A lot of 'wonder drugs' have burst
on the scene to great fanfare in recent years, only
to have their overblown reputations deflated upon contact
with actual patients. But for one drug class —
statins — the news just seems to get better and
better the more we learn.
This month brings another raft
of studies vindicating statins and showing, yet again,
additional benefits that go beyond their original purpose.
Statins are now preventing strokes and protecting lungs,
while still delivering on their original promise of
cardiovascular protection.
SCOTCH
BENEFIT
Lipid control is what statins are built for, and the
October 11 issue of the New England Journal of Medicine
provides further evidence that they do it well - and
continue doing it long after therapy is stopped. The
West of Scotland Coronary Prevention Study, numbering
6,595 middle-aged men with no history of myocardial
infarction, found a 30% reduction in the risk of heart
attack or heart disease death among those who had taken
pravastatin for an average of five years, compared to
those on placebo.
The study continued after that
point, with plenty of crossover between the two arms.
This enabled the researchers to measure the lasting
benefits in those who had quit statins. At an average
follow-up of nearly 15 years from the study's outset,
those who had taken pravastatin for the first five years
then quit were still benefiting from an 18% reduction
in risk of heart attack or cardiovascular-related death,
compared to those who had never taken the drug.
The West of Scotland study began
at the dawn of time as far as statins are concerned,
and provides the longest possible follow-up of real-world
statin patients. While the authors have every reason
to be pleased with the drugs' lingering effects, the
real message of this study is surely that taking statins
for a few years is very good, but staying on them is
even better.
THE
ITALIAN JOB
One class of patients who definitely don't seem to derive
continued benefit from statins after they quit is those
who've just suffered a stroke. Writing in October's
Stroke, Italian researchers who followed 631
isch emic stroke survivors relate that discontinuation
of statin therapy immediately following a stroke was
associated with a near tripling of mortality over the
first year. Stroke patients should not stop statin therapy
unless there is a compelling reason, they argue.
Statins also get an unexpected
pat on the back in the October 15 issue of the American
Journal of Respiratory and Critical Care Medicine.
Harvard researchers using data from the ongoing Veterans
Administration Normative Aging Study found that, among
those getting regular lung function tests, those who
took statins showed a markedly slower decline. They
were losing less than half the capacity each year of
non-statin users in both the FVC and FEV1
tests.
OTC
STATINS?
Add all of this evidence to the persistent hints of
a cancer protective effect, and it's no surprise that
a former president of the World Heart Federation is
arguing that these "safe and effective" drugs should
be made available over the counter to combat the coming
global epidemic of cardiovascular disease.
"There could be an enormous health
benefit to making nonprescription statins available
and enhancing patients' involvement in their own care,"
said Dr Valentin Fuster, director of Mount Sinai Heart,
writing in the September 1 issue of American Journal
of Cardiology. With backing like that, over-the-counter
statins may be an idea whose time is coming.
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