Wonder drugs - 24 November 2001

Wonder drugs

• 24 November 2001
• From New Scientist Print Edition

STEP aside aspirin—here come statins, the latest wonder drugs. A huge study has shown that one type of statin can reduce the chance of a heart attack or stroke by a third, yet causes no serious side effects.

Till now, statins have been prescribed only to people with high cholesterol levels. But the study showed that even people with low levels benefited. That means doctors should dish them out to far more people, the researchers say.

"Doctors need to be aware just how definite these results are," says Rory Collins of Oxford University, director of the seven-year Heart Protection Study involving 20,000 volunteers aged between 40 and 80. "There's no room for doubt—they're the sort of results you dream of," he says.

He wants existing guidelines on prescribing statins to be ripped up. "The default has changed, so doctors should now ask if there's a good reason not to give the drug," he says. It may not even be necessary to measure cholesterol levels beforehand, he says.

Statins don't come cheap, however. A year-long course of simvastatin, the drug given to the volunteers, costs £360. If people keep taking them for decades, it could stretch the resources of public health services such as Britain's NHS. But cheaper, generic versions might soon be available.

Patent protection for simvastatin doesn't expire until 2003, but for lovastatin, patents have already begun to run out. Though the drug is not licensed for use in Britain, Collins says the NHS should have a look at how to get generic versions of lovastatin.

"Even if the cost comes down significantly, the [huge] demand might mean we can't use them as liberally as we would like," says Peter Fellows, chairman of the British Medical Association's prescribing committee. And the BMA is recommending caution despite the spectacular results. "It's still possible there might be long-term effects that might not yet have come to light," Fellows says.

Statins work by blocking a liver enzyme that makes cholesterol. The liver compensates by withdrawing the harmful, artery-clogging cholesterol complex—called low-density lipoprotein—from the blood.

Presenting their findings last week in Anaheim, California, at the annual meeting of the American Heart Association, Collins and his colleagues said that simvastatin reduced heart attacks and strokes by a third among all those at risk. Contrary to expectations, it helped women and elderly people with heart problems, and diabetics.

Statins also reduced the need for surgery or balloon angioplasty to de-clog arteries, and the need for amputations triggered by poor blood flow to limbs, usually a result of smoking. Nor were there any serious side effects. The researchers didn't see any sign of the muscle wastage that in August led to the withdrawal of Baycol, a statin made by Bayer of Germany.

From issue 2318 of New Scientist magazine, 24 November 2001, page 7