Statin Drugs: Heart Benefits Last Long
Cholesterol-Lowering Drugs Turn Back Clock on Heart Disease
An End to Heart Disease? continued...
The 2006 study showed that people who carried certain PCSK9 gene variants had somewhat lower cholesterol levels than people with normal PCSK9 genes -- 28% lower LDL for one gene variant and 15% lower LDL for another variant.
But because they had these relatively modest LDL cholesterol reductions from the time they were born, people who carried the gene variants had far lower risk of heart disease -- 88% lower risk for one gene variant, and 47% lower risk for the other.
Moreover, Domanski points out, heart disease is almost unknown in people who live in hunter/gatherer societies that traditionally consume few saturated fats. Once these people adopt modern lifestyles, however, they have the same risk of heart disease as people living in Western cultures.
"It is a very different thing to prevent heart disease than to prevent cardiac events in people who already have heart disease," Domanski says. "If you started lowering LDL cholesterol early -- before someone has coronary artery disease -- you could get very big effects. The potential of LDL lowering, instituted early in life needs, much more research."
Domanski isn't suggesting that we put statin drugs in the water supply. But he does think a clinical trial of statin drugs, in a healthy group of people 30 to 40 years old, is worth the effort. If modest LDL cholesterol reduction early in life could cut heart disease by 50% or more, the impact would be huge.
"Dr. Domanski's very interesting suggestion is that if you were to start treatment earlier, the benefit of preventing heart disease would be greater than the benefit seen by starting at middle age," Cobbe says. "The opposing argument is you would end up medicalizing very, very large sections of the population, with potentially a quarter or a third of all adults being on statins."
Domanski says the answer to cholesterol lowering need not be statin drugs. Lifestyle changes can have just as big an effect. And new generations of cholesterol-lowering drugs -- including drugs that target PCSK9 -- are on the horizon.