For that specific group, Crestor makes sense, Nissen said. "Over a five-year period of time, you prevent one death or minor stroke for every 25 people treated," he noted.
Whether or not others with normal cholesterol should take Crestor or another statin remains unclear. "Not everyone with normal cholesterol should be treated," Nissen said. "You should give it to people with a high enough risk."
And he added that the results applied only to Crestor. Other popular statins include Lipitor, Pravachol and Zocor, as well as some generic versions.
Those statins might not produce the same benefits, Nissen said. "Statins differ from each other in terms of potency," Nissen said. Crestor, which is available only in a more expensive brand-name form, is toward the top of the list in terms of potency, he noted, while generic drugs such as simvastatin (Zocor) and pravastatin (Pravachol) have much less powerful effects.
"For patients who need a lot of cholesterol reduction, I use the most powerful drug," Nissen said. "If I can get a patient there with a generic drug, of course I use a generic drug."
But Hlatky has his doubts about the advisability of widening statins' reach. He said he's reluctant to have people at cardiovascular risk pop a pill rather than change the lifestyle factors that put them in trouble in the first place.
"My view has always been that you start with the basics and do the simple things first before you go to drugs," Hlatky said. "Lots of people are not doing the sensible things. They're not eating the right diet, they're not exercising, they're still smoking. Most of the people in the JUPITER trial were smack in the middle of that group."
So Hlatky says he might still prescribe a statin for someone in that group, "but I would have an informed conv
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