Should nearly eveyone be taking a statin drug?

Avery much-hyped recent study published simultaneously in the New England Journal of Medicine enrolled over 17000 people with “normal” cholesterol levels but with elevated levels of CRP, a protein that some people insist is a major marker for a higher risk of heart attacks and strokes.

Half the participants were given rosuvastatin or Crestor, one of the several statin drugs on the market, and half placebo.

The study was meant to run for 5 years but was terminated after 19 months because according to the evaluators, the results were so convincing: Crestor lowered the risks of every single “cardiovascular events” including heart attacks, strokes, and death from heart problems, by a pretty impressive 44 %, lowered CRP levels by 37 %, and reduced the already-low LDL levels by a whopping 50 %.

So the conclusion that most people drew is that

1) even people at presumably low risk of heart attack benefit from taking a statin drug, and

2) CRP should be measured in a great many more people.

But, here’s another way to look at the numbers: based on the 400 cardiovascular events seen in the entire study, statisticians conclude that you need to treat 95 patients with a statin drug for 2 years to prevent one such event.

In other words, if you’re wondering what to do, it’s sobering to learn, I think, that based on these numbers, the vast majority of people with “normal” LDL levels and raised CRP levels who are put on a statin will not benefit from taking it.

On the other hand, there is the cost of treatment, which according to another study, would prevent 30,000 cardiovascular events a year in the US but would cost $ 9 billion a year for this one treatment alone.

And that doesn’t take into account, of course, some of the other major costs that would accrue:

a higher risk of Type 2 diabetes (the statin group had somewhat higher insulin levels),

screening everyone who might have elevated CRP levels,

all the lost time from work to get prescriptions renewed

all the new drug interactions from 4 million more drug-takers

the side effects and complications, and

the potential cost of people not taking as good care of themselves since they would feel they were doing enough by taking drugs for their condition.

For me, this study raises as many questions as it answers, and the most important unsettled matter is this: what do you as an individual do with this kind of data.

Frankly, no one knows, but you can bet lots of people have strong opinions.