A U.S. Food and Drug Administration panel's recommendation that some adults with no prior heart problems should take the cholesterol-busting statin Crestor appears to have pitted cardiologists against many primary care physicians over the best use of the popular drug.
At stake in the debate is the health of millions of Americans who, if the recommendation is followed by the FDA, could soon find themselves urged by their doctors to take the drug.
"If the FDA accepts this recommendation, it will expand the number of Americans eligible for statin therapy by millions," said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic.
A number of cardiologists voiced their support of the idea that the drug should be given to men age 50 or older and women age 60 or older who have LDL cholesterol levels of less than 130 mg/L and triglycerides of less than 500 mg/L if the patient also had an elevated blood level of an inflammation marker known as C-reactive protein, or CRP.
"The FDA correctly saw beyond some of the adverse effects that were rare in this very large group," said Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at New York University. "It will hopefully allow easier access to Crestor and will also motivate physicians to be more aggressive in patients at risk and encourage patients to accept the recommendation of therapy."
Another cardiologist, Dr. Christopher Cannon of Brigham and Women's Hospital in Boston, described the recommendation as "outstanding news for people who are at risk but who would not previously known it.
"The treatment can reduce almost in half their risk of a first heart attack or other cardiac event," he said.
Meanwhile, many primary care doctors were far from enthused.
"I disagree completely with this recommendation," said Dr. Lee Green, a primary care doctor at the Department of Family Medicine at the University of Michigan in Ann Arbor. "I don't think that the FDA recommendation is ready for prime time, and extending it would most certainly be bad science and bad patient care."
"This is an interesting and in my mind dangerously premature development," said Dr. Michael Good of ProHealth Physicians in Middletown, Conn. "We know that giving statins to any population will lower their heart attack risk, and there are some in the cardiology community who feel that 'we should put it in the water.' However, unlike fluoride, which we do put in the water, statins have considerable side effects and risks. About one in 10 patients experience muscle pain and weakness, some have liver function changes and the statins as a group have many, many drug interactions."
The FDA expert panel voted 12 to four with one abstention to recommend that the potent statin, known generically as rosuvastatin, be approved to prevent heart attacks in people who have no history of heart disease and don't fit the traditional profile of an "at risk" population.
The FDA is not obligated to follow the advisors recommendations, but it often does. If it did so this time, it would mark a first -- a drug normally used to lower dangerously high LDL (bad) cholesterol in people with a history of heart disease or risk factors to develop heart attacks or strokes would be approved for the prevention of heart attacks in healthy people.