Harvard Heart Letter

Three (more) cheers for statins

A trio of studies bolsters evidence of their benefits and long-term safety.

Cholesterol-lowering statins have been around for a quarter-century, with a generally strong record of benefits outweighing risks. Indisputably, these drugs substantially reduce the number of heart attacks in people with or at risk for heart disease.

One new feather in the statin cap came from a study investigating whether two years of treatment with the highest recommended doses of rosuvastatin (Crestor, 40 mg) or atorvastatin (Lipitor, 80 mg) would reduce the amount of plaque in clogged coronary arteries.

Using a catheter-guided ultrasound device, researchers measured before-and-after plaque volume in the arteries of 1,039 people, half of whom took rosuvastatin and half of whom took atorvastatin. Statins reduced total plaque volume in two-thirds of all participants. And even with these high statin doses, the number of side effects, including abnormal levels of liver enzymes, was low, and no one experienced rhabdomyolysis, a potentially fatal breakdown of muscle tissue (New England Journal of Medicine, published online Nov. 15, 2011).

Whether reducing plaque volume translates into fewer heart attacks or deaths from heart disease remains to be seen. The latest thinking is that plaque characteristics other than size — such as surrounding inflammation or vulnerability to rupture — may be better indicators of serious trouble ahead. Still, research suggests that statins also possess anti-inflammatory and plaque-stabilizing properties.

Cancer, stroke concerns allayed

As drugs go, statins appear to be quite safe. The most notable side effects are muscle pain, abnormal liver function, and, very rarely, rhabdomyolysis.

But over the years, concerns have cropped up that using statins for a long time might increase a person's risk of cancer or bleeding in the brain (hemorrhagic stroke). No need to worry much about that, according to two other findings.

In the cancer study, British researchers tracked more than 20,000 people who were at increased risk for a cardiovascular event, like a heart attack or stroke. Half took simvastatin (Zocor, generic) daily, and half took a daily placebo. Researchers followed these folks for an average of 11 years, and during that time, 4,000 cancer cases occurred. But there were no differences between the two groups in the number of new cancer cases or cancer deaths (Lancet, published online, Nov. 23, 2011). In a related editorial, Dr. Christopher Cannon, a professor of medicine at Harvard-affiliated Brigham and Women's Hospital, said concerns about the link between cancer and long-term statin use "should be put to rest."

For the stroke study, another group of researchers pooled data from more than 40 studies that looked at the relationship between statins and bleeding in the brain. Among nearly 250,000 people and 15,000 cases of brain bleeding, there was no association between hemorrhagic stroke and statins, regardless of which statin was used or how low people got their LDL levels (Circulation, Nov. 15, 2011). That said, prior research suggests that anyone who has already had a hemorrhagic stroke should think twice about taking a statin.

Considered together, these three studies should make most statin users and their doctors even more confident about using these drugs over the long haul.