But prescribing them for protection would be questionable, expert says
TUESDAY, Nov. 10 (HealthDay News) -- Long-term use of cholesterol-lowering statins appears to reduce the incidence of gallstones and the need for surgery to prevent the excruciating pain they cause, a new study indicates.
"We're talking about people who have been taking them for about 1½ years," said Susan S. Jick, director of the Boston Collaborative Drug Surveillance Study at Boston University and a member of the team reporting the finding in the Nov. 11 issue of the Journal of the American Medical Association. "The protective effect seems to grow over time. The relative risk for them is about half the risk of someone who is not exposed to a statin."
Jick, an epidemiologist, was part of an international effort in which physicians at the University of Basel in Switzerland analyzed data collected in the United Kingdom. They studied the association between the use of statins, which are prescribed to reduce the risk of cardiovascular disease, and the incidence of gallstones.
Gallstones form in the gall bladder, which contains a fluid called bile that helps digest fats. About 80 percent of the time, gallstones consist of hardened pellets of cholesterol. They can block the ducts that carry bile from the gall bladder to the small intestine, and persistent blockage is not only painful but can cause dangerous infections. In many cases, removal of the gall bladder is necessary, through a surgical procedure called a cholecystectomy.
The study compared 27,035 people who had a cholecystectomy with 106,531 who had no history of gallstones. The numbers included 11,264 people who took statins, 2,396 of them in the cholecystectomy group.
Among those diagnosed with gallstones, the researchers found a gradual reduction in the need for surgery related to how long they had taken statins. For example, 2.6 percent of the people with five to 19 statin prescriptions required surgery, compared with 2.4 percent of those not taking the medication. For those with 20 or more prescriptions, the incidence of surgery was 3.2 percent, compared with 3.7 percent for those not taking the drug.
The study indicates that all statins provide the protective effect and that the effect increases with higher doses, the report said.
But the study results do not indicate whether a statin should be prescribed solely to help prevent gallstones in someone who did not have them, said Dr. Farid Kehdy, an assistant professor of surgery at the University of Louisville.
"This would have to be studied thoroughly, prescribing a medication for something that may or may not occur," Kehdy said.
And prescribing a statin to reduce the chance that surgery would be needed is also questionable, he said.
"You would have to take it for a year and a half to reduce the risk ratio," Kehdy said. "Will a patient be willing to do that? It would be a daily burden if you don't know for sure."
Medical history indicates that such a prescription would be questionable, he said. Several decades ago, Kehdy said, physicians routinely prescribed a medication, ursodeoxycholic acid, to help dissolve gallstones, but the high cost, inconvenience and side effects of the medication led to abandonment of the practice.
So a decision to prescribe a statin should center on its known benefits in cardiovascular disease, with gallstones a side issue, he said.
"If you are on a statin, the risk of gallstones would be lessened," Kehdy said. "If someone does not have gallstones, would you want to take a statin for the sake of preventing gallstones? That question remains to be addressed."
The U.S. National Digestive Diseases Information Clearinghouse has more about gallstones.
SOURCES: Susan S. Jick, D.Sc., M.P.H., professor, epidemiology, and director, Boston Collaborative Drug Surveillance Study, Boston University, Boston; Farid Kehdy, M.D., assistant professor, surgery, University of Louisville School of Medicine, Louisville, Ky.; Nov. 11, 2009, Journal of the American Medical Association
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