Statins have a long history dating back to discoveries in the 1970s showing they could block cholesterol synthesis. The first statin was released in 1987. While essential for life, cholesterol comes in both good and bad forms. Whether a 44-year-old woman should be on a statin is unclear given her risk factors of being overweight and a smoker but no family history or other major risks. Clinical trials examine both absolute and relative risk reduction. While statins provide clear benefits, they may modestly increase diabetes risk, especially in certain groups. Larger studies find no increased cognitive risks. Alternative lifestyle approaches like the Mediterranean diet may also help reduce stroke risk.

1. Statins: The Good, bad & ugly
Satish Madiraju, M.D., FACP, FACC,
FSVM
Interventional Cardiovascular Medicine
Saint Mary Mercy Hospital
Livonia, Michigan

6. A little history:
1976-Japanese scientists discover “Compactin” shown to block
cholesterol synthesis
1979-Merck investigators isolate the inhibitor “Lovastatin”
Rumors surface that Compactin might have caused cancers in dogs
Merck’s CEO Dr. Roy Vagelos decides to discontinue statin clinical
trials
July 1982-FDA helps Dr’s Illingsworth, Grundy & Bollheimer at OHSU
and Univ of Texas to treat familial hypercholesterolemia
JAMA Jan 20, 1984- results of LRCCPPT published-19% reduction in
heart disease, death or heart attack
March 23, 1984- Merck submits FDA application

7. First statin released by Merck in 1987

10. Cholesterol: Essential for life!

11. Good and bad cholesterol

19. Real Patient:
44 year old woman, single, overweight, works for
BCBS, smokes 1/2 pack per day and recently started
on Lipitor 20 mg.
No history of diabetes, hypertension, or family history
of coronary heart disease.
Recent blood test: Total cholesterol 210 mg/dl, LDL-C
137, HDL 43, Triglycerides 150
Should she be on a statin?

24. Absolute Risk versus
Relative Risk
Placebo compared to new drug in a clinical trial
Patients taking placebo have a heart attack risk of 2%
Patients taking new drug have heart attack risk of 1%
Absolute risk reduction with drug is 2% minus 1%=1%
Relative risk reduction: 1% is 50 percent less than 2%, hence
reported as a 50% reduction in heart attack risk

26. How much benefit do women
derive from statins?

28. Primary prevention trial
Seeks to show that in people without evidence of
cardiovascular disease, those treated with a statin will
be less likely to have a heart attack, or stroke or to die
of heart disease over the course of the trial than those
taking a placebo.

29. Secondary prevention trial
Seeks to show that in people with evidence of
cardiovascular disease, those treated with a statin will
suffer fewer subsequent events such as a heart
attack, stroke, or cardiac death over the course of the
trial than those taking a placebo.

41. Meta-analysis of statin trials and diabetes risk
13 percent increased risk of developing
diabetes

43. Statins & Diabetes
Elderly women at increased risk of developing
diabetes
Overweight and impaired glucose levels also
predispose
Patients should have glucose levels checked on
statins

44. No increased risk of cognitive
dysfunction

46. The Mediterranean diet

51. California Teacher’s Study
14 percent reduced risk of ischemic stroke
International Stroke Conference, February 12, 2015

52. Thank you