More Insight into Who Should Take Statins

You will be seeing a lot of news coverage coming out of this week's cardiology conference about a large study of the statin drug, Crestor, which supposedly found it cut cardiovascular deaths in a group of people with normal LDL better than a placebo.

What most news coverage is leaving out is this: The group of people with "normal" cholesterol who took Crestor in this study weren't just any old group of people. They were people with elevated CRP.

This is an important distinction. CRP stands for C-reactive protein and it is a measure of inflammation. Earlier studies had shown that statins are only helpful in reducing cardiovascular events in people with pre-existing heart disease. Accumulating evidence suggests that they do this by reducing the artery inflammation that is characteristic of heart disease, not by reducing cholesterol. There has never been any truly solid proof that high cholesterol in and of itself causes heart attacks.

So this latest Crestor study may actually have done to finally narrow down who it is who should be taking statin drugs to the subgroup of people, whatever their cholesterol might be, whose CRP is elevated.

Given the way this new story is being reported, I'm not sure we can count on the drug company to give doctors thats message. Instead, the message might be that everyone, no matter what their cholesterol might be, should take this expensive drug.

This might be a mistake. Statins cause serious and sometimes irreversible side effects, some of them affecting mental function. They are particularly dangerous in older people.

If your doctor wants you to take a statin, demand that you first have a CRP test. If your CRP is normal and you have not been diagnosed with heart disease using a definitive diagnosis from something like an artery scan, rather than an inference from something like a high cholesterol test value, you may not need the statin.

I've done this myself, and my CRP was rock solid normal. That is one reason I have been very resistant to the idea of taking statins no matter how high my LDL might be. I saw a statin cause almost instant deterioration in my dad's hitherto stellar mental functioning, and no way am I gambling with mine!

Another piece of Crestor news is that a smaller study, which reanalyzed results of the Asteroid trial, found evidence of some regression in artery plaque in people taking Crestor. This particular trial did not investigate whether the changes observed actually mapped down to fewer heart attacks.

Also, keep in mind that these are reports at a convention, not peer reviewed research studies, and we won't really know how significant the findings were until we see the actual data in a publication. We also won't learn about the side effect profile of Crestor that was observed in these trials.

So, as is usually the case, the devil may well be in the details. For now, it's worth noting that most of the coverage of these reports is in the business press because the bottom line is that $tatin$ are all about profit$.

Here's one of the more informative reports about these studies:

Another Blow for Schering and Merck