Nobody’s neutral when it comes to the cholesterol-lowering drugs known as statins.
Some doctors are so enthusiastic about these powerful medications that they would almost consider putting them in salt shakers or tap water.
Some patients who have experienced severe side effects believe they should be banned.
This controversy is likely to heat up with FDA’s recent approval of Crestor for healthy people who don’t have high cholesterol.
The idea that millions of people should be swallowing a pill every day even if they have normal cholesterol stems from a clinical trial called JUPITER sponsored by AstraZeneca, the manufacturer of Crestor. This very large experiment was done with 17,802 healthy men and women. They had levels of bad LDL cholesterol less than 130, which would be considered acceptable by many physicians. To qualify for the clinical trial, however, the subjects had high blood levels of C-reactive protein (CRP), a marker for inflammation in the body.
The trial was stopped early, after just two years of follow-up on average, because the results seemed so impressive: the relative risk of heart attack and stroke was reduced roughly in half (New England Journal of Medicine, Nov. 20, 2008).
That certainly sounds great. And it is easy to understand why many cardiologists have become such enthusiasts of statin-type drugs. The problem with such statistics is that they are easily misinterpreted. Many people assume that a relative risk reduction of 50 percent means that 50 people out of 100 treated would be spared a heart attack. That is far from true.
Over the course of almost two years, 31 people out of 8,901 on Crestor had a heart attack. Of the 8,901 people on placebo, 68 suffered a heart attack. That means thousands of people had to take Crestor so that 37 would be spared a heart attack.
Think of it this way. People taking Crestor suffered blood clots at a rate of 1.8 per 1000 people per year (New England Journal of Medicine, online March 29, 2009). Those on placebo had blood clots at a rate of 3.2 per thousand people per year. This works out to a relative risk reduction of 43 percent, but in real life healthy people have a low likelihood of suffering a blood clot, a heart attack or a stroke.
Is it really worthwhile for so many people to take a pricey pill that could cause side effects to make a low risk even lower? The FDA approved Crestor to lessen the possibility of heart attack and stroke among men at least 50 and women at least 60 years old with high CRP and at least one other classic risk factor: smoking, high blood pressure, low levels of good HDL cholesterol or a family history of heart disease.
Before you accept a prescription for prevention, make sure you actually fit those criteria. Crestor, like all statins, has risks. Muscle pain and weakness, joint pain and constipation affect quality of life. The manufacturer has also warned that Crestor may raise the chance of developing type 2 diabetes. For more information about the pros and cons of statins see our Guide to Heart Health and Cholesterol at www.peoplespharmacy.com.
Once you know both the benefits and risks of such medicine you will be better prepared to discuss them with your physician.
