Medically Clear #21: More HOPE for Statin Therapy
How does year’s presidential match-up make you feel?
Listen to the podcast here or in iTunes
Anxious, depressed, or perhaps even angry? Does the prospect of vulgar nicknames and factual disregard have your cortisol levels dialed up a notch and your heart doing the Red Bull jitterbug?
While your concern for the well-being of our nation is honorable (and warranted), remember, you should not let politics disrupt your own health.
We all know that stress is associated with poor health, especially cardiovascular health. Middle-aged or older? You may already be at risk for unwelcome events like heart attacks and strokes. Of course here in Marin most folks do a good job of maintaining healthy lifestyles — full of leafy greens and exercise — and this helps mitigate risk. But, this presidential election cycle may call for even more aggressive prevention. Fortunately, there is new HOPE from HOPE3 — that is the international Heart Outcomes Prevention Evaluation research consortium.
A recent article by Salim Yusuf and other HOPE medical researchers (one of three manuscripts by the team published in a single issue of the New England Journal of Medicine) demonstrates that statin medications are not just for patients with elevated cholesterol levels.
I’m sure you’ve heard of statins — they are one of the most widely recommended classes of drugs in the world and their use has been associated with decreased risk of stroke and heart attack as well as improved outcomes after such events. Thanks to the HOPE3 study we now have further evidence that people with normal cholesterol levels, who are at intermediate (medium) risk for cardiovascular disease, may benefit from statin treatment.
In the HOPE3 trials, 228 facilities across 21 countries enrolled more than 12,000 participants with intermediate cardiovascular risk (specifically men over the age of 55 and women over the age 65 with a risk factor such as high blood pressure or a family history of heart disease) and randomized them to one of four treatment groups. Participants got one of four possible combinations of the following: a blood pressure poly pill (one pill that combines two low-dose blood pressure medications), a statin (rosuvastatin, aka Crestor) at a low dose of 10 mg a day, and a placebo pill. So for example, the study subjects taking Crestor might get either Crestor with a placebo pill or Crestor with a blood pressure poly pill.
Looking at these 12,000 patients, Yusuf and colleagues compared Crestor treatment versus placebo. Following patients for an average of 5.6 years, the investigators found that the risk of a major cardiovascular event or stroke was 1 percent lower in the study (statin/Crestor) group (3.7 percent versus 4.8 percent) with a relative risk reduction of nearly one-quarter. While this may seem rather modest (preventing a heart attack or stroke in 1 out of every 100 people receiving treatment), it is worth considering that the benefits may accumulate over time and may, as suggested by a prior study, be more robust with a higher dose of statin.
Of note, a separate HOPE3 paper by Lonn and colleagues reported that taking the blood pressure polypill alone did not help prevent cardiovascular events in intermediate risk people.
The participants in the HOPE3 study were an international and diverse group and the benefits of treatment were seen across ethnicities — expanding evidence of statins’ therapeutic value to populations such as the Chinese and Hispanic where prior supporting evidence had been sparse.
On the other hand, we know that no treatments are risk free, not even seemingly benign and “natural” ones like oxygen and water. In keeping with this, the HOPE3 investigators did find an increased risk of certain side effects in the Crestor group. These included a higher rate of cataract development — a finding that has mixed support based on previous studies. Probably more important to consider is the higher rate (5.8 percent) of “muscle symptoms” such as pain or weakness in the statin group as compared to the control group (4.7 percent). Muscle issues are already a well-known side effect of statins and can cause some people to quit treatment. In this study, however, the rates of serious muscle-related complications (enough to cause sufficient muscle breakdown to damage the kidneys or so much discomfort that treatment was halted) were not significantly different between Crestor-takers and placebo-takers.
So, how’s your heart health and cardiovascular risk? There are a number of online options for calculating risk. This one from the American Heart Association is a detailed option that captures the essence of the intermediate risk criteria in the HOPE3 studies
If you’re somewhere in the middle — at intermediate risk for a cardiovascular event — it might be worth discussing the pros and cons of statin therapy with your doctor. As with any treatment, and as mentioned above, statins are not risk free and you’ll want to be well informed about the risks and benefits before starting therapy.
We can only HOPE that facts garner the same level of importance in our presidential campaign.
Listen to the podcast here or in iTunes
Next up, Clarity Re-visited
