Heart-attack prevention: Statins aren’t for everybody

I started getting phone calls from my patients almost as soon as the headlines starting appearing last week. All the media were trumpeting the results of a new study showing that rosuvastatin (Crestor), a powerful cholesterol-lowering statin drug, slashed the risk of heart attack and stroke even in people with normal—that’s right, normal—cholesterol levels who also had high blood levels of a substance called C-reactive protein. CRP rises when the arteries are inflamed, and, as we’ve previously reported, growing research has linked such inflammation with an increased risk of heart attack. All of those callers wanted to know the same thing: Should they start taking the drug?

Here’s my answer to that and two related questions.

Should I immediately start taking a statin?
Probably not, at least based on this study. The trial, released on Nov. 9 by the New England Journal of Medicine, looked at some 18,000 people with an LDL (bad) cholesterol level less than 130 milligrams per deciliter and a CRP level over 2 mg per liter. Half got Crestor and half got a placebo. After about two years the study was halted because there were 44 percent fewer cardiovascular events in one group than in the other. The winner turned out to be the group that took Crestor.

Sounds impressive, right? Well, maybe not very. That’s because cardiovascular disease is relatively uncommon in the group of people enrolled in the study. So the absolute reduction in the rate of heart attack, stroke, and cardiovascular death went from about 2 per 100 patients in the placebo group to 1 per 100 in the treatment group. At that rate, 120 people would have to be treated for nearly two years to prevent one event. A benefit, yes, but is it one that’s worth the treatment’s costs?

Those costs are both medical and financial. For example, people in the study who took rosuvastatin showed worrisome changes in blood-sugar levels that could signal an increased risk of diabetes. And, as our Best Buy Drug Report on statins discusses, all of the drugs can cause muscle aches, soreness, and tenderness in about 1 to 5 percent of people. And rarely, they can cause the muscle tissue to break down, which in turn can trigger life-threatening kidney damage. A year’s costs for the drugs—including Crestor—can exceed $1,000.

Should I get my CRP level measured?
That depends mostly on your overall risk of cardiovascular disease. People who are at high risk because they have a clearly elevated LDL level usually don’t need the test, since they should be treated with a statin regardless of their CRP. And I don’t think it’s time to measure CRP in people with low LDLs and no other coronary risk factors, because it’s not yet clear that the benefit of treatment for such very low-risk people outweighs the costs and possible harms. But for people at moderate risk of coronary disease—those with a borderline elevated LDL, for example, and perhaps one or more other risk factors—knowing the CRP can help you decide how aggressively to lower LDL. For more on how to use your LDL, CRP, and other risk factors to assess your need for cholesterol-lowering drugs, see our Guide to a Healthy Heart.

If I do need a statin, does this study mean I should definitely take rosuvastatin?
No. Other statins—including atorvastatin (Lipitor), lovastatin (Mevacor and generic), and simvastatin (Zocor and generic)—also lower both LDL and CRP. And some are much cheaper. For example, a month’s supply of Crestor costs, on average, about $105. But you can get a month’s supply of generic simvastatin for around $30 at many retail pharmacies or even as low as $6 at Costco.

—Marvin Lipman, M.D., Consumer Reports chief medical adviser

For more on how to treat high cholesterol, check out our Treatment Ratings (subscribers only).

Comments

[Elite Health]

Although many people think of heart disease as a man's problem, women can and do get heart disease. I was in the same misconception regarding the heart disease, but was made aware by a medical checkup campaign. In fact, heart disease is the number one killer of women in the United States. It is also a leading cause of disability among women. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks. Prevention is important: two-thirds of women who have a heart attack fail to make a full recovery. The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women can take steps to prevent it by practicing healthy lifestyle habits. Actually, right now I am suffering from a blockage in the coronary artery and was once blocked up to 85%. I got the stent implantation which is a mesh like spring which is used to broaden the artery and hence restoring back the blood flow. You can see further information regarding stent operation from www.heartsite.com/html/stent.html. I got to know everything regarding my stent operation from this site. I was really unaware of such a blockage. I sometimes feel dizzy, restless, lazy, but thought that to be something related to mental ability, and hence never worried about it. Once I got my basic medical checkup at Elite health medical office in New York (www.elitehealth.com/new_york_ny_medical_office.php). The ECG report went to be something suspicious. So, they advised me to have further advance diagnosis to determine and assure regarding the problem in the heart. After my MRI, CT scan and other such scans it came to me as a shock that I was facing a problem of blockage. It was quite surprising to me, and as I was not aware of anything regarding this, I was really frightened. The doctors explained me every information regarding my health and its treatment, and suggested me to have stent operation. That was some dreadful days of my life, which I faced only because I was careless about my health. It was my luck that I somehow went for a basic checkup at elite health, but every woman out there may not be so lucky.

[B]

David,
What you are describing, while unfortunate, is not a total surprise. That adverse effect is a well known and documented side effect of the drug class of statins. You are what it sounds to be "statin intolerant" like a small population of people are. Typically it's transient, or switching statins helps, but sometimes not. Your doctor should have discussed this possibility upon prescribing you the medicine, preventing your conspiracy theory post here. Try having a disc. with your physician about it, there are still options even for statin intolerent pt's. Alternative dosing and such.

[Bob]

I am disappointed, but not surprised, by this discussion. This physician, like many others, seems more interested in denying information to patients by restricting tests which could establish a baseline for a patient's informed decision-making. I turn 70 next week, take very little medicine, and monitor my overall health with routine blood pressure checks, cholesterol and other blood work checks, among others. I intend to press for a CRP test as part of my overall wellness program,and no physician is going to tell me I can't have one!

[Yitzhak Dar]

1. What about Genetic factors? don't they influnce our risk factors?
2. Is there really such a huge gender difference in risk factors? for a healthy 68 years old person, the risk is 2% for a female and 9% for a male.

[David]

I have taken several different statins, including Crestor. All were able to reduce my cholesterol levels to varying degrees, but all caused chronic muscle weakness which was unable to be improved with physical therapy.

Within a week after stopping statin use, in every drug's case, muscle strength increased and my symptom -- bursitis in the right hip joint -- eased.

I never would have connected statin use with joint pain except that I ran out of my first mail-order statin and the refill took several days to arrive. That's when my strength measurably and surprisingly.

I wonder how many others have had similar, seemingly unconnected and likely unreported adverse events?

[James Hubbard, M.D., M.P.H.]

Thanks for the perspective. Headlines don't tell the whole story. Statins are great to treat cholesterol, but not a panacea.

[B]

To say that any other statin is going to have the same effect as Crestor in this study, is simply bad science. Maybe would be a correct response. We don't know. These same people said the same thing about Vytorin and Zetia, who have since proved themselves wrong on that one. There's alot of different factors at play here, and to say that any molecule is going to provide this response is absolutely wrong. I am going to cancel my subscription to CR's due to this pandering to the "penny pinching" subscription base. I don't pay for bad science. Not asking for a Crestor commercial, just a fair and honest interpretation of the data.