results suggest that people with

such different problems as osteoporosis and multiple

sclerosis or patients recovering from transplants

might all benefit from taking statins. And researchers

in Toronto discovered that statins seemed to trigger

the self destruction of some cancer cells in the

laboratory, but only at higher than normal doses.

Quite why it happened is not yet known, but studies on

cancer patients are under way.

In perhaps the most bizarre finding, Drachman,

Professor of Neurology at the University of

Massachusetts Medical School, seems to have discovered

a link between statin use and dementia. He examined

the medical records of 60,000 British patients over 50

- those who had been prescribed statins to lower their

cholesterol, those who hadn't, plus those who had

normal cholesterol levels.

" Seventy per cent fewer people on statins developed

dementia compared to those who were not, " he explains.

" It was a tremendous result, and we are now hoping

that therapeutic trials will verify what we suspect we

know. "

Armed with all that exciting-sounding research, you

can understand why some doctors are half tempted to

put statins in the water. In Britain, the Government

recommends that 90 per cent of heart-attack sufferers

should get statins, and those with a 30 per cent

increased risk of heart disease over 10 years should

also get them.

So do they? All the evidence points to a resounding

no. A study of men aged 60 to 75, published in July,

revealed that only a quarter of angina sufferers and a

third of heart-attack sufferers had been prescribed

them. " We were very concerned that younger people were

much more likely to get them than older people - when

it was older people who could benefit more, " says

study author Professor Whincup of St 's

Hospital, London. " There was clearly age

discrimination at work.

" The simple message is that everybody who has

established coronary heart disease should be receiving

aspirin on a daily basis and they should also be

getting a statin unless there are particular reasons

why not. " He acknowledges that prescription rates have

risen since then (they went up by 30 per cent in 2001)

but is certain that there is still a long way to go.

The responsibility for prescribing statins falls on

GPs, but the fact is that if they did so at the

recommended levels, they would blow a huge hole in

their drugs budget. Statins cost £1 a day and, given

that people will be on them for life, it doesn't

require an accountant to work out that they could

bankrupt the NHS.

Dr Jane Armitage and her team at Oxford are working

out the true cost of statins and hope to have some

figures in spring 2003. " Yes, they are expensive, but

what about the savings in terms of fewer heart attacks

and strokes, fewer hospital stays and costs of

treatment? " she says.

In May, the first statin used in Britain - simvastatin

- will come off patent, meaning that much cheaper

generic drugs could be available within weeks. " It's

highly likely that statins will end up costing a few

pence a day after May, which will make a big

difference to GPs and their ability to prescribe

them, " says Dr Armitage.

Many doctors believe that eventually everyone over 45

will be popping their daily statin tablet. Dr Armitage

agrees, and she goes further: " I also believe they

will be available over the counter one day - probably

in less than five years. After all, they are probably

safer than aspirin and would be sold in fairly low

doses. All in all I'd say it's a good thing. "

I can't resist asking whether she takes them herself?

" No, because I haven't considered myself at high risk

of cardiovascular disease, but maybe in another

decade... who knows? "

This article was first published in the January 2003

issue of Saga Magazine

Ralph Giarnella MD

Southington, CT