Nov. 14--With a major study now suggesting that cholesterol-lowering statin drugs might help more people, Sacramento doctors are already fielding patient calls.
The main questions: Should I take a pill or get a test to be better protected from heart disease?
The answer varies by doctor, as physicians try to sort through the latest findings.
"There has been a dramatic falloff in the incidence of coronary heart disease in this country, and many people think that may be related to statins," said Dr. James A. Joye, chief of cardiology at Kaiser Permanente in Sacramento and Roseville.
"At the same time, some people can get quite sick on statins."
Statins can cause muscle aches and perhaps memory problems. While they clearly help middle-aged men at high risk of heart disease, they don't do as much good for healthier people.
At least 11 million Americans take statins, and calls to expand their ranks are frequent. This summer, the American Academy of Pediatrics said statins should be considered for some high-risk children as young as 8 years old. Now, millions more adults with normal cholesterol could also be targeted.
The latest study, published online Sunday in the New England Journal of Medicine, focused on otherwise healthy people who didn't have cholesterol problems but did have high levels of C-reactive protein, a blood protein that's a sign of inflammation.
When nearly 18,000 of them were given either a statin or a placebo pill for several years, those who got the statin had fewer heart attacks, fewer strokes, fewer cardiovascular hospitalizations -- and fewer deaths.
The research was paid for by AstraZeneca, maker of the statin used in the study and sold under the brand name Crestor.
The company was quick to say its drug cut heart attack and stroke risk by about half and cut deaths by 20 percent -- but several doctors noted that the underlying numbers were far less dramatic.
"The total number of patients (who benefited) is actually really small," said Dr. Michael Chang, medical director of cardiology at Mercy General in Sacramento.
For the time they were tracked, 247 people of the roughly 9,000 taking the placebo died from any cause, and 68 had heart attacks. Of the 9,000 taking the statin, 198 died and 31 had heart attacks.
"The folks who didn't get a statin, the vast majority did fine as well," said Dr. David Roberts, medical director of the Sutter Heart and Vascular Institute.
"That's where the rub is," Roberts said. "These drugs do have side effects. They make people achy. There's a risk of liver inflammation."
They're also not cheap. Crestor costs about $3.45 a day, according to Dr. Mark Hlatky, a Stanford professor of health research and policy who wrote an editorial in the medical journal about the new research.
It's going to be important, he said, for experts in evidence-based medicine, economics and public health to be well represented on panels that will set new guidelines about who should take statins.
"There clearly are examples in the past where a lot of experts named to the panels have strong ties to the drug companies," Hlatky said.
He worries that not enough is known about how relatively healthy people will be affected if statins lower cholesterol to "unprecedented" levels.
"Cholesterol is necessary for life. It's an important part of your cell membranes," the doctor said.
Statins open up arteries and enhance delivery of oxygen to tissues in some people, but they also interfere with energy production at a cellular level, said Dr. Beatrice Golomb, a UC San Diego medical professor who studies risks and benefits of medical treatment.
The drugs can cause muscle pain and weakness, as well as problems with memory and cognition, she said. In relatively rare cases, they can cause permanent disability or massive, fatal muscular breakdown.
"There is almost a religious zeal about cholesterol reduction in the medical community," but there is no strong evidence the benefits of statins outweigh risks in women or in people older than 70, Golomb said.
Because cholesterol has always been an imperfect measure of who will develop heart disease, she and other doctors suggested that the new study may also trigger a fresh look at other potential markers of danger, including C-reactive protein. Some doctors said they've already heard from patients interested in being tested.
As physicians decide what to make of the latest statin research, they also have to take into account that it was halted early because the drug helped more people than the placebo did.
That is part of what makes it a very important study with significant results, said Mercy cardiologist Chang.
It is also troubling, said Dr. Gnanagurudasan Prakasam, a Sacramento pediatric endocrinologist who on rare occasions will prescribe statins for children.
"You're talking about a long-term medication, and then you're giving two years of data," Prakasam said. "We already know we have to watch liver function closely" in people who take statins.
"Nobody knows what happens when you're giving that to a normal person for a long period of time."
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Call The Bee's Carrie Peyton Dahlberg, (916) 321-1086.
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