Should anti-cholesterol and blood pressure meds be used by everyone?

Cholesterol drugs known as statins are impressively effective at lowering the incidence of strokes and heart attacks in high-risk patients (take a look at the TNT, HPS and Jupiter studies that I previously wrote about here). Blood pressure medicines are similarly beneficial. Doctors, extrapolating from these findings, sometimes make statements that these drugs should be in the water supply (basically suggesting these medications should be taken preventatively like vitamins). After all, heart disease remains the leading cause of death in the United States (1 in 4 deaths) and it’s estimated that 73.5 million Americans have high cholesterol.

A great study recently published in the New England Journal of Medicine sheds light on this. My conclusion is that it makes sense to wait to treat until the need arises. Preventative care does not seem to confer a benefit.

Details of the study were as follows: A total of 12,000 low-moderate risk patients with borderline-elevated cholesterol or blood pressure were treated with active therapy or placebo and followed to understand the decrease (if any) in the risk of death, heart attack or stroke.

For blood pressure medicines, it appeared there was no benefit of treating these low-risk patients early (until blood pressure is clearly elevated).

Statins fared better, but only a little. These drugs lowered the annual risk of a cardiovascular problem from 4.8% to 3.7%. That means 100 people need to be treated to prevent one event. In my opinion, that’s a tough call as to whether it makes sense.

This was a great question to study.  Bottom line: while statins and blood pressure medication are effective for those with past heart attacks or high risk, it appears there’s no a benefit for low-risk individuals to take these meds prophylactically.

 

Sources: Heart Disease Facts (Centers for Disease Control); Blood pressure lowering in intermediate persons without cardiovascular disease (New England Journal of Medicine); Cholesterol lowering in intermediate persons without Cardiovascular Disease (New England Journal of Medicine); Treating to New Targets (TNT) Study: does lowering low-density lipoprotein cholesterol levels below currently recommended guidelines yield incremental clinical benefit? (The American Journal of Cardiology); Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high-risk conditions (Journal of Vascular Surgery); Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein (New England Journal of Medicine)

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