Heart-attack prevention: Statins aren't for everybody

I started getting phone calls from my patients almost as soon as the headlines starting appearing last week. All the media were trumpeting the results of a new study showing that rosuvastatin (Crestor), a powerful cholesterol-lowering statin drug, slashed the risk of heart attack and stroke even in people with normal—that's right, normal—cholesterol levels who also had high blood levels of a substance called C-reactive protein. CRP rises when the arteries are inflamed, and, as we've previously reported, growing research has linked such inflammation with an increased risk of heart attack. All of those callers wanted to know the same thing: Should they start taking the drug?

Here's my answer to that and two related questions.

Should I immediately start taking a statin?
Probably not, at least based on this study. The trial, released on Nov. 9 by the New England Journal of Medicine, looked at some 18,000 people with an LDL (bad) cholesterol level less than 130 milligrams per deciliter and a CRP level over 2 mg per liter. Half got Crestor and half got a placebo. After about two years the study was halted because there were 44 percent fewer cardiovascular events in one group than in the other. The winner turned out to be the group that took Crestor.

Sounds impressive, right? Well, maybe not very. That's because cardiovascular disease is relatively uncommon in the group of people enrolled in the study. So the absolute reduction in the rate of heart attack, stroke, and cardiovascular death went from about 2 per 100 patients in the placebo group to 1 per 100 in the treatment group. At that rate, 120 people would have to be treated for nearly two years to prevent one event. A benefit, yes, but is it one that's worth the treatment's costs?

Those costs are both medical and financial. For example, people in the study who took rosuvastatin showed worrisome changes in blood-sugar levels that could signal an increased risk of diabetes. And, as our Best Buy Drug Report on statins discusses, all of the drugs can cause muscle aches, soreness, and tenderness in about 1 to 5 percent of people. And rarely, they can cause the muscle tissue to break down, which in turn can trigger life-threatening kidney damage. A year's costs for the drugs—including Crestor—can exceed $1,000.

Should I get my CRP level measured?
That depends mostly on your overall risk of cardiovascular disease. People who are at high risk because they have a clearly elevated LDL level usually don't need the test, since they should be treated with a statin regardless of their CRP. And I don't think it's time to measure CRP in people with low LDLs and no other coronary risk factors, because it's not yet clear that the benefit of treatment for such very low-risk people outweighs the costs and possible harms. But for people at moderate risk of coronary disease—those with a borderline elevated LDL, for example, and perhaps one or more other risk factors—knowing the CRP can help you decide how aggressively to lower LDL. For more on how to use your LDL, CRP, and other risk factors to assess your need for cholesterol-lowering drugs, see our Guide to a Healthy Heart.

If I do need a statin, does this study mean I should definitely take rosuvastatin?
No. Other statins—including atorvastatin (Lipitor), lovastatin (Mevacor and generic), and simvastatin (Zocor and generic)—also lower both LDL and CRP. And some are much cheaper. For example, a month's supply of Crestor costs, on average, about $105. But you can get a month's supply of generic simvastatin for around $30 at many retail pharmacies or even as low as $6 at Costco.

—Marvin Lipman, M.D., Consumer Reports chief medical adviser

For more on how to treat high cholesterol, check out our Treatment Ratings (subscribers only).