Heart Disease - Top 10 Advances of the Millenium (well, so far) 

2)  The expanding role of statins

Over the past decade, the statin drugs have proven to be remarkably effective in lowering the levels of LDL cholesterol (the “bad” cholesterol – see Cholesterol and Triglycerides.) 

Over the past year, however, it has become increasingly clear that the potential benefits of statin drugs go far beyond the reduction of chronically elevated cholesterol levels.  The following information came to during Y2K:

-         Recent evidence shows that patients with low LDL cholesterol levels, but with elevated C-reactive protein levels, may receive as much benefit from the statin drug lovastatin as did patients with high LDL cholesterol levels.  Thus, elevations in CRP levels may become a new indication for the use of statin drugs.  (See CRP and fibrinogen – newer risk factors for coronary artery disease.)

-         A report in the December 2000 issue of Nature Medicine asserts that statins modify the inflammatory response of cells to bacterial infections such as those produced by Chlamydia pneumoniae.  Such infections have been postulated by some to accelerate the development of coronary artery disease.

-         In the September 2000 issue of Nature Medicine, statins were shown to mediate the development of new blood vessels in animals with ischemic tissue. Such new blood vessels can help to lessen ischemia of the heart muscle.

-         Evidence is accumulating that statin drugs may help to prevent osteoporosis and its consequences, such as fracture

These findings are all very exciting, and it is apparent that the use of statins needs to be expanded, but it is important to place the expanding role of statins into perspective.  We should keep in mind that the reason so many discoveries are being made with the statins is that pharmaceutical companies are pumping millions of dollars into expanding the indications for these “golden goose” drugs.  We ought not to get too carried away by these potentially exciting findings – given that the statins are expensive and are not free of side effects – until they have been validated by ongoing research. At the same time, even with what we know to be true today, it is clear that the statin drugs have much to offer beyond the lowering of cholesterol, and are being significantly underused by physicians.

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