Statins can cause heart attacks!

Axel Schlitt, Stefan Blankenberg, Christoph Bickel, et al. PLTP activity is a risk factor for subsequent cardiovascular events in CAD patients under statin therapy: the AtheroGene Study. Journal of Lipid Research 2009; 50: 723-729.

Department of Medicine III, Martin Luther-University Halle-Wittenberg, Department of Medicine II and Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg-University Mainz, Hospital of the German Federal Armed Forces, Koblenz, Department of Medicine IV, University of the Saarland, Homburg/Saar, GPR Clinic, Ruesselsheim, Germany, andDepartment of Anatomy and Cell Biology, State University of New York, Downstate Medical Center Brooklyn, New York, NY

Abstract

Phospholipid transferprotein (PLTP) mediates both net transfer and exchange of phospholipids between different lipoproteins. Although many studies have investigated the role of PLTP in atherogenesis, the role of PLTP in atherosclerotic diseases is unclear.

We investigated the association of serum PLTP activity with the incidence of a combined endpoint (myocardial infarction and cardiovascular death) and its relation to other markers of atherosclerosis in 1,085 patients with angiographically documented coronary artery disease (CAD).

In the median follow-up of 5.1 years, 156 patients had suffered from the combined endpoint of myocardial infarction or cardiovascular death including 47 of 395 patients who were on statins at baseline.

In Kaplan-Meyer analyses, serum PLTP activity was not associated with the combined endpoint in all patients. However, in the subgroup of patients receiving statins at baseline, PLTP was shown to be a significant predictor of cardiovascular outcome (P = 0.019), and this also remained stable in univariate (P = 0.027) and multivariate cox regression analyses (P = 0.041) including potential confounders (classical risk factors, HDL cholesterol (HDL-C), and others).

We showed in our study that, under statin treatment, high plasma PLTP activity was related to fatal and nonfatal cardiovascular events in CAD patients.

COMMENT: Over 38 million people in the U.S. are currently taking statin drugs to lower high cholesterol levels. However, German scientists at the Martin Luther-University in Halle-Wittenberg have just published research in the Journal of Lipid Research that shows, for some people, taking statins actually increases the risk of having heart attacks.

The researchers studied over 1,000 patients with coronary artery disease (CAD), and found that a subset of those had high levels of an enzyme called phospholipid transferprotein, or PLTP for short. PTLP is known to influence the metabolism of cholesterol-containing molecules like low density lipoprotein (LDL, or the "bad" cholesterol) and high density lipoprotein (the "good" cholesterol known as HDL) . While the exact role PLTP plays in cardiovascular health is not known, the enzyme is associated with atherosclerosis (the accumulation of plaque in arteries) and heart disease. So a team of scientists led by Axel Schlitt decided to measure the amount of PLTP in 1,085 patients with CAD and then track these PLTP levels to see what the relationship of the enzyme might be to future cardiovascular events.

A little over five years later, 156 of the study participants had suffered from fatal or non-fatal heart attacks, including 47 of the 395 people in the group who were taking statin drugs. Surprisingly, the researchers found that people with high PLTP levels didn't have more heart attacks, unless they were taking statins -- taking the drugs gave them a significant increase in their heart attack risk.

In a statement to the media, the researchers noted that while follow-up studies are needed to tease out the exact connection between PLTP and statins, their study does suggest levels of PLTP in the blood should be looked at before people are put on statin medications.

Although statin drugs have been shown to lower cholesterol levels dramatically, there are a host of natural and side-effect free ways to accomplish this, including increasing fiber in the diet, increasing exercise levels, and losing weight. On the other hand, popping a statin pill each day may seem like an easy short-cut to reducing cholesterol, but it can come with a significant price, and not only to the pocketbook. A host of side effects, from liver and kidney damage to memory problems and muscle damage have been reported.

In fact, approximately 200,000 Americans who take statins to treat high cholesterol may develop a life-threatening muscle disease called "statin myopathy", according to the National Institutes of Health (NIH). Currently there is no way to identify those who may be at risk for this debilitating condition, but new NIH-funded research is currently underway by scientists at the University at Buffalo to attempt to find out.

Wouldn't it have been better to find out before prescribing statins for everyone?

Last updated 3 April 2009