Despite Study, Docs Still Like Statins
Big Trial Fails to Support Earlier Studies That Show Statins Work
Dec. 17, 2002 -- Whoops. A major study was supposed to prove that cholesterol-lowering statin drugs save lives. It didn't.
The report, in the Dec. 18 issue of the Journal of the American Medical Association, looks at the much-used statin sold as Pravachol. It finds that the drug doesn't reduce either heart disease or death in a cross-section of older people whose high blood pressure is under control and who have moderately high cholesterol levels.
Does this mean statins don't work -- or that Pravachol isn't as good as other statins? No, experts say. Study leader Barry R. Davis, MD, PhD, of the University of Texas-Houston Health Science Center, urges patients with high cholesterol to keep taking their medicine, whether it is Pravachol or another statin.
"The bottom line is that cholesterol-treatment guidelines should remain the same," Davis tells WebMD. "This study says that people who are on statins should remain on them. All studies show statins are good at lowering cholesterol and that it is good to lower cholesterol to avoid heart disease and death."
The study looked at 10,355 people age 55 or older enrolled in a study comparing different kinds of blood-pressure drugs. All had too-high levels of LDL cholesterol -- the "bad" kind of cholesterol. About half the patients got Pravachol while the other half got "usual care." Usual care meant being placed on a specific national guidelines cholesterol-lowering diet.
Pravachol did what it is supposed to do. Patients who took the drug saw their LDL cholesterol levels fall by 28%. But those in the usual-care group had their LDL cholesterol levels drop by 11%. The end result: the Pravachol patients had about the same rate of death and heart disease as the usual-care group after nearly five years.
What happened? When the study began in the early 1990s, "usual care" didn't mean taking statins. That changed over the course of the study. It was an open-label study, in which patients knew what they were and weren't taking. Nearly a third of the usual-care patients started taking the lipid-lowering drugs -- particularly those at highest risk of heart disease. At the same time, many patients getting statins stopped taking their medication.