Statins for heart disease prevention, is the luster fading?

by Peggy Peck

First, my disclosure: I’ve written at least one news article about every major statin trial since 4-S, and I’ve been mightily impressed with almost all of the statin data. So, I was also impressed when the JUPITER results were reported about a year and a half ago — although I became a little less “impressed” as JUPITER continued to spew forth analysis after analysis almost monthly since then.

For those who have been living in a cave since November 2008, the JUPITER investigators found that giving people whose cholesterol falls into a normal range and who have no history of heart disease, but who did have an elevated level of a biomarker for inflammation (highly-sensitive C-reactive protein) 20 mg of rosuvastatin (Crestor) reduced their risk of myocardial infarction, stroke, need for revascularization, or death from cardiovascular disease by 44% compared with those taking placebo. That’s a reduction in relative risk, not an absolute reduction. But it was, nonetheless, highly signficant (P<0.00001).

It’s not too surprising that those results led to more talk of “let’s just add statins to the water.”

Statins are not about to join fluoride as part of the water supply, but all that good news deserves some reward, and in February the FDA delivered it.

The FDA said okay to AstraZeneca’s request to change the labeling indications for rosuvastatin so that it could be marketed for the primary prevention of coronary artery disease.


Prevention in a bottle. Could there be anything more appealing to the American public? And could there be any better news for Madison Avenue? Think of all the network news that is supported by ads for statins for people who actually have elevated cholesterol and imagine the possibilities now that the target audience includes people who haven’t yet crossed the line into “elevated” levels. Talk about a bonanza.

So, last week when I and the other MedPage Today editors were batting around ideas for our weekly survey, I suggested asking about statins for primary prevention. I figured that about half of the responses would favor the new indication and half would be opposed.

Take a look at the results and you’ll see why no one should take stock tips from me — eight of every 10 MedPage Today readers just said No to statins for primary prevention.

What’s up with this? Has all of the discussion about the cost of healthcare actually made Americans more cautious about prevention-in-a-bottle when the bottle contains expensive pills? Are Americans more skeptical about relative risk reductions than the “experts” who advise the FDA? Is the luster attached to statins fading?

Don’t look at me for the answers, I’m clearly not picking up the right vibe on this.

Peggy Peck is a MedPage Today Executive Editor and blogs at In Other Words, the MedPage Today staff blog.

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