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Cardiovascular Report - Who's most likely to need a statin?

Cardiovascular Report Winter 2011

Who's most likely to need a statin?

Date: February 28, 2011

A study of 950 healthy men and women shows that only those with calcium buildup in their arteries are likely to have a clear benefit from statin therapy over the next five years. The findings from the Johns Hopkins-led Multi-Ethnic Study on Atherosclerosis (MESA) are believed the first to pinpoint which patients with normal blood-cholesterol levels would benefit from a statin’s cardioprotective effects.

Led by Mike Blaha from the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, the researchers found that nearly 95 percent of all heart attacks, strokes or heart-related deaths occurred in participants who had measurable buildup of calcium in the blood vessels. And 75 percent of all acute cardiac events occurred in the quarter of participants with the highest calcium scores. By contrast, the 47 percent of participants with no detectable levels of calcium buildup had only about 5 percent of heart-disease-related events during the six-year study, meaning that statin therapy did not offer that much coronary protection. However, a statin may have slowed the progression of atherosclerosis during that interval.

Results also underscore the importance of measuring coronary artery calcium in predicting heart attack risk. High blood levels of C-reactive protein (2 or more milligrams per liter) offered no significant predictive value after accounting for established risk factors.

“Statin therapy should not be approached like diet and exercise as a broadly based solution for preventing coronary heart disease,” says study co-investigator Roger Blumenthal, director of preventive cardiology at The Johns Hopkins Hospital. “These are lifelong medications with potential, although rare, side effects, and physicians should mainly consider their use for those patients at greatest risk, especially those with high coronary calcium scores or other evidence of atherosclerosis.”

Presented Nov. 16, 2010, at the American Heart Association’s annual Scientific Sessions