Cholesterol-lowering drugs known as statins are an undeniable boon for heart patients. Study after study has shown that for those who have had a heart attack or other forms of heart disease, the medications can significantly lower the risk of future heart trouble.
But when it comes to healthy individuals who don't yet show signs of heart disease, the picture gets a bit cloudier. Many physicians already prescribe the drugs for individuals with several risk factors for heart disease, even if they haven't yet had a heart event. But what about those at even lower risk for the disease? Could statins be helpful in preventing heart disease, the leading killer of Americans each year, among healthy people?
To get some answers, researchers with the Cochrane Systematic Review conducted an analysis of existing trials, but their findings aren't likely to clarify matters much. After looking at 14 trials involving statins to prevent heart disease in healthy populations, scientists found little added benefit from the cholesterol-lowering drugs.
Even the authors admit that their conclusions should be interpreted with care, however, since the quality of the studies raised some questions. All but one, they note, were sponsored by the pharmaceutical industry. In addition, many of the studies were short-lived, and benefits from statins as a preventive measure may take years to emerge.
In the trials, the statin group was compared to those taking placebo and the researchers looked at deaths from all causes, as well as rates of non-fatal heart attack, stroke and the need for procedures to open up blocked blood vessels. Overall, statins did not provide benefit over placebo on many of these measures.
The biggest challenge, say the authors, in shifting the use of statins to a healthy population lies in defining which patients could benefit most. "Low-risk" individuals run the gamut from perfectly healthy folks with no risk factors for heart disease, to those with perhaps one risk factor, or overall marginal risk.
The review's authors define low risk as having a less than 1 percent chance of dying from any cause or having a less than 2 percent chance of suffering some sort of cardiovascular event. But there are other ways of determining a person's risk of developing heart disease, so experts suggest "low risk" may need to be better defined, especially among the elderly, whose age puts them at higher risk.
For example, inflammation levels are emerging as a potential risk factor that could identify healthy people who might become vulnerable to heart disease in coming years. Past research on these patients, who may have low cholesterol levels but elevated inflammatory factors, found that they could lower their risk of a heart attack by taking statins.