Statin Benefits Patients With Low Cholesterol

A large study suggests that millions more people could benefit from taking statins, even if they have low cholesterol, because the drugs can significantly lower their risk of heart attacks, strokes and death.

The study, involving nearly 18,000 people worldwide, tested statin treatment in men 50 and older and in women 60 and older who did not have high cholesterol or histories of heart disease. What they did have was high levels of high-sensitivity C-reactive protein, or CRP, which indicates inflammation in the body. The study, called the Jupiter study, was presented Sunday at an American Heart Association convention in New Orleans. It found that the risk of heart attack was more than halved for people who took statins and they were 20 percent less likely to die during the study. The statin was considered so beneficial that an independent safety monitoring board stopped what was supposed to be a five-year trial last March after less than two years. "Physicians can no longer assume that a patient with low cholesterol has a low risk for a heart attack or stroke," said lead researcher Paul M. Ridker, MD, of Boston's Brigham and Women's Hospital.

Scientists said the research could provide clues on how to address a long-confounding statistic: that half of heart attacks and strokes occur in people without high cholesterol. Several experts said that although the research was significant and would affect clinical practice, the study as published did not give enough detail about which patients should now be tested for CRP or given statins. Like many clinical trials, the study was sponsored by AstraZeneca. It makes the drug in the trial, rosuvastatin, which is sold as Crestor. The most potent statin on the market, Crestor has been criticized by consumer health advocates who say it is more likely to lead to muscle deterioration and kidney problems.

Others say cholesterol is much more important. Dr. Scott Grundy, a heart expert at the University of Texas Southwestern Medical Center, pointed out that in the Jupiter study, the statin not only lowered the protein but also significantly cut already low cholesterol levels, raising questions about whether the benefit actually came from giving patients superlow cholesterol. And because CRP can rise with short-term infections unrelated to chronic inflammation, some experts said test results needed to be weighed against other aspects of the patient’s health.

The issues here are that these study participants were average age 66 people who has a higher than normal BMI (28) but had a 'normal' cholesterol - again, these were NOT low risk people, just low cholesterol. The study shows that the benefits of taking drugs such as Crestor can apply across a broad range of individuals and, as we have known for some time, half the people that have heart attacks have a 'normal' cholesterol - so this is not a particularly powerful discriminator.

The problem is that using such measures of 'risk' across a population does not imply that you as an individual have a higher or lower risk; the best way to define risk is first to refine your risk by doing a heart scan and THEN define factors that contributed to this such as higher than necessary cholesterol.

Thus, the problem with these and many other studies is that they tell you who might be at risk but do not tell you the potential risk in a given individual which is best done by doing a heart or vascular scan.

John A. Rumberger, M.D., FACC

Medical Director, PrevaHealth