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Cholesterol OK? Statins Still Help Heart

Study Shows Statins Reduce Heart Attacks and Strokes in Patients With Normal Cholesterol
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WebMD Health News

July 1, 2009 -- Millions of people without established heart disease could benefit from cholesterol-lowering statin therapy even if they don't have high cholesterol, a new analysis suggests.

Combined data from 10 trials that included more than 70,000 patients without cardiovascular disease, but with cardiovascular risk factors, showed a 12% reduction in deaths among patients who took statins.

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The statin group also had 30% fewer heart attacks and 20% fewer strokes over four years of follow-up.

The findings add to the growing evidence favoring an expanded use of statins -- such as Lipitor, Zocor, Mevacor, Pravachol, and Crestor -- for the primary prevention of heart and vascular disease.

But the researchers concede that it is not entirely clear which patients without established heart disease would benefit most from statin therapy.

"It is likely that many more people could benefit, but the question is: 'Where do you draw the line?" study co-author Jaap W. Deckers, MD, tells WebMD.

Statins for Everyone?

The new analysis includes data from the 17,800-patient Jupiter trial, which made headlines late last year by showing a dramatic reduction in heart attack, stroke, and even death risk in men and women with normal cholesterol who took the drug Crestor.

Statins are recommended for just about everyone who has had a heart attack or stroke, and for many people with elevated low density lipoprotein (LDL) "bad" cholesterol levels and other risk factors for heart and vascular disease.

But the safety of long-term statin therapy in women, the elderly, and patients with diabetes or other medical conditions has been questioned because these groups have been underrepresented in clinical trials.

In the new analysis, which included trials like Jupiter with a diverse patient population, no significant differences in treatment benefit were found between men and women, elderly and younger patients, and those with and without diabetes. There was also no evidence of an increased risk of cancer with statin therapy.

"It is very clear in this analysis that the benefits seen in the older studies extend to older people and to women," cardiologist Sidney C. Smith, Jr., MD, who is a former president of the American Heart Association, tells WebMD.

Deckers and colleagues conclude that men over 65 with risk factors for cardiovascular disease and women over 65 with diabetes and cardiovascular risk factors should take statins because these individuals are at high risk of developing heart disease over time.

Their analysis appears in the latest issue of the journal BMJ Online First.

Revision of Guidelines for Disease Prevention

Smith, who is a professor of medicine at the University of North Carolina, currently chairs a National Institutes of Health panel that is revising guidelines for cardiovascular disease prevention, which should be finalized by late next year.

He would not discuss specific changes in recommendations regarding statins, but he did say that millions of people who should be taking a statin under the existing guidelines are either not prescribed them or don't take them.

"We need to figure out how to get these patients treated," he says.

Cardiologist Roger Blumenthal, MD, says women are far less likely to receive statin treatment than men because the existing treatment guidelines are based on heart attack risk.

Blumenthal directs the Johns Hopkins Ciccarone Preventive Cardiology Center in Baltimore and he is a spokesman for the American Heart Association.

"Women are far less likely to have a heart attack as the first manifestation of heart disease," he says. "They are far more likely to have strokes or angina (chest pain with exertion). Women rarely qualify for lipid-lowering therapies under existing guidelines, but the experts rarely talk about this and government officials don't acknowledge it."

He tells WebMD that new treatment guidelines need to address this gender inequity.

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