Giving more people statins could cost effectively prevent heart attacks

Giving cholesterol-lowering statin drugs to more people could be a cost-effective way of preventing heart attacks, US researchers said Sept. 27, as reported by Reuters. The study was published in Circulation.

Researchers analyzed the impact of giving statins to people who currently do not have high heart risks and found that the drugs were well worth the extra cost of the treatment.

The study follows the findings of Jupiter, a major heart study 2 years ago, which found giving the rosuvastatin (Crestor, AstraZeneca) to people with average to low cholesterol but other heart risks helped prevent heart attack and strokes. In the study, patients had low cholesterol but high levels of C-reactive protein (CRP), a sign of inflammation that could mean a higher risk of heart attacks or strokes.

Under current guidelines, doctors recommend statins if their patients have a 20% or greater risk of having a heart attack or a stroke in the next 10 years.

In the most recent study 2 strategies were: either simply giving statins to more people or only giving them to people with a high CRP test.

“The real message is that either one of those strategies looked better than what we do now,” said Mark Hlatky, MD, of the Stanford University School of Medicine. “Of the two alternatives, the idea of just lowering the threshold and not bothering with the CRP test came out ahead.”

Researchers developed a computer model that analyzed 3 approaches: following current guidelines, treating people who do not meet current guidelines but have high CRP, and treating those who have heart risks but do not meet current guidelines for receiving statins. They found that prescribing statins based on risk was the most cost-effective.

“The critical thing was getting more people treated who don’t currently meet the guidelines,” Dr. Hlatky said.

But even slight changes in the assumptions, such as the safety of statin drugs, could tip the finding back to the status quo, Dr. Hlatky stressed. “We probably need more information on how safe and effective these drugs are in low-risk populations,” he pointed out.
A National Heart, Lung, and Blood Institute panel is updating the clinical guidelines for statin therapy.

In other rosuvastatin news, Sun Pharmaceutical has received tentative approval to market a generic version of Crestor tablets 5 mg, 10 mg, 20 mg, and 40 mg.