Statin drugs have achieved near wonder-drug status for their ability to lower cholesterol and, in high doses, even reverse the formation of atherosclerotic plaques. But now a new study from Sweden has finally broken the winning streak of statins in clinical trials.
Previous trials have confirmed that statins reduce the risk of heart attacks and strokes by lowering harmful LDL (low-density lipoprotein) cholesterol a lot and raising protective HDL (high-density lipoprotein) cholesterol a little bit.
The new trial, dubbed CORONA (for Controlled Rosuvastatin Multinational Trial in Heart Failure), reported less-than-glowing results of the statin drug rosuvastatin (Crestor) in 5,000 elderly heart-failure patients.
Published in an early online version of the New England Journal of Medicine (NEJM), the results showed that rosuvastatin lowered LDL cholesterol by about 40 percent, as well as the inflammatory marker C-reactive protein, but it did not significantly lower the combined rate of cardiovascular death and nonfatal heart attacks or strokes in these older patients with heart failure. The average age of the participants, who were followed for 2.7 years, was 73 years.
One possible explanation for these findings is that most cardiovascular deaths in older people result from heart-rhythm disturbances caused by prior damage to the heart's electrical system, and not from progressive atherosclerosis produced by high levels of LDL cholesterol.
On a positive note, the trial showed a highly significant reduction in the number of hospitalizations for heart failure and other cardiovascular causes in the rosuvastatin group compared with those taking a placebo.
This finding, that rosuvastatin still reduced the number of hospitalizations among elderly patients, was one topic discussed in an accompanying editorial in the NEJM by cardiologist Frederick A. Masoudi. He urged that "clinicians should continue to prescribe statins for patients with ischemic heart failure and left ventricular systolic dysfunction."
I'll add one final caveat: Patients who have heart failure, if they happen to read about the CORONA findings, should not be tempted to discontinue their statin.
