All for one… and statins for all?

By Dr. Franco

Since the 70’s when statins were discovered by Japanese Drs. Endo and Koruda, these pharmacological compounds have attracted broad attention and have been widely investigated. Statins act by inhibiting an enzyme called HMG-CoA reductase, which is key in the production of cholesterol in the liver and therefore lower the blood levels of cholesterol. By these and other mechanisms (e.j. inflammation reduction, improvement in endothelial function) statins substantially contribute to decrease the risk of developing cardiovascular disease (namely myocardial infarction and stroke).

Different studies have demonstrated the ample benefits of administering statins to individuals suffering from heart disease. Whether to administer statins to those without heart disease nevertheless remains controversial. In a recent meta-analysis (a collection and summary of studies performed in a particular subject) published in the British Medical Journal (BMJ), researchers from Erasmus MC in Rotterdam, the Netherlands, aimed to evaluate the benefits of giving statins to people without cardiovascular disease but with different risk factors for this disorder. The results of this study provide a complex picture, showing that although taking statins reduced mortality as well as heart disease events, many people would have to be treated to prevent one event or death. Furthermore, potential adverse effects could occur among those taking statins, as the authors conclude: “Concerns might remain about the higher risk of cancer in elderly patients (70-82 years)… and further follow-up studies in such patients are required”

It appears from this comprehensive summary of the evidence that statins are a good alternative to reduce the risk of cardiovascular disease but that needs to prescribed to many in order to save a few and that could generate unnecessary adverse effects. Should those who do not suffer from heart disease use statins? That remains a partly unanswered question, but why not avoid the need of taking statins by following a healthy lifestyle? Adequate levels of physical activity, following a healthy diet, no smoking and good sleep patterns have all been related with potential reductions of heart disease risk. Its never too late and you could have fun and improve your quality of life while doing it.

Reference:
Brugts JJ, Yetgin T, Hoeks SE, Gotto AM, Shepherd J, Westendorp RG, de Craen AJ, Knopp RH, Nakamura H, Ridker P, van Domburg R, Deckers JW. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ. 2009 Jun 30;338:b2376