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8/22/2000

Statins for Young Adults May Be Bad Investment

Katherine M. Bennett

Using a model to simulate the treatment of adults with high levels of low-density lipoprotein (LDL) cholesterol, researchers found that cholesterol-lowering drugs may not be more cost-effective than a low-cholesterol diet for certain younger patients.

For men and women younger than 45 years with a 160-mg/dL or higher LDL cholesterol level and few risk factors, prevention of coronary heart disease with a statin such as pravastatin may not be a cost-effective treatment, researchers reported in the May 16 issue of Annals of Internal Medicine. 

The researchers used a computer simulation model known as the "Coronary Heart Disease Policy Model." This model was designed by another research team to predict the incidences of coronary heart disease and death from noncardiac heart disease for adults 35 to 84 years old with various characteristics, such as diastolic blood pressure less than 95 mm Hg. Costs and benefits were analyzed by the researchers from society's point of view. 

Compared with no treatment, a low-cholesterol diet seems to be cost-effective at preventing coronary heart disease for everyone with a high LDL cholesterol level except otherwise healthy women 35 to 44 years old, the researchers also found. 

In general, use of a statin to prevent coronary heart disease becomes cost-effective as patients get older and they have more risk factors, especially a high diastolic blood pressure and a low level of high-density lipoprotein cholesterol. Also, primary prevention with statin therapy tends to be more cost-effective when given to men than to women. 

Use of a statin to prevent a second coronary-heart-disease event seems to be cost-effective, compared with no preventive therapy, for all patient types. When given to middle-aged men who smoke, statins may even save money, according to the study. 

For primary prevention, addition of niacin to a low-cholesterol diet was more cost-effective than a low-cholesterol diet alone, but the substance's addition to statin therapy was not cost-effective for most types of patients. 

The National Cholesterol Education Program (NCEP) guidelines recommend treatment on the basis of a patient's LDL cholesterol level and number of risk factors---an approach described by the researchers as simple but nonspecific. The researchers note the importance of clinicians understanding that the cost-effectiveness of a treatment varies significantly when adjusted for specific risk factors, not just the total number. 

To view the article, go to www.annals.org/issues/v132n10/pdf/200005160-00002.pdf.