A large new study suggests that millions more people could benefit from taking the cholesterol-lowering drugs known as statins, even if they have low cholesterol, because the drugs can significantly lower their risk of heart attacks, strokes and death.
The study, involving nearly 18,000 people worldwide, tested statin treatment in men 50 and older and in women 60 and older who did not have high cholesterol or histories of heart disease. What they did have was high levels of a protein called high-sensitivity C-reactive protein, or CRP, which indicates inflammation in the body.
The study, presented Sunday at an American Heart Association convention in New Orleans and published online in The New England Journal of Medicine, found that the risk of heart attack was more than cut in half for people who took statins.
Those people were also almost 50 percent less likely to suffer a stroke or need angioplasty or bypass surgery, and they were 20 percent less likely to die during the study. The statin was considered so beneficial that an independent safety monitoring board stopped what was supposed to be a five-year trial last March after less than two years.
Scientists said the research could provide clues on how to address a long-confounding statistic: that half of heart attacks and strokes occur in people without high cholesterol.
''These are findings that are really going to impact the practice of cardiology in the country,'' said Dr. Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute, which was not involved in the research. ''It's at a minimum an extremely important study and has the potential to be a landmark study.''
The study is stirring debate over who should take a blood test to check CRP and under what circumstances someone with high levels of the protein should be given a statin. Because heart disease is a complex illness affected by many risk factors -- including smoking, hypertension and being overweight -- most researchers said high CRP alone should not justify prescribing statins to people who have never had heart problems.
Some experts cautioned against testing people for the protein unless they had other risk factors, and they said more research was needed to pinpoint the patients for whom the benefit of statins outweighs the risks. On rare occasions, statins have been linked to muscle deterioration or kidney problems, and some patients reported fogginess of memory. Other researchers recommended testing for CRP more frequently and using statins more aggressively.
The study, called Jupiter, is also fueling a debate among scientists about the protein's importance and inflammation's role in heart disease.
Dr. Nabel said national panels were likely to revise their official guidelines for doctors to recommend CRP testing and statin therapy for some people not previously considered candidates.
Current practice, she said, is to treat people with high cholesterol with statins and to counsel people at low risk for heart disease about diet and exercise.
''What cardiologists have never known what to do about is the intermediate range'' of patients, Dr. Nabel said, who may be overweight, smoke or have hypertension but do not have the most serious red flags of high cholesterol or diabetes. ''I think CRP will emerge as a new risk factor added to traditional risk factors.''
The leader of the Jupiter study, Dr. Paul M. Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston, said expanding statin use could prevent about 250,000 heart attacks, strokes, vascular procedures or cardiac deaths over five years.
Some experts not involved in the study said several million more Americans should probably be taking statins. About 16 million to 20 million do now.
