A large new study seems to suggest that millions of people with low cholesterol could benefit from taking the cholesterol-lowering drugs known as statins. That would be a boon for some drug companies, but whether it would be good for all patients remains an open question.
The study, led by researchers at Brigham and Women’s Hospital in Boston, involved some 17,800 patients with normal or low levels of the bad form of cholesterol but high levels of C-reactive protein, or CRP, which is often a measure of inflammation in artery walls. Half were given the statin Crestor, made by AstraZeneca; the other half received a placebo.
The benefits of the statin were so striking that a monitoring board stopped the trial in midcourse so that the placebo group could get the medicine, too. Those who got the statin had 54 percent fewer heart attacks, 48 percent fewer strokes and 20 percent fewer deaths from all causes. The participants included men 50 and older and women 60 and older with no history of heart disease or high cholesterol. But they all had high levels of CRP, and many had such other risk factors as high blood pressure, obesity and smoking. Whether the statin helped because it reduced normal cholesterol to even lower levels or because it reduced CRP levels is not clear.
Some 16 million to 20 million Americans take statins to reduce bad cholesterol, but some experts believe the new study suggests several million more should probably take statins as well.
Before rushing ahead it will be crucial to establish who might really benefit. An editorial in The New England Journal of Medicine, where the study was published, stresses the importance of establishing the long-term safety of drastically lowering cholesterol levels before committing patients who have no clinical signs of disease to decades of drug treatment. Participants who took Crestor also had a worrisome increase in diabetes.
The results must also be evaluated in the light of two potential conflicts of interest. The lead investigator stands to benefit from a patent involving the use of CRP to evaluate the risk of cardiovascular disease, and AstraZeneca financed the study whose results it is now trumpeting as “dramatic.”
Given that half of all heart attacks and strokes occur in people whose cholesterol is not considered high, it seems likely that there is a group of people with normal cholesterol who could benefit by taking statins. The task ahead for the writers of medical guidelines is to define just who those people might be.
