Drug therapy isn’t always the answer

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.

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/