Statins May Help Already Low Cholesterol Levels

RENEE MONTAGNE, host:

This is Morning Edition from NPR News. I'm Renee Montagne.

ARI SHAPIRO, host:

And I'm Ari Shapiro, good morning. A new study suggests that even people with normal or low cholesterol levels can benefit from a cholesterol-lowering drug known as a statin. The research was released yesterday at the American Heart Association meeting in New Orleans.

MONTAGNE: And it has already provoked debate. Some experts say they want to mull over the results before recommending that people with normal cholesterol levels start taking the drug. NPR's Joanne Silberner has more.

JOANNE SILBERNER: The study is impressive in its size: nearly 18,000 apparently healthy men and women from 26 countries. All had normal cholesterol levels but indications of a particular type of inflammation. More on that later. The study is also impressive in its results in what happened when half of these people took a drug called Crestor, which is known by its generic name, rosuvastatin. Harvard University cardiologist Paul Ridker headed the study.

Dr. PAUL RIDKER (Cardiologist, Harvard University): Even though these patients had low cholesterol, giving them a statin drug lowered the risk of heart attacks, stroke, cardiovascular death by almost 50 percent.

SILBERNER: That's a bigger benefit than people with high cholesterol get from statin drugs. Steven Nissen heads the department of cardiovascular medicine at the Cleveland Clinic. He's enthusiastic about what rosuvastatin did.

Dr. STEVEN NISSEN (Chairman, Department of Cardiovascular Medicine): This degree of reduction in heart attack, death, and stroke is unprecedented. In all of medicine, there are few, if any, therapies that I'm aware of that can reduce risk by half.

SILBERNER: That from a man who's actively criticized several other blockbuster studies. Nissen and Ridker can't say if it's specifically Crestor or whether other statins would yield similar results. That's an important issue because Crestor costs $1,200 a year. That's 20 times as much as other statins available in generic form. The study arose from a conundrum that's bedeviled doctors for years. Half of people who get heart attacks have normal cholesterol levels. In those people, something else must be going on. Again, study leader Paul Ridker.

Dr. RIDKER: The idea was raised that inflammation, or this process by which our body heals itself, might give us a clue to why certain people are at high risk and perhaps a clue to how drugs might work in them.

SILBERNER: With funding from AstraZeneca, the maker of Crestor, he and dozens of others tested the drug, which like all statins appears to reduce some kinds of inflammation. The link here is that heart attacks happen when a cholesterol deposit in an artery gets inflamed and bursts. Statins may prevent that. This raises another issue. Should people with normal cholesterol levels be checked for inflammation with a test called highly sensitive CRP? Ridker says, yes. It's needed to determine who should take statins.

He's listed his co-inventor on patents that cover this kind of CRP testing. He could gain financially when doctors test people with normal cholesterol levels. He says his financial interests don't affect the study results that statins, which reduce inflammation, worked better than anyone expected, and safely too. But some heart experts are holding back. Cardiologist Mark Hlatky at Stanford University says you can't draw sweeping conclusions from a study in which people are only on the drug for about two years.

Dr. MARK HLATKY (Cardiologist, Stanford University): It is very likely that people, though, who are started on this drug, are going to stay on it for life. You're talking about 20 years worth of treatment. They are lowering cholesterol to levels that have not been seen in other studies because people started low, and then they lower them yet further. Is that safe for 20 years? We don't know.

SILBERNER: And he knows the study showed a slight increase in diabetes. Before healthy people start taking statins, what Hlatky and others would like is consideration of all the data, not just that released yesterday, by a diverse group of experts. The National Heart, Lung and Blood Institute is doing just that and plans to release its recommendations by the end of next year on who should have their inflammation levels checked and who should take statins. Joanne Silberner, NPR News. Transcript provided by NPR, Copyright NPR.