Statins In the News: The New Miracle Drugs?

Derek S. Honda , PharmD Candidate 2009

Bernard J Dunn School of Pharmacy, Shenandoah University

Prepared during Consumer Health Information Corporation Clerkship
McLean, VA

“Is it time to put cholesterol-lowering statin drugs in every medicine cabinet?” This was the question raised by Tara Parker-Pope in the New York Times on November 18, 2008.   

Researchers conducting a recent groundbreaking clinical study found that patients receiving the cholesterol-lowering drug Crestor® had a 50% lower likelihood of having a stroke or being hospitalized for angina. They were also 20% less likely to die than patients taking a placebo or sugar pill.1-2  This widely-publicized study, called the JUPITER Trial, was intended to last 5 years but it was halted at 2 years because patients receiving Crestor® were responding so much better than anticipated.

But statins may have wide-ranging usefulness in additional areas of therapy. Other studies have found that statins are also useful in the prevention of:

• Osteoporosis and arthritis
• Breast, lung, and colon cancers
• Kidney diseases
• Alzheimer’s disease
• Breathing problems
  
  

How statins are used in the treatment of these diseases remains unclear but is believed to be related to their anti-inflammatory properties. 

The recent buzz in pharmaceutical news is that statins are the “magic pill”.  But this is still new information and patients as well as doctors should be cautious. Before a person starts taking a statin drug, it is very important to learn about its potential risks as well as its benefits.

How do statins lower cholesterol?

Statins are able to lower cholesterol by blocking an enzyme in the liver that the body needs to make cholesterol.  They lower the “bad cholesterol” (LDL) and raise the “good cholesterol” (HDL).  Statins, along with a healthy diet and lifestyle, can limit cholesterol production.  This will decrease the total cholesterol in the bloodstream and slow down the build-up of cholesterol plaque in arteries. This is how statins can reduce a person’s risk of heart problems.

Do you know your CRP level?

Doctors use a simple blood test to screen for CRP (C-Reactive Protein) levels. The presence of too much CRP in the blood  means a person has more inflammation in their body than normal. The level of CRP rises as inflammation rises. For example if a person has pneumonia, arthritis or clogged arteries, the CRP will be higher than normal.  

To check for the risk of heart disease, the American Heart Association recommends a very sensitive CRP test. This is called high sensitive CRP (hs-CRP).

CRP is generally rechecked every 2 months if levels are average to high.  If a patient is found to have low levels of CRP then a retest would be done every 2 to 5 years.

This recent JUPITER study demonstrated how beneficial the CRP level is in predicting heart disease.  The study found that even though a person might have low cholesterol and CRP level is 2 mg/L or higher, Crestor® helped prevent future heart problems and death.

Is a statin right for me?

With the widespread news of statins benefiting people with already low cholesterol, physicians have been receiving questions from patients on whether or not a statin is beneficial for them.  Currently, the answers to patients’ questions appear to be cautious in nature. Dr. Thomas H. Lee, Professor of Medicine at Harvard Medical School, told his 60-year-old female patient, who met the criteria of low LDL and high CRP levels, to “just wait and see if any evidence of cardiovascular problems, or trends in her laboratory risk factors becomes dangerous to her health”.  He also advised his patient to “wait and see what new discoveries are found from further research”.

According to clinical guidelines, cholesterol levels along with risk factors are indicators to see if someone can be considered for statin therapy.  Some of these risk factors include:

• Family history of high cholesterol or heart problems

• High blood pressure

• Age (men over 45 years and women over 55 years)

• Presence of diabetes

• Overweight

• Central obesity (men  > 40 in. and women > 35 in. around the waist)

• Smoking

• Poor circulation; narrowing of the arteries in your neck, arms or legs

However, even having one or a few of these risk factors does not mean someone will need statins. Simple lifestyle changes such as quitting smoking, reduced stress, healthy diet and daily exercise may be all that are necessary to lower cholesterol and reduce heart problems.

Check your enzymes

As with all drugs, be aware of the risks involved with taking statins.  The most common side effects
of statins are:

• Muscle and joint aches

• Nausea

• Diarrhea

• Constipation

Major risks of statins are potential liver and muscle damage.  It is especially important for people with liver or kidney disease to be extra cautious when considering statins. 

• To check how your liver is doing while on statins your doctor should give you a Liver Function Test (LFT) every 6 to 12 months.  This test measures liver function from enzymes in a sample of your blood.   
• To check if your muscles and kidneys are healthy, a creatinine phosphokinase (CPK) test is used. This test measures muscle decay and kidney problems from enzymes found in your heart, brain and muscles. 
  
  

Keep in touch with your physician and pharmacist about any side effects that are bothersome.  You may need a lower dose or a different drug.

What to expect in the future

In the near future, more people will be getting their CRP level checked as news about this study unfolds. If you don’t know your CRP level, check with a doctor to see if a CRP level test is a good thing to do.  If you are prescribed a statin you need to know how to use it correctly and safely. 

© 2008 Consumer Health Information Corporation. All rights reserved.