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Statins for healthy men may save money: study

Kathryn Doyle

NEW YORK (Reuters Health) - More than $1 million worth of heart attacks, strokes and hospitalizations for other reasons were avoided by 1,000 Scotsmen aged in their 40s through 60s who had taken cholesterol-lowering statins for five years, according to a new study.

"Treating middle aged men, who do not have heart disease, with cheap off-patent statins for 5 years, not only prevents heart attacks and deaths due to heart disease, but substantially reduces days spent in hospital, for coronary heart disease, stroke and heart failure," said the report's senior author Ian Ford, a biostatistician at the University of Glasgow.

The so-called statin drugs, including torvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol) and simvastatin (Zocor), are usually prescribed to patients with heart disease or other known risk factors for heart attack, Ford said. They act primarily by lowering low-density lipoproteins, or "bad" cholesterol.

Because cardiovascular diseases are the number one cause of death and a major cause of disability in the U.S. and elsewhere, however, experts have debated whether giving statins preventively to larger swathes of the population could save lives and cut healthcare costs.

To test how that idea would affect healthcare usage and costs in Scotland, Ford and his colleagues analyzed data from a trial that included more than 6,000 middle-aged Scotsmen with high cholesterol, but who had never had a heart attack.

The participants, who were all between 45 and 54 years old at the outset, were randomly divided into one group that received 40 milligrams of pravastatin daily for five years and another group that got a placebo for the same period. The researchers then followed the men through their health records for another ten years.

In the statin group, 265 men had heart attacks over the 15-year study period, compared to 369 in the placebo group.

Heart disease or heart attack killed five percent of the statin group compared to seven percent of the placebo group - a result that was reported in a 2007 paper in the New England Journal of Medicine. But the authors of the current study reanalyzed the data to determine if the apparent benefits of statin use in healthy men were also cost-effective.

For every 1,000 men taking the statins, there were 163 fewer hospital admissions for heart problems and a total saving of 1836 days in the hospital compared to men on the placebo, according to the new results published in the European Heart Journal.

The statin group had fewer admissions for heart attack, stroke and heart failure, and the researchers estimated that the statin group spent $4.3 million on heart disease costs compared to $5.4 million in costs for the placebo group.

In the U.S., the cheapest statins are available for $12 per month, according to Consumer Reports. But the idea of advising generally healthy people to take the drugs preventively remains controversial.

The statins carry their own risks, which doctors and regulators would have to take into account before using them preventively in the U.S., according to cardiologist Rita Redberg at the University of California San Francisco School Of Medicine.

"The risks of memory loss, diabetes, weakness and muscle problems outweigh the possible benefits for most people in primary prevention," Redberg, who was not involved in the new study, told Reuters Health.

Ford agreed that statins have some risks, but because there were no more hospitalizations for those side effects in the statin group than in the comparison group in his study, he believes that the heart benefits of statins outweigh the risks.

Redberg points out that the Scottish men in the study had lifestyle risk factors that are different from those of most U.S. adults, so the results of this study may not be generalizable to other countries.

Most American men and all American women are naturally at lower risk for cardiovascular disease than the Scottish men in the study, she said, so they would not reap the same dramatic benefits from statins.

SOURCE: http://bit.ly/11VhSQG European Heart Journal, online July 9, 2013.

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