Cholesterol-lowering statins are the best-selling class of drugs in the country. But as their pool of takers has expanded, critics have complained that the meds, while effective in reducing heart attacks and strokes, haven’t been proved to save lives.
But new research, published today in the Archives of Internal Medicine, indicates that statins do, in fact, reduce the risk of dying for both people with heart disease and for those who are taking the drugs because their cholesterol is elevated. (Not everyone who suffers a heart attack has high cholesterol, so prescribing statins just because a person's levels are high is controversial.)
The study followed nearly 230,000 members of an Israeli health-maintenance organization whose doctors prescribed them a variety of statins and doses for an average of five years. At the end of the study, 4,259 of the people taking the drugs to lower their cholesterol had died, as had 8,906 of those taking the meds because they had heart disease. People who took theirr statins 90 percent or more of the time had a 45 percent lower risk of dying than those who only took their meds 10 percent of the time.
The reason for the reduction in death (which was from any cause, not necessarily heart disease) isn’t known, but the researchers, from Maccabi Health Services and Tel Aviv University, say the drugs may have cut not just cholesterol levels, but inflammation indicated by a marker called high-sensitive C-reactive protein (CRP) that has been shown to decrease with use of the meds.
They also speculate that the statins may even have reduced their takers' risk of developing cancer, a hypothesis that hasn’t been proven. Cancer is the leading cause of death in Israel, but only a review of the death certificates of those who died will show whether their rates of the disease were lower.
"It very clearly demonstrates that there's an enormous benefit of statins to people who haven’t got disease but do have raised cholesterol," Anthony Heymann, a lecturer at Tel Aviv University, tells ScientificAmerican.com. Right now, doctors recommend statins for people without known coronary disease whose LDL, or "bad" cholesterol, is 190 mg/dL or higher, and people with lower LDL who have other risk factors may also take the drugs. But Heymann says the findings "call this recommendation into question. This research clearly points the way to increasing the pool of patients who could benefit from treatment; the question is who we could recommend."
But not everyone is sold. In a study published in November in the journal Clinical Therapeutics, the Israeli scientists reported that three-quarters of the patients had stopped taking their statins within two years of starting them. Beatrice Golomb, an associate professor of medicine at the University of California, San Diego who's leading another study of statin side effects, said the Archives research shows a dramatic reduction in mortality from statins because people who stick to their meds may be healthier than those who suffer side effects. The likelihood of suffering statin side effects is greater among people with conditions that increase the chance of dying, such as diabetes, obesity and hypertension, Golomb noted in a paper she published last year in the American Journal of Cardiovascular Drugs.
"It is completely unacceptable to refer to these as benefits of statins," Golomb tells ScientificAmerican.com. "It should be clear that people who are 'able' to be compliant on a drug are different from those not able."
None of the Israeli scientists have financial ties to statin manufacturers, they said. Maccabi's departments of community medicine and medical informatics paid for the research.
Image © iStockphoto/Max Delson