Health & Medicine - Posted by Dennis O'Shea-JHU on Wednesday, November 17, 2010 11:34 - 6 Comments 
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(No Ratings Yet) Loading ...Drug therapy isn’t always the answer
New research finds taking statin drugs should no longer be considered, like diet and exercise, as a broadly based solution for preventing coronary heart disease. (Credit: iStockphoto)
JOHNS HOPKINS (US) — A daily dose of a cholesterol-lowering statin drug is not always necessary to protect coronary arteries and ward off heart attack or stroke.
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In a six-year study of nearly 950 men and women who were healthy when the research began, nearly 95 percent of those who suffered heart attacks, strokes, or heart-related deaths came from the half of study participants with measurable buildup of artery-hardening calcium in their blood vessels.
Only that group, the investigators say, might have benefited from preventive drug therapy. Seventy-five percent of all heart emergencies occurred in the quarter with the highest calcium scores.
The 47 percent of study participants with no detectable levels of calcium buildup in their blood vessels suffered only about 5 percent of heart-disease related events during the study, meaning that drug therapy may not have offered any coronary protection to that group.
“Our results tell us that only those with calcium buildup in their arteries have a clear benefit from statin therapy, and those who are otherwise healthy and have no significant calcification should, with their physicians, focus on aggressive lifestyle improvements instead of early initiation of statin medications,” says Michael Blaha, a cardiology fellow at Johns Hopkins University.
Blaha, who presented the results Nov. 16 at the American Heart Association’s annual Scientific Sessions in Chicago, says statin therapy can benefit some healthy men and women with normal or even low cholesterol levels.
But, “it certainly is not the case that all (healthy) adults should be taking it to prevent heart attack and stroke, because half are at negligible risk of a sudden coronary event in the next five to 10 years.”
The findings—from the Johns Hopkins-led Multi-Ethnic Study on Atherosclerosis, (MESA)—are believed to be the first to pinpoint precisely who among the more than 6 million healthy American adults with normal blood-cholesterol levels and, thus, potential candidates for preventive statin therapy, would benefit from a statin’s cardio-protective effects.
“Statin therapy should not be approached, like diet and exercise, as a broadly based solution for preventing coronary heart disease,” says Roger Blumenthal, professor and director of the Ciccarone Preventive Cardiology Center at Johns Hopkins,.
“These are lifelong medications with potential, although rare, side effects, and physicians should only consider their use for those patients at greatest risk, especially those with high coronary calcium scores.”
Blumenthal points out that as many as 5 percent of people on statins develop serious side effects, including muscle pain and one in 255 will develop diabetes.
Coronary heart disease is the nation’s leading cause of death, responsible for one in five deaths in adults in the United States.
All people should monitor their risk factors for heart disease, according to age and gender, diabetes, blood-cholesterol levels, hypertension, and smoking, Blumenthal says. If it is recommended by a physician, get a coronary calcium CT scan to gauge actual risk.
Researchers from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, the University of Miami, Brigham and Women’s Hospital in Boston, and Carney Hospital in Dorchester, Mass. contributed to the study.
More news from Johns Hopkins University: http://releases.jhu.edu/
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6 Comments
emc2
Maureen martin
Why is it said that if one starts satin it is a lifetime use drug? Is there a withdrawal? Is there a problem if one suddenly stops using it? What is the story behind the lifetime necessity once one starts using a satin?
Drew
Maureen, I’m a medical student, so take my comment with a grain of salt; there are no withdrawal effects from stopping a statin. The reason it’s a “lifetime” drug is because atherosclerosis and coronary artery disease takes many years to develop. Healthy cholesterol levels (Low LDL cholesterol – the bad cholesterol and high HDL levels – the good cholesterol), which statins can help with mostly by lowering LDL levels, can help slow the development of atherosclerosis and partially reverse it (very very slowly).
John Mulholland
Please ask Dr Blumenthal or Blaha about the “coronary calcium CT scan” indications. How routinely should it be done. If one is aware of calcium/atherosclerotic developement in the terminal aorta or femoral arteries ( say picked up on some type of kidney study shown by xrays of the pelvis), is it assumed that they also have it in their coronary arteries and should go on a statin, almost independant of the blood lipid levels. How costly is this test which I presume would not be covered by Medicare. Thanks you very much and say hello to Dr Blumenthal. Jack M
Michael Blaha
Sorry for this late response to your inquiry – this e-mail got lost in my inbox.
1. A calcium scan is best used in someone of intermediate risk of developing coronary artery disease (5-20% likelihood in next 10 years) in whom the decision to treat with aspirin, statin, and more aggressive lifestyle therapy is uncertain.
2. We don’t recommend repeat scans at this time in people with positive scans. In those with a calcium score of zero, we recommend repeat testing in 5 years.
3. If there is other vascular calcification, it is highly likely that there will be coronary calcium but certainly no certainty. Women tend to get aortic calcification before coronary calcification in fact. Noticing calcium in other vascular beds should encourage physicians to look for calcium in the coronaries if it will change their recommendations to the patient.
4. The test can be done for about $100 in Baltimore.
Thanks,
Mike Blaha
Steven DeLuca
My doc said “Congratulations, you have the highest calcification score I have seen” “Take statins” …
Online I read about 11 or less, likely very good, 400 or more, 20% chance of a heart attack or stroke in the next year. My score is 3,700 – After looking over several sites I found one mention of over 500 and on of over 1,000 but little info. I am 64, a 100% disabled vet with PTSD. I understand that stress can cause problems with arteries and heart problems too. Many vets with PTSD die young and we can’t get life insurance except through the VA. Here is the problem. My cholesterol is 107 and sometimes less. BP is often 115 over 75. I jog, bike ride, do push-ups and chin-ups, kayak. I eat little meat and rarely eat beef. I don’t have a pot belly or even close… Docs ask if I need Viagra (More blunt than that, smile) No, I don’t need Viagra (so that means circulation is good?) I took a stress test with ultra-sound, easily passed the test in all aread, maxed out, good recovery. So how is it possible that 3,700 is reached and why, if a PET scan from cancer three years ago “noticed” some calcification – didn’t test for the level, was looking for cancer – have I made it 3.5 years without angina, … I should have died a few times with such a score. IF I take statins, have depression, muscle weakness, feel sick and stop exercising, would I not be worse off than skipping statins and exercising? I also didn’t have children until age 40, should my son and daughter start looking at statins at college age, or before age 40? I have lots of questions and few answers.
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How do you know if you have calcium buildup? If your cholesterol is good, they don’t check anything else. If your cholesterol is bad, they don’t check anything else.