Statins considered as new super aspirins

Aspirins and statins deserve to be in the hall of fame for cardiovascular drugs, if ever there’s one.

Heart specialists recognize the important contributions of these two drugs in improving the clinical outcome of patients with established heart disease or those considered at high-risk in developing cardiovascular complications.

Aspirin prevents the blood from getting sticky leading to blood clots which cause heart attack and stroke. As small a dose as 80 mgs daily – what used to be called pediatric dose – has been shown by various clinical trials to be effective in reducing heart attacks, strokes and heart-related deaths. Some studies suggest that it might also be good in preventing some types of cancers.

Statins, a cholesterol-lowering class of drugs, is now labeled as the new super-aspirins. Clinical data over the last 10 years have shown that tens of thousands of deaths each year may be prevented with the use of 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 diplomat in cardiology and a fellow of the Philippine Heart Association (PHA) and Philippine College of Cardiology (PCC), statins were often prescribed previously only to people who had 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 attacks or strokes.

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 Prof. Sir Charles George, medical director of the British Heart Foundation, the United Kingdom’s leading heart charity.

George 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 Institute of Health (NIH) in the US, as well as by professional bodies such as the European Society of Cardiology (ESC) and the American Heart Association (AHA).

The HPS, which is by far the biggest clinical trial on cholesterol-lowering therapy, contradicts conventional wisdom in a number of other areas. Current guidelines maintain that there is no sufficient evidence that statins benefit the elderly population.

With a large number of older patients enrolled in the study, the researchers were able to show that cholesterol-lowering with simvastatin was just as effective for those over 70 as for those in the middle-aged and younger group.

Likewise, the issue on the benefits and safety of statins in women has been answered convincingly, according to Raymundo. With more than 5,000 women included in the HPS, it has shown that statins work just as well for women as for men.

Prof. Rory Collins, HPS lead investigator, says, "HPS shows unequivocally that statins can produce substantial benefit in a very much wider range of high-risk people than had been thought. These new findings are relevant to the treatment of some hundreds of millions of people worldwide. If now, as a result, an extra 10 million high-risk people were to go into statin treatment, this would save about 50,000 lives a year – that’s a thousand each week. In addition, this would prevent a similar number of people from suffering non-fatal heart attacks or strokes."

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.

Local medical practitioners welcome the introduction of an affordable simvastatin by Therapharma, which can maximize the benefits of statins among Filipino heart patients. Therapharma is a division of Unilab, a local-based company well-known for introducing affordable drugs at half the price of comparable brands from multinational companies.