Statin Drugs & Cholesterol
Chester J. Zelasko, Ph.D. | December 18, 2001

The recent meeting of the American Heart Association (AHA) produced an interesting report from the Heart Protection Study (HPS) on the cholesterol-lowering drug simvastatin (sold under the brand name Zocor) and antioxidants. HPS was a 5½-year study on over 20,000 people at risk for death from cardiovascular disease, based on risk factors such as previous heart attack, diabetes, or hypertension. Participants received either simvastatin, antioxidants (vitamin C, E, and beta-carotene), or a placebo. The reported results were that antioxidants did not provide any reduction of death due to heart disease or any other cause in this population. The group receiving simvastatin were 16% less likely to die from a cardiovascular event and 12% less likely to die from any cause. Further, they were 27% less likely to have a stroke and 24% less likely to suffer other cardiovascular events.

The study's primary author speculated, "If an extra 10 million high-risk people worldwide go onto statin treatment, this would save about 50,000 lives each year." To put that in more manageable numbers, 5 lives would be saved every year for every 1,000 people taking the drug. He went on to say that statin drugs are the new aspirin for their potential to save lives.

Based on a Medline review of all scientific articles published on simvastatin and other statin drugs, they seem to have been developed for people with familial hypercholesteremia--high cholesterol levels due to genetics. They have a high death rate, with some people dying before 30 years of age. Statin drugs work by inhibiting an enzyme (HMB CoA Reductase) that helps make cholesterol, and they have been very effective in helping people with this genetic abnormality.

Most people who are at risk for heart disease have many risk factors. While they may have high cholesterol, it's usually the result of lifestyle factors such as obesity, sedentary living, a high-fat diet, and smoking, among others. The implication of the HPS is to use statin drugs for prevention as well as treatment. The question is whether the results justify the expense.

The study hasn't been published yet, so we have to rely on what has been reported in online sources. Medscape, a physician-oriented website (www.medscape.com), published some of the HPS data in their reports on the AHA meetings. One of the graphs revealed that 7.7% of people died from vascular events while taking simvastatin for over 5 years, which was lower than the 9.2% who took the placebo. While that is 27%, what it means is that 77 people out of a thousand who took the drug everyday for 5 years died while 92 out of a thousand who took the placebo died. Absolutely true, but is it meaningful in the real world?

Consider the following:

  • Most people in the study would have benefited from weight reduction, exercise, a reduced-fat diet, and smoking cessation, all changes that also lower cholesterol. With over 20,000 subjects, those results could have been extracted if that data were collected.
  • The average cost of the simvastatin used in the study would range from $110 to $130 per month.
  • Statin drugs cannot be taken by everyone. The list of warnings for people taking them is extensive.
The question raised by this study is whether we should become dependent on pharmaceuticals before we attempt to change our lifestyles. While the first instinct is to say "No," we haven't exactly rushed to adopt a healthy lifestyle in America, in spite of urgings from the medical community to do so. It's reasonable for healthcare professionals to become frustrated and to try to find a way to help us in spite of ourselves. A pharmaceutical intervention is reasonable in their eyes because we just won't do it on our own.

Let's be clear: statin drugs have helped millions of people reduce their risk of heart disease and saved many lives in the process. If your doctor tells you to take it, you should. But you should also do all you can to help yourself. The choice may be in your hands. Don't drop the ball.
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