Should Healthy People Take Statins?
FAQ: Preventing First-Time Heart Disease With Cholesterol-Lowering Drugs
April 2, 2010 – Should healthy people take a cholesterol-lowering drug to prevent heart disease even if they don't have high cholesterol?
The answer, for some people, is yes. It's a controversial answer that raises a lot of questions. Here are WebMD's answers to those questions.
Who should consider taking statins to prevent heart disease?
Statins are a class of drugs that lower cholesterol. In February 2010, the FDA approved the use of AstraZeneca's statin drug Crestor for preventing first-time heart disease. The approval is for people who meet all of the following conditions:
- Age: Men 50 or older or women 60 or older
- High blood levels of C-reactive protein (CRP). CRP is an indicator of inflammation in the body. Inflammation is a major part of the process leading to heart disease.
- At least one other risk factor for heart disease, such as high blood pressure, low HDL "good" cholesterol, smoking, or a family history of premature heart disease
Not included on this list is a high level of LDL "bad" cholesterol. Why? LDL cholesterol is a major contributor to heart disease. But half of all heart attacks and strokes happen in apparently healthy people with LDL cholesterol levels below the current level of concern.
Can a statin drug help such patients? One controversial idea was to test a statin -- AstraZeneca's Crestor -- in people with normal cholesterol levels but high levels of CRP. The AstraZeneca-sponsored JUPITER clinical trial enrolled 17,802 such men over age 50 and women over age 60.
An independent review panel stopped the trial after two years when it became apparent that patients receiving a placebo were having more heart attacks, strokes, angina (heart pain), and death from cardiovascular disease than those taking 20 milligrams of Crestor daily.
Even so, the risk wasn't extreme. There were 251 heart disease events in the 8,901 placebo patients and 142 events in those taking Crestor. But the reduction in heart disease risk was about twice as great as seen in most clinical trials of statins that enrolled patients with high LDL cholesterol.
So who should consider taking Crestor or perhaps another statin to prevent heart disease? The answer: men 50 or older and women 60 or older with relatively low cholesterol but with other factors that put them at high risk of heart disease should discuss statin therapy with their doctors, especially if they have high CRP levels.
The results of this discussion will vary. Different people have different constellations of heart disease risk -- and different reasons they should or should not take statin drugs.
Whether to start taking statin drugs is not a simple decision. Once a person starts statin therapy, treatment may continue for life. And while generic drugs cost less, treatment isn't cheap. Crestor, which is not available as a generic drug, costs about $3.45 per day.