Healthy Skepticism Library item: 7871
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Kirkey S.
Cholesterol drug no preventive for women, study says
The Gazette (Montreal) 2007 Jan 23
http://www.canada.com/montrealgazette/news/story.html?id=67bb713b-8849-49f0-806a-f6070994199f
Full text:
No otherwise healthy woman of any age should be on a cholesterol-lowering drug to prevent heart disease, suggests a new analysis of the fastest-growing drug class in Canada.
Millions of Canadians take cholesterol reducers, called statins, to lower their risk of heart attacks and cardiovascular disease. For people who already have artery disease, statins save lives.
More controversial is whether people who don’t have evidence of occlusive vascular disease, which leads to clogged arteries, should be taking the drugs.
About three-quarters of people on statins fall into that category. “It’s not a trivial, minor thing. It’s the bulk of the prescribing,” said Jim Wright, medical director of the B.C.-based Therapeutics Initiative and a professor at the University of B.C.
In a brief article published in the most recent issue of the journal The Lancet, Wright and co-author John Abramson of Harvard Medical School pooled data from eight randomized trials comparing statins with a placebo in people at increased risk of cardiovascular disease. The statins did not reduce total deaths. And, when they looked at women alone, they found no benefit.
Overall, statins reduced the risk of heart attack or stroke. But the absolute risk reduction of 1.5 per cent “is small
(and) means that 67 people have to be treated for five years to prevent one such event,” according to the researchers.
When they looked closer, the benefit appeared to be limited to high-risk men age 30 to 69.
The drugs did not reduce heart attacks in 10,990 women in the primary prevention trials. Statins also did not reduce heart attacks or strokes in men older than 69.
“Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years,” the researchers write in the Lancet.
“If someone says that they should, then give us the evidence,” Wright said in an interview.
“It doesn’t make sense to me. Each doctor prescribing these drugs and each patient taking them wants to know, what is the magnitude of the potential benefit and harm in people like me?”
But George Fodor, one of the authors of the Canadian cholesterol-lowering guidelines, said a study published last year involving 8,000 people found giving statins to low-risk men significantly reduced their risk of cardiovascular disease, and that there was a “trend” toward improvement for women.
“The efficacy and safety of the drugs is outstanding,” said Fodor, a spokesperson for the Heart and Stroke Foundation and head of research in preventive cardiology at the University of Ottawa Heart Institute.
In the United Kingdom, statins are available over the counter, without a doctor’s prescription.
Fodor said the drugs “are much safer than Aspirin.”
“Somebody who has no detectable risk and is apparently healthy should not take (statins). But how many middle-aged people in Canada do not have some atherosclerosis? We cannot detect them easily at the moment.”
More than 23.6 million prescriptions for cholesterol reducers were dispensed from Canadian retail drug stores for the 12-month period ending Sept. 30, according to the drug-tracking firm IMS Health. In Canada alone, statins are a $2-billion market.
There were more than 12.3 million prescriptions over the period for Pfizer’s Lipitor, the No. 1-selling drug in the country.
“Most people have the impression that statins are going to make them live longer,” Wright said. “For primary prevention, there hasn’t been demonstrated to be any survival advantage.”
