Statins have once again hit the news

Rohit Thummalapalli
By Rohit Thummalapalli April 6, 2008 19:38

Last year, statins made headlines when they appeared on Forbes magazine’s list of “America’s 20 Best Selling Drugs.” Pfizer’s Lipitor came in first place with a whopping $8.4 billion worth of sales, and Merck’s Zocor came in second with $4.4 billion. Among newer drugs, Vytorin (a combination treatment of Zetia and Zocor) held the number one spot on Forbes’ ranking of “America’s Fastest-Growing Medicines.” It is no surprise, then, that statins—a class of drugs that work to lower low-density lipoprotein (LDL, also known as “bad” cholesterol) and prevent plaque buildup inside the arteries—have once again hit the news.

According to new data compiled by the prescription benefit manager Medco Health Solutions, Inc., use of cholesterol medications among the 20-44 year old age group has increased by 68% in the last 6 years alone. Furthermore, this increase is accompanied by a 21% jump in blood pressure medication use in the same demographic.

Such large numbers are indeed startling. However, is this so unexpected? We have been long aware of what is perhaps the most widespread epidemic of the Western world: metabolic syndrome—the name given to the collection of risk factors such as obesity, type 2 diabetes, high LDL cholesterol, and high blood pressure, that predispose one to vascular disease.

Why, then, is it not good that more people are taking statins in greater quantities at lower ages to proactively combat this disease? In fact, some do view the increase as an improvement in the numbers of patients taking preventative measures.

Others, however, point out that a move towards such extensive (and perhaps excessive) drug use is worrying evidence of the spread of the current obesity epidemic to 20-44 year olds, and should be taken as a warning that we may be moving towards dependency on a pill—rather than on the fundamental therapeutic personal lifestyle changes of improving diet and increasing exercise—for cardiovascular health.

Indeed, the increase in statin use by young people may be due in part to the nation’s deteriorating health: one quarter of all “vegetables” consumed in this country are French fries, and a Hungry Man microwaveable breakfast meal alone contains 690 mg of cholesterol (231% of the recommended percent daily value). We are a society that eats the wrong foods and doesn’t exercise enough, leading our doctors to prescribe statins. But before we blame the observed increase in American pill-popping solely on a surge in obesity, hypertension, and high cholesterol among the younger segment of the population, we must first look carefully at the social context of this increase.

First, we must take into account that the new U.S. guidelines for cholesterol and blood pressure levels have been dropping steadily. The latest recommended LDL level is 70 mg/dL, a number so low that if those individuals who had LDL concentrations above 70 mg/dL needed treatment, then most of Western society would be taking statins.

Recommended numbers for blood pressure have also faced the possibility of a move from 120/80 to 115/75. With these targets, no wonder Medco saw such an increase in statin prescription. Furthermore, these strict new guidelines for disease diagnosis are combined with a recent change in physicians’ attitudes towards metabolic syndrome treatment.

“Hit it hard, hit it fast and hit it early” seems to sum up the new motto. After all, what is the use of prescribing statins for a fifty-year-old who has just suffered a heart attack, after it is too late to prevent it? In accordance with this drastic change in medical philosophy, doctors are becoming more and more aggressive in taking preventative measures in young patients who exhibit family history of metabolic syndrome or even a trace of a pre-diabetic or pre-hypertensive condition.

Finally, it is no surprise at all that the greatest increase in drug use occurs in an age group previously under-diagnosed and ignored with regard to cardiovascular disease. In the same study, Medco found that over the past six years the drop in median age of patients taking statins was greater for women than for men.

The gender difference was attributed to heart disease’s history as naturally a ‘man’s condition’, as it was once thought to be. With the gradual unveiling of the fact that women also suffer from heart disease, there came an increase in diagnosis in females. Why, then, should this not be the case with the unveiling of the fact that young people may also show precursors of full-blown cardiovascular disease? Armed with this newfound knowledge, should we not expect the use of medications among the younger demographic to show a similar leap?

Although it is tempting to blame the increase in statin prescription for younger people on the nation’s obesity crisis, these numbers are reflective more of changing attitudes towards diagnosis, treatment, and prevention of the metabolic syndrome. Actually, such an increase in statin use may not be such a bad thing.

The merits of these drugs extend beyond their lipid-lowering capabilities: they are anti-inflammatory agents, they may raise HDL “good” cholesterol, and they block the growth of some cancer cells, cutting the risk of prostate and lung cancer by up to 50%. The traditional time-tested prescription of diet and exercise of course is not irrelevant. However, when such healthy lifestyle modifications are combined with statin therapy, metabolic health is augmented. The increased drug usage may therefore be less worrisome than it sounds, for as we move forward with statin therapy to treat metabolic syndrome before it harms the body, we further the goal of better national health.

 

References:

*Medco News Alert
*Forbes “America’s 20 Best Selling Drugs”
*Professor Kelly Brownell’s Intro Psyc Lecture (for food facts)
*CDC (for current BP and cholesterol recommendations)

Rohit Thummalapalli
By Rohit Thummalapalli April 6, 2008 19:38