Statins' expanding reach falls short among women, minorities

Use of cholesterol-lowering statin medications in the United States rocketed upward 80% in the decade between 2002 and 2013. But new research suggests that the drugs shown to prevent heart attacks and strokes remain underused, especially among women, ethnic minorities and the uninsured. 

Close to 40 million American adults over 40 took statin medications in 2013, up from about 22 million individuals in 2002, says a study published Monday in JAMA Cardiology. Even as the percentage of over-40 Americans taking a statin rose from 18% to 28%, the growing availability of generic versions of these drugs was driving down the national bill for such medication, from $17.2 billion in 2002 to $16.9 billion in 2012-2013.

Statin medications are widely credited with helping drive down death from heart attacks in the United States by 70% from its peak in the late 1960s.

The new research suggests, however, that there are “missed opportunities” for greater gains. It found that in 2013, only 63% of people with established coronary heart disease are taking a statin — only a slight uptick from 2002. And while people with diabetes and established arterosclerosis are most likely to benefit from taking very high doses of a statin, fewer than three in 10 were getting such “high-intensity” therapy. 

In 1987, the pharmaceutical giant Merck won approval to market the first statin — a medication it called Mevacor (generic name lovastatin). President Ronald Reagan was on the hot seat for trading arms for hostages, and Michael Jackson had just released the album “Bad.” Mevacor and the statin drugs that quickly followed it onto the U.S. market — Zocor (simvastatin), Pravachol (pravastatin), Leschol (fluvastatin), Lipitor (atorvastatin) and Crestor (rosuvastatin) — were initially taken by people who had already suffered a heart attack and wanted to prevent another.

By the year 2002 — just before Crestor hit the U.S. market — 17.9% of U.S. adults over 40 were taking one of the new class of cholesterol-lowering drugs. Most of those statin users, the authors of the new report noted, were non-Hispanic white males with health insurance.

As evidence of the drugs’ effectiveness in reducing repeat heart attacks grew, researchers and cardiologists increasingly argued that statins could protect adults who were at risk of heart disease from having a first heart attack. Despite many patients’ complaints of muscle weakness and pain with the medications, an era of boom times for statins had begun. 

The authors of the new research suggested those health improvements were not evenly distributed among Americans.

Three in 10 American males over 40 were taking a statin in 2013. But the new research shows that just short of 26% of women over 40 did so.

Minorities too lagged behind whites in taking a statin. While 30% of non-Latino white Americans took the cholesterol-lowering drugs in 2013, just 24% of black Americans and 21% of Latinos did so.

Differences were starkest among people who were uninsured. In 2013, only 8% without any insurance took a statin. Among people insured privately or throughout state Medicaid or federal Medicare insurance programs, rates were far higher — 20%, 30% and 48%, respectively.

These gaps “reflect unacceptable healthcare disparities in our society,” wrote Dr. William S. Weintraub, a cardiologist at the Christian Care Health System in Newark, Del.

While statins have been widely hailed as a wonder drug, patients do not always welcome them. As many as one in 10 users of statins complain of muscle aches and pain — side effects that may subside with time but can be debilitating and dangerous. 

In 2012, the FDA demanded that warnings that taking statins is linked to a slightly increased risk of higher blood sugar levels and eventual Type 2 diabetes diagnosis. Statin labels must now also warn of potential confusion and memory loss in some patients.

melissa.healy@latimes.com

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