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High Dose Statin

by Ng Peng Hock

High blood cholesterol level can raise the risk of getting heart disease. And if one with high blood cholesterol already develops some form of heart disease for example heart attack, then the situation becomes more serious.

As such, persons with heart trouble and high blood cholesterol levels are sometimes put by their doctors on high dosage of statin drugs so as to quickly lower their blood cholesterol levels. However, a study, published in the online version of the Journal of the American Medical Association in 2004, reported that the high dosage of statin can offer only a marginal benefit compared to the current treatment.

Under normal circumstances, patients at risk of another heart attack are first stabilized and put on low-cholesterol diets before introducing cholesterol-lowering drugs such as statin. Nonetheless, in the study funded by Merck and Co. Inc., half of the 4,500 patients were given a daily dose of 40 mg of simvastatin, which the company sells under the brand name Zocor, for 30 days and then raised to 80 mg daily. The drug was given within about 4 days of the initial heart event. The other half of the patients were given a placebo for 4 months, the put on a 20 mg dose of simvastatin.

While cholesterol levels dropped more sharply in the first group, the risks of suffering another heart attack, stroke, readmission to the hospital or heart-related death were comparable in the 2 groups.

Among those who went on the drug regimen right away, 14 percent suffered another heart event, compared to 17 percent taking a placebo initially - a difference that was not seen as statistically significant. Patients were followed for between 6 months and 2 years.

In addition, 0.4 percent of those on the heavier dose of simvastatin suffered from myopathy, a type of muscle pain and weakness, and statins can cause liver problems in a few cases. Even so, the researchers said the findings favored quick use of statins.

Until recently, little information was available about the timing of initiating statin drugs after a heart attack. The findings from the trial suggested that statins can be initiated earlier and in dosages well above the typical starting dose. However, patients should be closely monitored by the doctors for side effects.

In the eyes of some observers in this field, the study's findings point to a cautious approach in using the 80 mg simvastatin dose, though 40 mg dose appears to be safe and effective.

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