The use of cholesterol-lowering statin medications in the United States rose 80 percent from 2002 to 2013. But new research suggests that the drugs, which have been shown to prevent heart attacks and strokes, remain underused, especially among women, ethnic minorities and the uninsured.
Nearly 40 million adults in the U.S. over 40 took statin medications in 2013, up from about 22 million in 2002, according to a study published Monday in JAMA Cardiology. Even as the percentage of over-40 people taking statins rose from 18 percent to 28 percent, the increased availability of generic versions of the drugs drove down the national cost of 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 percent 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 percent of people with established coronary heart disease are taking statins _ only slightly more than in 2002. And while people with diabetes and established arterosclerosis are most likely to benefit from taking very high doses of statins, fewer than three in 10 were getting such therapy.
In 1987, the pharmaceutical company Merck won approval to market the first statin _ a medication it called Mevacor (generic name lovastatin). Mevacor and the other statin drugs that quickly followed it to the U.S. market _ Zocor (simvastatin), Pravachol (pravastatin), Leschol (fluvastatin), Lipitor (atorvastatin) and Crestor (rosuvastatin) _ at first were taken by people who had already had heart attacks and wanted to prevent more.
By 2002 _ just before Crestor hit the U.S. market _ 17.9 percent 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 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, the statin boom had begun.
The study's authors of suggested that those health improvements were not evenly distributed among Americans.
Three in 10 U.S. men over 40 were taking statins in 2013. But the research shows that just under 26 percent of women over 40 did so.
Minorities too lagged behind whites in taking statins. While 30 percent of non-Hispanic white Americans took the cholesterol-lowering drugs in 2013, just 24 percent of black Americans and 21 percent of Hispanics did so.
Differences were starkest among people who were uninsured. In 2013, only 8 percent without any insurance took statins. Among people insured privately or throughout state Medicaid or federal Medicare insurance programs, rates were far higher _ 20 percent, 30 percent and 48 percent, respectively.
These gaps "reflect unacceptable health care 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.
