Broader use of cholesterol-lowering statins may be a cost-effective way to prevent heart attack and stroke, researchers suggest.
In the study, published online in the journal Circulation, the researchers also found that screening for high sensitivity C-reactive protein (CRP) to identify patients who may benefit from statin therapy is only cost-effective in certain cases. Elevated levels of CRP indicate inflammation and suggest an increased risk for heart attack and stroke.
Currently, statin therapy is recommended for high-risk patients - those with a 20% or greater risk of some type of cardiovascular event within the next 10 years. But statins may also benefit people with a lower risk, according to Dr Mark Hlatky, professor of health research and policy and of cardiovascular medicine at Stanford University School of Medicine in Stanford, Calif., and colleagues.
Hlatky's team set out to determine the cost-effectiveness of three statin therapy approaches in patients with normal cholesterol levels and no evidence of heart disease or diabetes: following current guidelines; conducting CRP screening in patients who don't meet current statin treatment guidelines and offering statins to those with elevated CRP levels; and providing statin therapy based on a patient's cardiovascular risk alone, with no CRP testing.
The researchers analysed which of the three approaches met the generally accepted cost-effectiveness threshold per quality-adjusted life-year. They found that statin therapy based on cardiovascular risk alone, without CRP testing, was the most cost-effective strategy.
Initiating statin treatment at lower risk levels - without CRP testing - "would further improve clinical outcomes at acceptable cost, making it the optimally cost-effective strategy in our analysis," the researchers wrote.
"Ideally, a marker would tell us who will benefit from drug treatment and who will not," Hlatky pointed out in the release. "If a test could give us that information, it would be very cost-effective. But there's not good evidence yet that CRP, or any other test, works that well." (September 2010)
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