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Do Healthy People Need a Statin Drug?

by Susan Flagg Godbey

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A $20 blood test and a prescription for a statin drug could cut your risk for a heart attack or stroke by 44 percent, even if you’re healthy. That’s the conclusion of a headline-grabbing study of nearly 18,000 people that experts are calling it a breakthrough in heart attack prevention for millions of Americans.

But do you need the test—or the drug? The study, spearheaded by Harvard Medical School heart researchers, tracked 17,802 women and men with LDLs (heart-threatening “bad” cholesterol) under 130 mg/dl (fairly healthy), but who had a hidden heart risk: high levels of C-reactive protein (CRP), a sign of inflammation that has been linked not only to heart attack but other diseases, including cancer. After about two years, those who took a statin saw CRP fall 37 percent, and their risk for a heart attack dropped to less than 1 percent while risk was 1.8 percent for those on a fake pill.

“There’s a large group of people who might benefit from a CRP test and a statin, but that doesn’t mean everyone needs them,” cautions cardiologist Erin Michos, MD, assistant professor of medicine at Johns Hopkins University School of Medicine. “This study is extremely important. But it doesn’t overshadow the core risk factors for heart attacks and strokes, such as high cholesterol, high blood pressure, or smoking.”

Here’s what you need to know about the test, the drug, and inflammation:

What is C-reactive protein and why is it so dangerous?

CRP is a very sensitive marker of inflammation in the body. If you have inflammation, plaque inside the walls of your arteries is more likely to rupture. This leads to the formation of blood clots that travel to the heart or brain where they cause heart attacks and strokes. That’s why it can be important for people who have normal or nearly normal cholesterol levels to have a CRP test. They may not be at risk for developing large amounts of plaque, but if they have a lot of inflammation, the plaque they have may be unstable and more likely to break open.

The test used to check for heart-threatening levels of CRP is called a high-sensitivity-CRP (or hs-CRP) test. It’s different from the traditional CRP test that’s used for other inflammatory conditions like rheumatoid arthritis.

Does everybody need a C-reactive protein test?

No. Every adult should start by keeping core risk factors at healthy levels. These include your blood pressure, your LDL and HDL cholesterol levels, triglycerides, blood sugar, body weight, and waist circumference (waists over about 35 inches for women and 40 for men raise heart disease risk). If you smoke, work on quitting. Get regular exercise. It’s also important to know if you have a family history of heart disease or stroke, especially before age 55 in men and 60 in women, which increases your risks.

Those who may need a CRP check are men over age 50 and women over age 60 who are at “intermediate” risk for a heart attack or stroke. Perhaps your cholesterol is a little high, or you’re a little overweight or have a large waistline. In cases like that, your inflammation level can be the tiebreaker in helping your doctor decide whether you can continue with lifestyle changes alone to lower your heart risk or if you need to start a statin drug sooner.

It’s important to mention that this study only looked at older people. Younger people with no heart disease risks probably don’t need an hs-CRP test; neither do people at high risk for heart disease or stroke, such as those with diabetes or known heart disease or those who have already had a heart attack, stroke, or treatment for a coronary artery blockage. If you’re at high risk, your doctor should be treating you aggressively with statins, aspirin, and other medications, so knowing your CRP won’t change the intensive treatment you’re already getting.

Do I have to take a statin to lower inflammation?

Losing weight, reducing abdominal fat, and exercising can all reduce inflammation, and at the same time lower your risk for cardiovascular disease by reducing blood pressure, blood sugar, LDL cholesterol, and triglycerides and by raising levels of “good” HDL cholesterol. There’s no one drug that has all of those benefits. Everyone should take these important steps, whether or not you have high CRP levels.

If your hs-CRP test result is 2 or higher—the level considered elevated in the study—you may want to try lifestyle changes for three to six months and then have a second test before considering a statin. Lifestyle changes can lower CRP. Since infections and inflammatory conditions—such as arthritis—can also raise your CRP level, it’s good to be tested more than once before starting a statin just for inflammation.

By Susan Flagg Godbey and the editors of Better Health & Living®