Some Statins May Be Over-Prescribed For Healthy People

People with elevated cholesterol levels often take a prescription statin medication to prevent heart attack or stroke. But new research suggests these expensive medicines might not really be needed by everyone who is taking them.

A Johns Hopkins study of 950 healthy men and women has shown that taking daily doses of a cholesterol-lowering statin medication to protect coronary arteries might not provide additional protection.

Statins are a class of drug used to lower cholesterol levels by inhibiting the enzyme that plays a critical role in the production of cholesterol in the liver. Brand names of statins include Lipitor, Zocor, and Crestor.

The Johns Hopkins team found that nearly 95 percent of all heart attacks, strokes or heart-related deaths occurred in the half of study participants with some measureable buildup of artery-hardening calcium in the blood vessels.

The conclusion? This subgroup might have benefited from preventive drug therapy. Seventy-five percent of all heart emergencies occurred in the quarter with the highest calcium scores, it turns out.

The 47 percent of study participants with no detectable levels of calcium buildup in their blood vessels suffered about five percent of heart-disease related events during the six-year study, meaning that drug therapy may not have offered any coronary protection.

Healthy lifestyle might be better therapy

"Our results tell us that only those with calcium buildup in their arteries have a clear benefit from statin therapy, and 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," said study lead investigator Dr. Michael Blaha.

"While statin therapy can benefit healthy men and women with normal or even low cholesterol levels, it certainly is not the case that all adults should be taking it to prevent heart attack and stroke, because half are at negligible risk of a sudden coronary event in the next five to 10 years."

Results of the study underscore the importance of measuring coronary artery calcium deposits, Blaha says, in predicting who is really at risk of suffering a heart attack.

High levels of C-reactive protein in the blood, a CRP score at or above 2 milligrams per liter, offered no predictive value after established risk factors are taken into account, including age, gender, ethnicity, hypertension, blood cholesterol levels, obesity, diabetes, smoking and a family history of heart disease. Study participants in the new analysis had varying blood levels of the inflammatory byproduct, believed by some to be a predictor of all kinds of coronary disease.

While this study suggests statin drugs are being over-prescribed, a 2006 study concluded statins were being under-prescribed.

Researchers, reporting their findings in the Public Library of Medicine,  examined two national databases that tracked outpatient visits to hospitals from 1992 to 2002, including what drugs were prescribed during the visit.

The researchers found that less than half the patients who were at high risk for heart trouble and should have received a statin got one. The drugs were also underused in moderate risk patients.