Should you be taking a statin?

Statins are prescribed to reduce cholesterol. One of them, Lipitor, has become the best-selling pharmaceutical in history.

C-reactive protein

Two years ago a major clinical trial known as JUPITER showed that millions more people could benefit from taking statins, even if they have low cholesterol. That study involved patients with low cholesterol levels but elevated levels of CRP, or C-reactive protein, which indicates inflammation in the body and suggests a greater risk of heart attack and stroke.

A new study suggests that broader statin use among adult patients may be a cost-effective way to prevent heart attack and stroke. The Stanford University School of Medicine study also found that screening for  CRP to identify patients who may benefit from statin therapy would be cost-effective, but only under certain scenarios.

The researchers developed a model to analyze the cost-effectiveness of three approaches: following current guidelines; doing CRP screening in individuals who don't meet the current guidelines for treatment, with statin therapy for those with elevated CRP levels; and providing statin therapy based on an individual's cardiovascular risk alone, without CRP testing. Their model followed hypothetical patients, starting at 40 years of age, with normal lipid levels and no clinical evidence of heart disease or diabetes.

Their conclusion? Assigning statin therapy based on risk alone, without CRP testing, was the most cost-effective strategy. The optimal strategy for men with no risk factors, for example, would be to start a statin at the age of 55.

The researchers found, however, that the optimal strategy for prevention changed if the assumptions in the model were altered. For instance, if patients with normal CRP levels get little or no benefit from statin therapy, CRP screening would be the optimal strategy. And if harms from statin use are only slightly greater than currently thought, statin therapy would not be reasonable in low-risk individuals, and following current clinical guidelines would be the most cost-effective strategy.

So a lot of questions remain. But it's worth a discussion with your doctor. And here's something you can use: the researchers have developed an interactive tool that doctors can use to determine the most cost-effective approach to statin therapy for individual patients. The calculator can be found at http://med.stanford.edu/hsr/crp-screening/.