A statin a day? Signs encouraging, but docs say not so fast

Recent headlines reported that the drug Crestor cut nearly in half the number of heart attacks and strokes even in people with low cholesterol.

The results sounded so good, people may have been tempted to run out and ask their doctor for a prescription.

The news is good, but local doctors caution that the implications apply only to people who are already at elevated risk for heart attack and stroke - potentially 7 million Americans.

And Crestor, critics point out, carries the potential for nasty and potentially fatal side effects.

The key to knowing if statins like Crestor could do a patient some good depends for now on a blood test of C-reactive protein or CRP.

CRP is a sign of inflammation in the blood vessels, which is increasingly suspected as a possible cause of heart attacks and strokes.

Crestor is one of a class of drugs known as statins that not only lower cholesterol but also reduce signs of inflammation.

Statins, however, have their own problems. They've been associated in some cases with liver damage, muscle weakness and pain and a rare but sometimes fatal muscle deterioration known as rhabdomyolysis.

Public Citizen, a patient advocacy group in Washington, D.C., has long tried to get the FDA to warn the public about statins.

Dr. Sidney Wolfe, Public Citizen's watchdog on the issue, said the Crestor study showed it increased the risk of diabetes, while its absolute benefit was small, preventing only one heart attack or stoke for 120 patients over two years. Any cheaper generic statin, he said, should provide the same benefit as Crestor without some of the risks.

Critics also note the study was conducted by a holder of the CRP test patent and paid for by Crestor's maker, AstraZeneca, which stands to make billions of dollars if Crestor use increases significantly.

Currently, guidelines set by the American Heart Association and the U.S. Centers for Disease Control say people should take statins if they have high CRP combined with other risk factors such as high cholesterol, being overweight, smoking, lack of exercise, high blood pressure or diabetes.

Dr. Leonard Cerullo, founder of the Chicago Institute of Neurosurgery, called the new study results that show statins help even people with low cholesterol levels "remarkable."

They raise the question, he said, of whether the currently accepted levels of cholesterol are too high.

For a patient with low cholesterol but high CRP and other risk factors, he said, he would now consider prescribing statins.

Similarly, Dr. David Cooke, a cardiologist and president of the Midwest affiliate of the American Heart Association, said if someone has moderate risk for heart attack or stroke, high CRP should be enough to qualify them for statins.

A panel of experts will look at the question and try to establish new guidelines sometime next year.

Because those taking Crestor had only 74 fewer heart attacks and strokes out of nearly 18,000 patients, and because a Crestor prescription costs more than $1,000 a year, an editorial in the New England Journal of Medicine cautioned against routine CRP measurement and Crestor use until more is known to weigh the costs and benefits.

Until then, the doctors advise, patients should check with their physicians to see if they have risk factors for heart attack or stroke that would make them candidates for a CRP test and for statin treatment.