Thursday, November 13, 2008

Statin drugs and cholesterol, and easy guide

What is all the fuss about that pesky cholesterol, anyway? Why do doctors and nurses care so much about it?

Having high cholesterol is one of the major risk factors for life-threatening cardiovascular events.

For those interested in more detail, cholesterol is a soft, waxy-like substance produced by your liver. Everyone has cholesterol and everyone needs it. Cholesterol produces cell membranes, some of your body's hormones, and other important structures. However, technically, your liver produces practically all that your body needs (about 1000mg per day). The excess comes from your diet (anywhere from about 500-1000mg/day), and that is where the trouble usually begins. If your body has excess cholesterol, it lingers in your bloodsteam and clogs your artieries, causing atherosclerosis, strokes, and heart attacks.

For a good breakdown on types of cholesterol, you can go here.

Do you know your cholesterol numbers? If not, you should, as that is the first step in reducing your risk of cholesterol-related cardiovascular events.

If you have already had a lipid panel, and your previous cholesterol levels were normal, then you only need to get re-checked every 5 years. Of course, that time frame decreases if you already have high cholesterol.

Why am I bringing up this seemingly random topic, you may ask?

Because researchers are making important discoveries regarding medications for cholesterol, and they affect each and every one of us. These studies, for the first time ever, included black people, Hispanic people, men, and women.

And, in all of its inclusiveness, these studies focus on people who already have low cholesterol. In other words, they focus on what nurses love best: preventive care.

A couple years ago, in one of my pharmacology classes, my professor mentioned that cardiologists with already-low cholesterol levels were all taking statin drugs as heart prevention. It appears that they, as would be expected, were probably ahead of the curve.

The above-mentioned study showed that when people with relatively low cholesterol levels take statin drugs like Crestor (rosuvastatin), their rate of heart attack and strokes were half that of the group who took the placebo. [Note: The study I am referring to involved Crestor. However, the researchers believe that the cheaper generic statins would be just as effective in reducing the risk of cardiovascular events. Also note that other statins are relatively safer. Crestor especially has been known to cause a rare, but serious, muscle side-effect.]

An article on MedicineNet describes the reasoning behind the study here:

"Statins are generally prescribed only for people with high cholesterol or those who have borderline high cholesterol and other risk factors for heart attack and stroke, such as diabetes or established heart disease.

But as many as half of all heart attacks and strokes occur among people without these risk factors who have LDL cholesterol levels that are below recommended thresholds for statin treatment.

The newly reported trial was designed to explore whether statins might also benefit these people."

The study was originally planned to last for 5 years, yet independent monitors stopped the study when they determined that those in the Crestor-group were faring better than the placebo-group.

Whether or not this finding is cost-efficient is another matter. Crestor is expensive, and that rare muscle-side effect can be very serious. Are the benefits worth the risks and cost in a person with practically no risk factors for heart disease?

The specific findings are as such: "Looked at another way, there were 136 heart-related problems per year for every 10,000 people taking dummy pills versus 77 for those on Crestor."

From the Crestor package insert:

"Creatine kinase (CK) elevations (>10 times upper limit of normal) occurred in
0.2% to 0.4% of patients taking rosuvastatin at doses up to 40 mg in clinical studies. Treatment related myopathy, defined as muscle aches or muscle weakness in conjunction with increases in CK values >10 times upper limit of normal, was reported in up to 0.1% of patients taking rosuvastatin doses of up to 40 mg in clinical studies."

So there we have it. Here is a quick break-down:

-If you have low cholesterol and don't take a statin, you could be one of the 136/10,000 people who have a serious cardiovascular event (1.36%).

-If you have low cholesterol and take a statin, your risk of a cardiovascular event decreases to 77/10,000 (.77%).

-However, if you do choose to take a statin, your risk of rhabdomyolosis is about 0.1%.

One thing worth mentioning is that if you have low cholesterol, your doctor is not going to put you on a maximum dose statin, either, as that increases the rhabdomyolosis risk. While I am not a fan of having to take or prescribe daily medications when they aren't necessarily indicated, the study offers promising news in preventing those heart attacks that occur despite a lack of any known risk factors. Or in preventing heart attacks in those with low cholesterol but high C-reactive protein levels, which some doctors believe increases risk of heart attacks.

Just a thought, while I am not saying that everyone should start asking for a statin prescription today for heart attack prevention, it is something you can bring up with your doctor if you are concerned. It is perhaps especially worth mentioning to your doctor if you have any other risk factors (high blood pressure, smoking, obesity, family history of high cholesterol/early heart attacks) or your cholesterol levels are nearly elevated.

It will be interesting to see if any physician groups or the American Heart Association start to change their guidelines and advocate for use of statins for everyone for heart attack prevention.


Anonymous said...

Thanks Jane, for enlightening us. I have to admit, I never really knew anything about cholesterol or why it was really bad. We hear a lot about checking calories, saturated, unsaturated, and trans fats...but not much about cholesterol.

I am also happy to see a study that actually includes a wider demographic of people. It is hard to do any form of analysis or health education when many research studies are performed on the same demographic of people, namely, white men. We are just now starting to discover how some finding are actually not accurate at all when tested on a wider range of people, namely, women said...

For my part one and all must browse on this.