What is Cardiovascular Disease?
Approximately 81 million American adults are living with cardiovascular disease (CVD). Cardiovascular disease includes hypertension, coronary heart disease, heart failure, stroke and/or congenital cardiovascular heart defects. More than 17 million people with CVD have coronary heart disease (also called coronary artery disease), which is a build-up of fat (atherosclerotic plaque) in the walls of the arteries around the heart. Coronary heart disease is the number one cause of death in the United States.
What are Statins?
Statin medications (statins) are drugs that help lower cholesterol levels in the blood. Statins help prevent coronary heart disease in patients without a history of CVD (primary prevention) and those who are at very high risk of developing CVD (such as patients with diabetes) or have had some form of CVD, including heart attack, stroke, transient ischemic attack (TIA), angioplasty, coronary artery stent placement or peripheral vascular disease (secondary prevention).
Statins are the first-line treatment of choice for patients with high cholesterol and those diagnosed with coronary heart disease. Statins have additional benefits beyond lowering cholesterol levels (pleiotropic effects); they also help the lining of the blood vessels work better (improved endothelial function), enhance the stability of atherosclerotic plaques, reduce the amount of inflammation and damage done to cells through oxidation (oxidative stress), and keep blood platelets from clumping together (platelet aggregation), thereby reducing the risk of a blood clot (thrombus).
The Jupiter Trial (Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin) included more than 15,000 patients without CVD. Participants included men over the age of 50 and women over the age of 60 with normal cholesterol levels (their LDL [“bad” cholesterol] level was less than 130 mg/dL), and elevated levels of ultra sensitive C-reactive protein (2.0 mg/L or higher). High levels of C-reactive protein indicates inflammation and is an independent risk factor for CVD. In other words, people with high levels of C-reactive protein are at risk of developing CVD even if they have no other risk factors.
The Jupiter Trial was a randomized, double-blind, placebo-controlled, multicenter trial that involved 1,315 sites in 26 countries. Participants were randomly chosen to be part of one of two groups: those who took rosuvastatin (Crestor) 20 mg daily or those who took a placebo (a pill containing no drug). The trial was scheduled to run for five years, but it was terminated after 1.9 years because there was an overwhelming amount of data that showed that participants who were taking a statin had a reduced risk of CVD.
The trial showed that compared to patients taking the placebo, patients taking a statin had a 54% lower chance of heart attack, 48% lower chance of stroke, 46% lower chance of needing angioplasty or coronary artery bypass surgery, and a 20% lower chance of dying from any cause. In addition, among patients taking a statin, their level of ultra sensitive C-reactive protein was reduced by 37%, and their LDL cholesterol levels were reduced by 50%.
The Jupiter trial also provided the first results to show that statins are highly effective in female and minority patients — groups typically excluded in clinical trials. The take-home message from this study is that patients with higher-than-normal levels of ultra-sensitive C-reactive protein levels, even those with normal cholesterol levels, may benefit from statin therapy.
Other studies have shown that statins can have the same types of benefits in patients with a history of or at high risk of developing CVD. These studies include the Treating to new Targets Study (TNT). The purpose of this trial was to see how well statins worked to lower patients’ LDL levels to below 100 mg/dL, and to see how safe this type of treatment was. The trial results showed that patients in this trial also gained additional benefits from taking a statin.
Another secondary prevention clinical trial, Prove IT-TIMI 22, compared the benefits of lowering LDL levels to below 100 mg/dL versus below 70 mg/dL. The study showed that patients whose lipid levels were drastically lowered (intensive statin therapy) had a lower risk of dying and having a major cardiovascular event.
In the ASTEROID trial, researchers studied intensive statin therapy with rosuvastatin (Crestor) 40 mg to see if it can reverse plaque build-up and thickening of the arteries (coronary atherosclerosis). Although further studies are needed to compare the results of the trial to clinical outcomes, researchers found that lowering LDL cholesterol to lower-than-recommended levels plus increases in HDL cholesterol (“good” cholesterol) can, indeed, reverse atherosclerosis in patients with coronary disease.
Some patients cannot tolerate a daily statin medication because of muscle discomfort. For these select patients, taking a lower or less frequent dose of a statin may be beneficial. Patients who experience muscle discomfort can take Coenzyme Q-10 (CoQ-10) to help relieve the symptoms. Some studies show that patients may better tolerate statins when they take them with CoQ-10. Coenzyme Q-10 is fat-soluble, and it’s better absorbed when taken with a meal containing mono- or polyunsaturated fat.
Statins can be associated with other side effects. Your doctor will discuss these potential side effects with you. If you have any questions about statins or side effects, please be sure to talk to your doctor about your concerns.
Statins are not a Cure-All
Statin medications are not meant to be used as a substitute for a healthy lifestyle that includes regular exercise (about an hour each day), smart food choices and maintaining a healthy weight (body mass index [BMI] below 25). Healthy lifestyle habits also include eating breakfast every day, weighing yourself at least once a week and watching less than 10 hours of TV per week.
Brisk walking is a great form of exercise. Wearing a pedometer can help motivate you to increase the amount of walking you do. A good goal is to walk 10,000 steps per day, which is five miles (2,000 steps per mile, on average).
A heart-healthy diet is one that includes fresh fruits and vegetables, lean meats, whole grains and healthy fats (polyunsaturated fats, monounsaturated fats, and Omega 3 fatty acids). Saturated fat and trans fats should be avoided.
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-reactive Protein. N Engl J Med. 2008;359:2195–2207.
Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics–2010 Update: A Report from the American Heart Association. Circulation. 2010;121: e46-e215. Epub 2009 Dec 17.
LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK; Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425–1435.
Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM; Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495–1504.
Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, Davignon J, Erbel R, Fruchart JC, Tardif JC, Schoenhagen P, Crowe T, Cain V, Wolski K, Goormastic M, Tuzcu EM; ASTEROID Investigators. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis. JAMA. 2006;295:1556–1565.