Statin Therapy for Prevention of Heart Attack and Stroke

Researchers at the Stanford University School of Medicine (CA, USA) developed a model to analyze the cost-effectiveness of three different approaches to statin therapy: following current guidelines; doing C-reactive protein (CRP) screening in individuals who do not meet the current guidelines for treatment, with statin therapy for those with elevated CRP levels; and providing statin therapy based on an individual's cardiovascular risk alone, without CRP testing. The researcher's model followed hypothetical patients, starting at 40 years of age, with normal lipid levels and no clinical evidence of heart disease or diabetes.

The researchers then looked at which approaches met the threshold of costing no more than U.S. $50,000 per quality-adjusted-life-year, a common metric that takes into account quality of life as well as length of survival. The researchers found that assigning statin therapy based on risk alone, without CRP testing, was the most cost-effective strategy. The optimal strategy for men with no risk factors, for example, would be to start a statin at the age of 55. The optimal strategy for prevention changed, however, if the assumptions in the model were altered. For instance, if harms from statin use are only slightly greater than currently thought, statin therapy would not be reasonable in low-risk individuals, and following current clinical guidelines would be the most cost-effective strategy. The study was published online on September 27, 2010, in Circulation.

"This is not a slam-dunk decision in terms of: you should take people at low risk and put them all on treatment,” said senior author Mark Hlatky, M.D., a professor of health research and policy and of cardiovascular medicine. "If you run the model and change the assumptions even a little bit, you get a different answer. Our model shows that we need better data to be confident about the best approach to drug treatment of lower-risk individuals.”

Statins are a class of drug used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver, which have been associated with cardiovascular diseases. Studies have shown that they are most effective in those already suffering from cardiovascular disease, but they are also advocated and used extensively in those without previous CVD but with elevated cholesterol levels and other risk factors, such as diabetes and high blood pressure.

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Stanford University School of Medicine