STEP aside aspirin鈥攈ere 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.
鈥淒octors need to be aware just how definite these results are,鈥� says Rory
Collins of Oxford University, director of the seven-year Heart Protection Study
involving 20,000 volunteers aged between 40 and 80. 鈥淭here鈥檚 no room for
doubt鈥攖hey鈥檙e the sort of results you dream of,鈥� he says.
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He wants existing guidelines on prescribing statins to be ripped up. 鈥淭he
default has changed, so doctors should now ask if there鈥檚 a good reason not to
give the drug,鈥� he says. It may not even be necessary to measure cholesterol
levels beforehand, he says.
Statins don鈥檛 come cheap, however. A year-long course of simvastatin, the
drug given to the volunteers, costs 拢360. If people keep taking them for
decades, it could stretch the resources of public health services such as
Britain鈥檚 NHS. But cheaper, generic versions might soon be available.
Patent protection for simvastatin doesn鈥檛 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.
鈥淓ven if the cost comes down significantly, the [huge] demand might mean we
can鈥檛 use them as liberally as we would like,鈥� says Peter Fellows, chairman of
the British Medical Association鈥檚 prescribing committee. And the BMA is
recommending caution despite the spectacular results. 鈥淚t鈥檚 still possible there
might be long-term effects that might not yet have come to light,鈥� Fellows
says.
Statins work by blocking a liver enzyme that makes cholesterol. The liver
compensates by withdrawing the harmful, artery-clogging cholesterol
complex鈥攃alled low-density lipoprotein鈥攆rom 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鈥檛 see any sign of the muscle wastage that in August led to the
withdrawal of Baycol, a statin made by Bayer of Germany.