People With Normal Cholesterol May Benefit From Statins

Apparently healthy people with normal or even low cholesterol levels might benefit as much from taking statin drugs as people with high cholesterol, U.S. researchers said on Tuesday.

They studied people with normal cholesterol readings but high levels of C-reactive protein — a marker of inflammation — and found statins reduced the risk of heart attacks, clogged arteries and other problems in this group as well as they did among people with high cholesterol.

Most people are not routinely screened for C-reactive protein, but the researchers argue that it may be time to start testing for it in the hopes of preventing heart attacks in people who might otherwise go untreated.

"This paper provides what we think is pretty persuasive evidence that the time may be at hand for a shift in how we go about preventing heart disease," said Dr. Paul Ridker of Brigham and Women's Hospital in Boston, whose study appears in the journal Circulation: Cardiovascular Quality and Outcomes.

Ridker led a major study last year called Jupiter that found giving AstraZeneca's cholesterol fighter Crestor, or rosuvastatin, slashed deaths, heart attacks, strokes and artery-clearing procedures in apparently healthy patients.

In the latest study, which was funded by AstraZeneca, Ridker and colleagues looked to see how the benefits of statin use in people with high C-reactive protein compared with statins in people with high cholesterol.

They chose a common yardstick used to help doctors evaluate treatments — a measurement of the number of patients who need to take a drug over time to derive a benefit.

In this case, the researchers looked at how many patients with low cholesterol and high C-reactive protein would need to take Crestor for five years before the drug prevented a heart attack, stroke, treatment to unblock a clogged artery or death from a heart attack or stroke.

They found the number needed to treat, known as NNT, was 20 patients.

"Those NNT values are comparable or even superior to NNT values we already consider acceptable to prevent cardiovascular disease with statins in people with high cholesterol levels," Ridker said.

He said in other prevention studies, the five-year NNT values for people with high cholesterol ranged from 44, for those taking the statin drug pravastatin or Pravachol, made by Bristol-Myers Squibb, to 63 for people taking Merck's Mevacor, or lovastatin.

They also calculated even if people with high levels of C-reactive protein took another statin and only got half or 75 percent of the benefit that patients got taking Crestor in the Jupiter study, the benefit was still comparable to that seen in people who take statins to lower their cholesterol.

"This study suggests that many patients outside our current treatment guidelines could benefit substantially from statin therapy," said Ridker, who disclosed that he has received consulting fees and grants from several drug companies including AstraZeneca.