Should Healthy People Take Statins?
FAQ: Preventing First-Time Heart Disease With Cholesterol-Lowering Drugs
Can any statin prevent heart disease in people with normal cholesterol levels?
Statin drugs currently on the market include Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor. The JUPITER trial isn't the first to show that statins can prevent heart events even in people with normal cholesterol levels.
However, Crestor is the only statin approved by the FDA for preventing first-time heart disease in people who do not have high cholesterol.
While it's tempting to conclude from available data that any statin might have the same effect at effective doses, this has not been proven in clinical trials. And not all statins are the same. Some have more potent effects at lower doses, and some are more likely than others to cause side effects.
Does CRP cause heart disease?
Few issues are more hotly debated by researchers than the role CRP plays in heart disease.
Inflammation swells cholesterol-crammed artery walls, making the lining of those arteries vulnerable to breaking down or bursting. When the lining of an artery wall is disrupted, a cascade of events is set off, culminating in the formation of a blood clot, which can go on to cause a potentially deadly heart attack or stroke.
Some studies suggest CRP plays a major role in the development of heart disease. Others suggest it's merely a marker for the process that is the real culprit, while still others reject CRP as a distraction.
The consensus of opinion is that high CRP levels indicate high risk of heart disease.
In the JUPITER study, participants' CRP levels were very high. But all by itself, CRP did not identify the patients whose risk of heart disease was lowered by statin therapy. All of the patients who benefited had at least one other traditional risk factor for heart disease: family history of premature heart disease, high blood pressure, smoking, or low HDL "good" cholesterol.
What are the risks of statins for healthy people who do not have high LDL cholesterol?
Neither Crestor nor other statins are without risk. This means that these risks should be weighed carefully against expected benefits.
Statins are linked to a number of minor side effects. They also are linked to a rare but serious side effect: muscle breakdown.
In its mildest form, this appears as myositis, a painful inflammation of the muscles. A muscle enzyme called CPK may build up in the blood. The most serious form of muscle breakdown is rhabdomyolysis, in which muscles all over the body become painful and weak. A flood of muscle proteins collects in the kidneys and can lead to kidney failure and death.
Another troubling problem linked to statin use is an increased risk of diabetes. This risk became apparent in the JUPITER trial, in which more individuals taking Crestor developed diabetes than those taking placebo.
A 2010 analysis of statin clinical trials suggests that increased diabetes risk is linked to all statins, not just Crestor. It appears to occur more often in patients over age 60.