17 November 2010

Anti-cholesterol drugs over prescribed

Cholesterol-lowering statin medications, miracle drugs for those suffering from heart disease, may be over-prescribed as a preventative measure for healthy adults.


Cholesterol-lowering statin medications, miracle drugs for those suffering from heart disease, may be over-prescribed as a preventative measure for healthy adults, a new study said.

The study by cardiologists at Johns Hopkins University found that, among healthy adults, only those with measurable build-up of artery-hardening calcium would significantly benefit from the treatment.

"Our results tell us that only those with calcium build-up in their arteries have a clear benefit from statin therapy," the study's lead investigator Michael Blaha said.

"Those who are otherwise healthy and have no significant calcification should, with their physician, focus on aggressive lifestyle improvements instead of early initiation of statin medications," he added.

The statin class of pharmaceuticals, including the popular cholesterol-lowering drugs Lipitor and Crestor, lowers cholesterol by blocking an enzyme in the liver.

Heart deaths linked to high calcium build-up

The six-year study found that 75% of all heart attacks, strokes or heart-related deaths occurred in the 25% of participants who had the highest calcium build-up in their blood vessels.

The 47% of participants who had no detectable levels of calcium build-up meanwhile suffered just 5% of heart disease-related events, meaning the statin therapy would have offered little protection.

"It certainly is not the case that all adults should be taking (statin therapy) to prevent heart attack and stroke, because half are at negligible risk of a sudden coronary event in the next five to 10 years," Blaha said.

Roger Blumenthal, another Johns Hopkins researcher who carried out the study, said the drugs "should not be approached like diet and exercise as a broadly based solution for preventing coronary heart disease."

Lifelong medications

"These are lifelong medications with potential, although rare, side effects, and physicians should only consider their use for those patients at greatest risk, especially those with high coronary calcium scores."

He added that as many as 5% of people on statins develop serious side effects, such as muscle pain, while one in 255 will develop diabetes. The report is the latest in a series of studies questioning the widespread prescription of preventative heart medication for otherwise healthy adults.

Contrasting studies

A US meta-analysis of 11 studies had already revealed that statin treatments do not reduce the death rate among patients with high cholesterol but no history of heart disease.

The two studies contrast the results of a 2008 clinical trial known as "JUPITER," which found that a daily doses of 20 milligrams of Crestor, a statin treatment marketed by the British pharmaceutical giant AstraZeneca, halved the number of potentially fatal coronary blockages in 18,000 adults.

All of the adults in the JUPITER study had high levels of C-reactive protein (CRP), believed by some to predict coronary disease. But Blaha said the latest study underscores the view that calcium deposits are a better indicator than CRP, which he said offered no predictive value.

Coronary heart disease remains the leading cause of death in the US , responsible for one in five deaths among adults.

(Sapa, Jean-Louis Santini, November 2010)


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