When it comes to preventing heart disease, most of us know what to do — lower our cholesterol, lose weight, quit smoking and try to avoid stress. But we also know that if eating right and going to the gym aren’t enough, there are cholesterol-lowering statin drugs that can give us a push in the right direction.
Now scientists at Stanford University report an economic benefit to taking statins: putting more patients on the cholesterol medication may be a cost-effective way to reduce the growing burden of health-care costs associated with treating heart disease, the researchers report.
Currently, national guidelines recommend that among people who have not yet had a heart event, only those at highest risk — defined as more than a 20% chance of having a heart attack, stroke or angina over 10 years — should take a statin. For people under that threshold, the consensus is that the risks of the drug may not outweigh its benefits; while statins are relatively safe, like any drug they do carry side effects, including muscle weakness, which can get severe. (One type of statin was taken off the market due to these concerns.) (More on Time.com: Are You a Type D Personality? Your Heart May Be at Risk)
But because heart disease has remained the No. 1 killer of Americans for several years now, the Stanford scientists wanted to know whether those guidelines should be modified. Are there more people who could still benefit from statins — perhaps people with a 10% or 15% risk of having a heart event over 10 years? Would it be cost-effective to expand the so-called primary prevention group for the drug?
Indeed, the data showed that by folding in more of these lower-risk individuals, more health-care dollars could be saved in terms of hospital care and physician visits, compared with current guidelines. But, the researchers note, the savings only apply if the current side effect profile stays the same and no additional adverse events from the drugs emerge.
Expanding the patient population who takes statins has been a controversial issue in the heart field. The issue gained attention after a large 2008 study suggested that the drugs may reduce heart risk not only by lowering cholesterol but possibly also by dampening inflammation, which is thought to cause unstable plaques in heart vessels to rupture and cause heart attacks. In the 2008 trial, people with low cholesterol levels but high levels of C-reactive protein (CRP), a marker of inflammation, dropped their risk of having a heart event by 47% by taking a statin during the nearly two-year study period, compared with subjects taking a placebo.
The new Stanford study suggests, however, that prescribing statins to people with a 10% or 15% 10-year risk of a heart event would be more economical than screening people for CRP, which some have proposed as another way to identify people who are at risk. (People with high CRP who may be at risk for heart disease may also have normal cholesterol levels and, therefore, would be missed by current cholesterol screening guidelines.) It turned out that screening the entire population for CRP, when only some may have high levels, was simply not cost-effective, says co-author of the study Dr. Mark Hlatky. And despite the 2008 trial data, scientists are still not convinced that enough people with high CRP would benefit from the cholesterol-lowering drugs. “In cancer, we have gene tests that say a person’s mutation will help them respond to this drug or that drug,” he says. “In cardiology we don’t have things like that. We don’t have the data to say that people who have a high CRP will respond to statins and people with a low CRP won’t.” (More on Time.com: Chocolate Helps the Heart — But Not If You Eat It Everyday)
The results should be helpful to the panel of experts now debating a revision of the national guidelines for cholesterol screening and treatment. “Our basic conclusion was that it would make sense for the [panel] to just lower the risk threshold rather than recommend widespread testing,” says Hlatky. That would mean lowering current thresholds for statin eligibility by shrinking down the “normal” range of cholesterol, blood pressure and body mass, which could save both lives and health-care dollars.
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