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Science/Tech See other Science/Tech Articles Title: New test to identify which (heart) patients should take statins Thousands of patients could be needlessly taking statins even though they are at low risk of suffering heart attacks or stroke, research suggests. Scientists say they have found a much better way to work out which people are in danger of developing heart problems. Half of the middle-aged adults they studied were found to have no coronary artery calcium, and only a handful of them went on to suffer a heart attack or a stroke. They say the findings have “important public health implications” and could mean large cost savings if the cholesterol-lowering drugs are prescribed only for those whose health would genuinely be improved by taking them. But other experts point out that the test for coronary artery calcium is an expensive scan that involves exposing the patient to radiation, so is unlikely to be used widely. In addition, they say that statins do have long-term benefits, such as slowing the hardening of the arteries, so doctors are unlikely to take patients off them regardless of their calcium levels. However the paper, published in The Lancet on Friday, is just the latest in a series suggesting that too many people are currently taking the medicine once seen as a wonder drug. As many as 7million middle-aged and older people in England are thought to take statins, at a cost of almost £500million a year to the NHS. But there are growing fears that many of these are the “worried well” who are at low risk of heart problems, while other studies have linked statins to liver problems and kidney failure. In the latest paper, Dr Michael Blaha at John Hopkins Hospital in Baltimore and colleagues studied 2,083 people with an average age of 67 who had low cholesterol, were not on statins and did not have diabetes. Of these, 46 per cent had high levels of high-sensitivity C-reactive protein (hsCRP), which a previous study known as JUPITER had suggested would make them suitable for statin therapy. The researchers used cardiac CT scans to work out the subjects’ levels of coronary artery protein (CAC) and then followed up their progress about six years later. They found that 47 per cent of the patients had had a CAC score of zero, and hardly any of them had suffered heart problems. Only 6 per cent of the coronary heart disease events (interruption of the blood supply, leading to heart attacks) and 17 per cent of the cardiovascular disease events (heart attacks or stroke) were in those with CAC scores of zero. By contrast, “hsCRP status did not predict coronary heart disease events or cardiovascular disease events”. The researchers say that to prevent one heart attack in people with a CAC score of zero, doctors would need to treat 549 people with statins for five years. But to prevent one heart attack in patients with CAC scores over 100, they would only need to treat 24 people. The experts say their findings show doctors should try to measure atherosclerosis – thickening of the artery walls – by calculating CAC levels rather than just using blood tests and traditional risk factors such as family history or obesity. They say this “could represent a more appropriate allocation of resources, and reduce overall health-care cost, while preventing a similar number of events”. However they insist a longer-term study is needed to confirm that patients with high CAC levels do benefit from statins, regardless of hsCRP levels. Prof Peter Weissberg, Medical Director at the British Heart Foundation, said: “The greatest challenge for preventive medicine is identifying people who are at highest risk of heart disease and who should therefore be given drugs, particularly statins, to reduce that risk. “This study has shown that coronary artery calcium is better than C-reactive protein at identifying people at highest risk of a future heart attack. But the former is expensive and involves radiation so it’s unlikely to be offered as a screening test for everyone. “Nevertheless, it’s likely it will be increasingly used in the coming years to refine how we identify those most in need of preventive medicines.”
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