Millions more patients could benefit from taking
statins, drugs typically used to prevent heart
attacks and strokes, than current prescribing guidelines
suggest, Johns Hopkins doctors report in a
new study.
Doctors have long known that statins can help prevent
subsequent heart attacks and strokes in
patients who have already had one of these cardiovascular
events. Additionally, statins have been
shown to have a protective effect for patients who haven't
yet had a heart attack or stroke but are at
high risk for developing cardiovascular disease.
Consequently, doctors currently prescribe these drugs
to patients with established cardiovascular disease, and
also to those with high cholesterol and other
risk factors for developing cardiovascular disease such as
diabetes. About 33 million older adults — men
age 50 or older and women age 60 or older — are
currently eligible to take statins based on these
criteria.
However, said Erin D. Michos, assistant professor of
medicine at the Johns Hopkins University
School of Medicine and its Heart and Vascular Institute,
about half of all cardiovascular events occur
in patients who don't have high cholesterol, and about 20
percent of these events occur in people who
have no identifiable cardiovascular disease risk factor.
Until recently, doctors haven't been sure if any
of these patients might also benefit from statin
therapy.
Last November, a research team led by doctors at
Brigham and Women's Hospital in Boston
announced the results of a study known as the JUPITER trial
that involved nearly 18,000 patients.
They found that statins protect against heart attacks and
strokes even in older adults without known
cardiovascular disease or diabetes and with low
cholesterol, below 130 mg/dl — a group that isn't
usually
prescribed statins — as long as these patients also
had high levels of C-reactive protein, or CRP, a blood
marker for inflammation. Recent research has shown that
inflammation plays an important role in
initiating cardiovascular events, Michos said, but at-risk
patients aren't routinely tested for CRP
levels.
Building on the JUPITER trial results, Michos and
Roger S. Blumenthal, a professor of
cardiology at Johns Hopkins, wondered how many patients in
the United States fit the low-
cholesterol, high-CRP profile featured in the study and
might also benefit from taking statins. To get
an estimate, they gathered data generated by the National
Health and Nutrition Examination Survey,
or NHANES. This research program, which has gathered
various health data from thousands of
Americans from 1971 to the present, weights the data from
its participants so that they're
representative of the entire United States population.
After searching NHANES between the years 1999 and 2004
for participants who fit the
JUPITER profile, then extrapolating that to the general
population, Michos and Blumenthal estimate
that about 6.5 million older adults with low cholesterol
and high CRP might benefit from statins. If
they expanded their search criteria to the cholesterol
level cutoff of 160 mg/dl that doctors often
use when deciding to prescribe statins, the researchers
increased this statin-benefiting group's size
to 10 million.
"We're showing that doctors may be able to prevent
thousands of heart attacks, strokes and
deaths each year if we expand statin-prescribing criteria
to include C-reactive protein levels,
something we can assess as part of a simple blood test,"
Michos said.
The team points out in the study, published in the
March 17 issue of the Journal of the
American College of Cardiology, that based on JUPITER's
results, prescribing statins to older adults
using this new criteria that incorporates CRP would prevent
about 260,000 cardiovascular events over
five years.
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