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Have you taken your statin today?
« on: 2006-03-17 15:27:49 » |
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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.
Source: http://www.saga.co.uk/health_news/article/2B9EFF2A-DE8F-446C-8DC1-64E57F5DC875.asp?bhcp=1
Authors: Rachel Carlyle
Dated: 2003-01
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 David 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 Peter 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, David 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 Peter Whincup of St George'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 (Hermit: 2003), 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
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