STEP aside aspirin—here come statins, the latest wonder drugs. A huge
study has shown that one type of statin can reduce the chance of a heart attack
or stroke by a third, yet causes no serious side effects.
Till now, statins have been prescribed only to people with high cholesterol
levels. But the study showed that even people with low levels benefited. That
means doctors should dish them out to far more people, the researchers say.
“Doctors need to be aware just how definite these results are,” says Rory
Collins of Oxford University, director of the seven-year Heart Protection Study
involving 20,000 volunteers aged between 40 and 80. “There’s no room for
doubt—they’re the sort of results you dream of,” he says.
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He wants existing guidelines on prescribing statins to be ripped up. “The
default has changed, so doctors should now ask if there’s a good reason not to
give the drug,” he says. It may not even be necessary to measure cholesterol
levels beforehand, he says.
Statins don’t come cheap, however. A year-long course of simvastatin, the
drug given to the volunteers, costs £360. If people keep taking them for
decades, it could stretch the resources of public health services such as
Britain’s NHS. But cheaper, generic versions might soon be available.
Patent protection for simvastatin doesn’t expire until 2003, but for
lovastatin, patents have already begun to run out. Though the drug is not
licensed for use in Britain, Collins says the NHS should have a look at how to
get generic versions of lovastatin.
“Even if the cost comes down significantly, the [huge] demand might mean we
can’t use them as liberally as we would like,” says Peter Fellows, chairman of
the British Medical Association’s prescribing committee. And the BMA is
recommending caution despite the spectacular results. “It’s still possible there
might be long-term effects that might not yet have come to light,” Fellows
says.
Statins work by blocking a liver enzyme that makes cholesterol. The liver
compensates by withdrawing the harmful, artery-clogging cholesterol
complex—called low-density lipoprotein—from the blood.
Presenting their findings last week in Anaheim, California, at the annual
meeting of the American Heart Association, Collins and his colleagues said that
simvastatin reduced heart attacks and strokes by a third among all those at
risk. Contrary to expectations, it helped women and elderly people with heart
problems, and diabetics.
Statins also reduced the need for surgery or balloon angioplasty to de-clog
arteries, and the need for amputations triggered by poor blood flow to limbs,
usually a result of smoking. Nor were there any serious side effects. The
researchers didn’t see any sign of the muscle wastage that in August led to the
withdrawal of Baycol, a statin made by Bayer of Germany.