One Tiny Pill Takes on Heart Attack, Stroke, and Diabetes
The latest reports are based on analysis of data from three large trials of pravastatin that included a combined total of almost 20,000 patients.
Gaw tells WebMD that the 5,974 men enrolled in his trial, called WOSCOPS, "were relatively healthy middle-aged men. If we were to look at the drug in an older group of patients or in African-Americans or Asians -- both of which tend to have a higher rate of diabetes -- the effect might be even greater."
According to Levy, the finding about diabetes is especially welcome because diabetes is a well-established risk factor for heart disease, and "heart disease is the leading cause of death among diabetics," he points out. While he says that the WOSCOPS analysis reports a "degree of reduction that is fairly considerable and not likely due to chance," he still feels that this is something that deserves further research.
Gaw says the finding is especially compelling because earlier studies showed that simply reducing cholesterol by either diet or with other medical therapies "did not reduce the risk of diabetes." He adds that other drugs that lower lipids have not been shown to protect against diabetes just by lowering the cholesterol levels in the blood. That suggests, he says, that something about the way statins work is exerting this protective effect. A likely explanation, according to Gaw, is that statins affect the blood vessels, and so does diabetes. So this is where the statins may be exerting their protective effect. The drugs may also counter inflammation, which some experts say may lead to diabetes.
In the second study, Robert P. Byington, PhD, and colleagues found that pravastatin use was associated with a 22% reduction in total strokes and a 25% reduction in nonfatal strokes. Byington, a professor of epidemiology at Wake Forest University School of Medicine in Winston-Salem, N.C., tells WebMD, "I feel pretty comfortable hanging my hat on the finding that pravastatin does reduce the risk for both fatal and nonfatal stroke. Since the drug has already been shown to reduce the risk of first heart attack and second heart attack, it does appear to offer a survival benefit."
While the Byington study is reassuring, Levy points out that the protective effect of statins for stroke has been discussed previously at various scientific meetings and is not 'news' per se. The publication of the paper is nonetheless welcome, he says.
The only downside to the statin story, says Levy, is that statins are known to be so effective that many physicians may be reaching for the prescription pad before trying other ways to lower their patients' cholesterol levels, such as diet and exercise. This is an important consideration, he says, because daily statin therapy can be expensive, costing hundreds of dollars a year.