Almost two million Dutch people take a cholesterol-lowering drug. This is usually a statin, such as simvastatin, atorvastatin or rosuvastatin. You would think that we would know everything about these drugs, but we don’t. The JAMA released new figures on the effect of statins. And the BMJ proposes a new cholesterol measure to help choose the right dose for people with diabetes.
You usually don’t notice high cholesterol in your blood. Yet you often get cholesterol-lowering drugs, because high cholesterol increases the risk of cardiovascular disease. Especially if the cholesterol levels are high and you also have other risk factors, such as diabetes, being overweight or because you smoke. But how big is that effect? What good is that daily statin? The scientists are still not finished talking about it.
Effect on heart and vessels
The JAMA published a compilation study, combining the results of 21 studies. The main question was: how much effect do statins really have on premature death or cardiovascular disease? For example, the risk of a heart attack is reduced by almost 30 percent with statins. But that is relative, because in absolute terms it is only 1.3 percent. In other words: to prevent a heart attack, 77 people have to take statins for a year. Conclusion of the study: the absolute risk of (premature) death decreases by 0.8 percent, of heart attack by 1.3 percent and of stroke by 0.4 percent, if you take a statin. This could receive a little more attention in the consulting room, the researchers write. Not everyone knows that the effect is so small.
Is statin useless?
NRC headlined ‘Cholesterol inhibitor does not always make sense’† Frank Visseren, internist for vascular medicine at UMC Utrecht, explains in the newspaper that statins are indeed very effective, but especially in people who already have a high risk. So not for everyone. Medical news watchdog Doctor Media NRC therefore thought the headline went too far: whether it makes sense differs per patient. For a smoker over seventy who has diabetes, the statin will have a much greater effect. The chance that the statin really saves your life, or prevents a heart attack, is then greater. The effect is smaller for healthy people in their sixties with good blood pressure who cycle regularly. Anyway: in the Netherlands doctors use a model in which risk factors are taken into account. For example: the age, whether you smoke and whether high cholesterol runs in the family and so on. You can look this up on U-prevent. The Thuisarts website also explains, when a statin is needed for high cholesterol, and when not. A personal assessment with the general practitioner or internist is therefore always wise, because it just depends on the other risk factors that you have.
New cholesterol measure diabetes
One of the biggest risks for developing cardiovascular disease is diabetes. That is why you are quickly attached to a statin, the standards for a ‘good’ cholesterol value are very strict. But not everything has been explored about this yet. A major investigation in the BMJ looked at 42 studies of people with diabetes taking a statin. The key question is: are these people well-adjusted? Are doctors using the right cholesterol measure to choose the best statin dose? The studies examined the effect on all cholesterol, except the good HDL cholesterol, or non-HDL-c. Previous research has shown this to be a better measure than LDL cholesterol, which many guidelines are now looking at. The non-HDL-c gave a better indication of the risk of cardiovascular disease. The new BMJ study shows: to lower this non-HDL-c value, you have to take very high doses of simvastatin or atorvastatin, and moderate to high doses of rosuvastatin. So here too, the last word has not yet been said.
Read more about cardiovascular disease here: www.plusonline.nl/hart-en-vaatdoelen
