Lipitor (atovastatin), a statin, had sales of more than $12 billion in 2007, establishing it as the best-selling drug in history. Starting with Merck’s introduction of Mevacor (lovostatin) in 1987, and now including more than six other similar drugs, the statins are the world’s best-selling drugs, with annual sales of $40 billion. These are the most effective drugs currently available to reduce cholesterol.
Cholesterol is formed in the liver, and the statins block a critical step in their manufacture by inhibiting the enzyme HMG-CoA reductase. Statins also speed up the removal of cholesterol from the body. Both effects contribute to the 20–60 percent reduction of cholesterol blood levels seen after they are taken.
Who should receive statins? Elevated levels of cholesterol are a major risk factor for heart attack and stroke, leading causes of death in developed nations. By reducing LDL (bad) cholesterol levels, it’s clear that these drugs prevent heart attack, stroke, and the risk of death by as much as 30–40 percent in individuals who have previously experienced a heart attack. In addition, people with increased risk factors for heart attacks, such as those with diabetes and high blood pressure, also benefit from these drugs, even if they have little or no elevation in cholesterol levels.
However, it is highly controversial whether the statins provide benefits to individuals with elevated cholesterol levels but who have not had a heart attack. The JUPITER study, funded by a pharmaceutical company (with vested interests in its positive findings) purported to show protection in this group, but these conclusions may have been biased. Moreover, consider the following: Experts agree that diet and exercise should be the first approach taken to lower elevated cholesterol levels. Failing that, should the statins be made freely available to everyone without a prescription? The answer differs depending on which side of the Atlantic you reside. The UK drug-regulatory agency voted yes in late 2004, while their U.S. counterparts rejected the same proposal months later, based on concern as to whether statins could be used safely in the absence of medical supervision.
SEE ALSO Diuril (1958), Captopril (1981).
Atherosclerosis is a condition in which the walls of an artery thicken because of a cholesterol build-up. This fatty plaque can narrow the vessel’s diameter or rupture, causing a blood clot that blocks a blood vessel and increases the risk of heart attack or stroke. Mevacor, an inhibitor of cholesterol synthesis, is the world’s all-time best-selling drug.