Statins: Evidence of Broader Benefits

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Statins, those wonder drugs that reduce cholesterol, have proven to be a lifesaver for people at high risk of having a heart attack. Among those who have already suffered one heart attack, statins have shown to cut the risk of another event by more than 30%, making them indispensable for the 8 million people in the U.S. who fall into this category.

What has been trickier to show is whether statins can also help healthy people avoid a first heart attack. But a new 10-year study of nearly 230,000 patients by researchers in Israel hints that the drugs may be up to the challenge.

In the trial, published Feb. 10 in the Archives of Internal Medicine, scientists at Tel Aviv University found that patients taking statins for up to five years reduced their risk of death from any cause by 45%, compared with those not taking statins. Granted, most of the people who benefited had high levels of LDL cholesterol, the "bad" cholesterol, to start, so they were more likely than others to be helped by the drugs' ability to prevent plaque build-up in artery walls. But many patients also had never had a heart attack or other heart event. That means statins may have helped stave off such an event altogether, a hopeful finding given that heart disease still kills more Americans than any other medical condition each year.

"We now have some growing evidence that indeed when statins are prescribed in the right indication in the right amounts, they can reduce heart attack and stroke and reduce death from cardiovascular disease," says Dr. Robert Bonow, chief of cardiology of Northwestern University and past president of the American Heart Association.

While the bulk of prevented deaths in statin-takers were attributable to heart-related factors, the authors note that mortality from other illnesses, such as cancer, also declined. That leads the authors to hypothesize that statins may benefit the body in many different ways. "The benefit cannot be explained by a reduction in cardiac death alone," said the study's lead author, Dr. Anthony Heymann, in an email. "It must mean that there are a large number of additional factors involved in preventing death that are influenced by taking statin medication."

If that's the case, it would add to the growing list of statins' unexpected benefits. Initially the drugs were designed to inhibit the liver's ability to make cholesterol, but it turned out that they not only lowered LDL, but raised levels of HDL, or good cholesterol, in the blood as well. In the early 2000s, researchers reported that statins also reduced inflammation, a process that appears to contribute to the rupture of unstable plaques in the heart vessels, which triggers heart attack.

The drugs have not been without problems, however. Statins have been linked to a rare but serious muscle weakening, and no studies have fully explored the effects of statins in patients who take them long term, perhaps for decades — today, the first generation of American heart patients to be prescribed statins have been taking the drugs for some 15 years.

Still, the new study offers further evidence that statins may help prevent heart attack in a much broader population than previously thought. Last fall, a large trial of middle-aged people who had not had a heart attack but showed signs of inflammation suggested that statins could reduce their risk of having a first heart attack by 45% to 47%. If more studies like these confirm the drugs' beneficial role in reducing cholesterol, inflammation and heart disease, doctors may someday consider advising otherwise healthy people to lower their levels of cholesterol and inflammatory protein markers below currently accepted limits — whether they make lifestyle changes or use medications such as statins.

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