Cholesterol-lowering drugs, known as statins, are widely credited with significantly reducing the risk of dying from coronary heart disease, such as having a heart attack or stroke.
The underlying theory behind the medication is that cholesterol creates atheromatous plaques, or fatty lumps, in the walls of our arteries that can narrow and restrict to the passage of blood. This type of Arteriosclerosis is particularly dangerous when they rupture — it’s the major cause of heart attacks.
Research for a compound to reduce cholesterol is back to the early 1970s when Akira Endo at Sankyo pharmaceuticals in Japan identified the agent mevastatin (ML-2356B) produced by the fungus Penicillium citrinum.
The pharmaceutical giant Merck and Co. recognized an opportunity and brought the first statin, lovastatin, to market under the name Mecavor in 1987. (If you have ever eaten wild Oyster Mushrooms they contain the active compound in lovastatin.)
It wasn’t until results from the Scandinavian Simvastatin Survival Study (4s) conducted in the 1990s were published that the healthcare industry began to take notice of using statins to help prevent cardiovascular disease. This clinical trial assessed the effect of Simvastatin on a group of 4,444 patients between the ages of 35 and 72 had coronary heart disease. The absolute mortality due to coronary heart disease was reduced 3.5%, a 30% relative risk reduction.
Merck marketed this drug as Zocor, and it (along with the earlier Mecavor) earned the company over one billion dollars in 1995.
Thanks to expensive public awareness campaigns, Merck has educated a broad spectrum of the American public about ‘good’ and ‘bad’ cholesterol. Many of us are aware of our own ‘bad’ cholesterol number, which is associated with an increased risk of cardiovascular disease.
Now that medical researchers have more data about statin drugs, there is a more nuanced recommendation from the American College of Cardiology and the American Heart Association about who should take cholesterol-lowering drugs, and when they should start.
These guidelines, first published two years ago, indicate that doctors and patients should consider the patient’s overall risk for coronary heart disease first, rather than just relying on a high cholesterol number before prescribing medication.
Since the release of this study, the question is whether these new guidelines are working out or not. As of this month, we have some new evidence endorsing the revised guidelines.
Medical researchers have published two papers this month in JAMA, the Journal of the American Medical Association.
In the first paper, researchers compared to the new guidelines with the old ones using patients enrolled in the Framingham Heart Study. The new guidelines were found to be more accurate and efficient in identifying people with increased risk of cardiovascular disease. In other words, evaluating patient risk for heart disease is more accurate than just relying on a bad cholesterol number alone.
In other words, if your overall risk for heart disease is low, one elevated cholesterol level test shouldn’t necessarily lead you to automatically begin treatment with statin drugs. On the other hand, if you have high risk factors, such as diabetes (considered a high risk for cardiovascular disease), then it is recommended treatment on statins, even if the cholesterol test number is low.
The second JAMA study took on the problem of what percentage of risk is the best go/no-go decision point for commencing cholesterol treatment?
As we all well understand, no medication is without side effects. While statins are considered generally safe, there have been side effects involving muscle problems, adverse reactions with grapefruit juice, and possible increased risk of diabetes. There may also be long-term risks that are not understood at this time.
The researchers concluded that statin treatment should begin if an individual’s risk of a heart attack or stroke is more than 7.5% in the next 10 years. And, from a macro economic standpoint, it might make sense for patients to begin treatment if their risk was as low as 4%.
Because many of the popular statins are no longer under patent protection, they don’t cost a small fortune as they once did. Consequently Medical researchers calculated that patients with risks as low as .5% per year could elect to take statin drugs and have positive benefits. .
The upshot is that research indicates that patients who have lower risk of cardiovascular disease have more leeway in making a decision about whether to start statin treatment. However, once the risk of heart attack or stroke increases to more than 7.5% over the next 10 years, statin treatment is recommended.