Statins may prevent heart attacks, strokes, say experts

Tens of thousands of deaths each year may be prevented with the use of the class of cholesterol-lowering drugs called statins.

Heart experts worldwide are calling for a major change in treatment guidelines recommending statins in high-risk patients even if their blood cholesterol levels are just slightly elevated or still within normal limits. It is predicted that the results of recent landmark trials are set to revolutionize the way cholesterol-lowering drugs are prescribed.

Available scientific data published in prestigious international journals show that using statin drugs to lower blood cholesterol levels protects a far wider range of people at risk of heart attacks and strokes than had been previously shown.

According to Dr. Roberto Raymundo, a diplomate in cardiology and a fellow of the Philippine Heart Association (PHA) and Philippine College of Cardiology (PCC0, statins are often prescribed previously only to people who have heart disease and elevated cholesterol levels. But, with the new findings from the 20,000-patient Heart Protection Study (HPS) conducted in the United Kingdom, he believes that there is now strong evidence showing that statins also cut the risks of heart attacks and strokes in the high-risk population which includes patients with diabetes, narrowing of arteries in their legs and a history of heart attack or stroke. Simvastatin was used in the HPS.

"Even those high-risk patients considered to have normal or low cholesterol levels benefited from the use of simvastatin," adds Raymundo, cardiology consultant at the Manila Adventist Medical Center. He supports the recommendation that guidelines should be changed so that – irrespective of the blood cholesterol level – a statin is considered for anybody at increased risk of either heart attack or stroke.

Heart experts worldwide share the same sentiments on the potential benefits from a wider use of statins. "The clear message from this study (HPS) is ‘Treat risk, not cholesterol level,’" emphasizes Professor Sir Charles George, medical director of the British Heart Foundation, the UK’s leading heart charity. He calls for an urgent review of national and international guidelines on statin use by government organizations such as the National Institute of Clinical Excellence (NICE) in the UK and the National Institutes of Health (NIH) in the USA, as well as by professional bodies such as the European Society of Cardiology (ESC) and the American Heart Association (AHA).

The HPS team estimates that implementing these new findings fully would more than triple the number of people benefiting from statins. However, heart specialists worldwide lament that the big hindrance to optimal long-term compliance with statin therapy is its high cost of treatment. Local medical practitioners welcome the introduction of an affordable simvastatin (Vidastat) by Therapharma, which can maximize the benefits of statins among Filipino heart patients.

An outline of the HPS findings was presented at the American Heart Association (AHA) conference in Los Angeles. It was published in Lancet, a leading international journal read by most medical practitioners.

Many believe that the presentation of the HPS in the AHA convention and its publication in Lancet would pave the way for a review of official guidelines and for doctors to change their prescribing practice. This could have a significant impact in reducing the high rates of heart attacks and strokes in both developed and underdeveloped countries.

It would also be important for many developing countries such as the Philippines where the rates of heart attacks and strokes are already high or are rising rapidly, and where diabetes is becoming increasingly common.

Although statins, as a class of drugs, are generally expensive, its use is considered cost-effective and may turn out cheap in the long run, considering the reduction in strokes, heart attacks, repeated hospitalizations and clinic consultations.