Cholesterol drug may lower blood clot risk
Study of Crestor suggests statins do double duty
ORLANDO, Fla. - Statin drugs, taken by millions of Americans to lower cholesterol and prevent heart disease, also can cut the risk of developing dangerous blood clots that can lodge in the legs or lungs, a major study suggests.
The results provide a new reason for many people with normal cholesterol to consider taking these medicines, sold as Crestor, Lipitor, and Zocor and in generic form, doctors say.
In the study, Crestor cut nearly in half the risk of blood clots in people with low cholesterol but high scores on a test for inflammation, which plays a role in many diseases. This same big study last fall showed that Crestor dramatically lowered rates of heart attacks, death, and stroke in such patients, who are not usually given statins now.
"It might make some people who are on the fence decide to go on statins," although blood-clot prevention is not the drugs' main purpose, said Dr. Mark Hlatky, a Stanford University cardiologist who had no role in the study.
Results were reported yesterday at the American College of Cardiology conference and published online by the New England Journal of Medicine.
The study was led by statistician Robert Glynn and Dr. Paul Ridker of Harvard-affiliated Brigham and Women's Hospital in Boston. Ridker is a co-inventor on a patent of the test for high-sensitivity C-reactive protein, or CRP. It is a measure of inflammation, which can mean clogged arteries or less serious problems, such as an infection or injury.
It costs about $80 to have the blood test done. The government does not recommend it be given routinely.
For the study, researchers in the United States and two dozen other countries randomly assigned 17,802 people with high CRP and low levels of LDL, or bad cholesterol (below 130), to take dummy pills or Crestor, a statin made by the British company
With an average of two years of follow-up, 34 of those on Crestor and 60 of the others developed venous thromboembolism - a blood clot in the leg that can travel to the lungs. Several hundred thousand Americans each year develop such clots, leading to about 100,000 deaths.
However, this is uncommon compared with the larger number who suffer heart attacks. Many doctors have been uncomfortable with expanding statin use to people with normal cholesterol because so many would have to be treated to prevent a single additional case.
"I don't know that it changes the big picture very much" to say that a statin can prevent blood clots, Hlatky said. "Where do you draw the line? Are we giving it to 10-year-old kids that are fat?"
AstraZeneca paid for the study, and Ridker and other authors have consulted for the company and other statin makers. Many doctors believe that other statins would give similar benefits, though Crestor is the strongest such drug. It also has the highest rate of a rare but serious muscle problem, and the consumer group Public Citizen has campaigned against it, saying there are safer alternatives.
Crestor costs $3.45 a day versus less than a dollar for generic drugs. Its sales have been rising even though two statins - Zocor and Pravachol - are now available in generic form.
Many doctors remain reluctant to expand CRP testing or use of statins. Some doctors surveyed by the New England journal questioned why so few people in the study were getting other treatments to prevent heart problems.