The Evolving Role of "statin" medications in medicine and underwriting life insurance.
Coronary heart disease (CHD) continues to be a major cause of morbidity and mortality throughout North America. Heart disease is the leading cause of death in US with over 500,000 deaths per year. The role of lipid disorders is well established in coronary heart disease. The American Heart Association estimates that about 12.6 million Americans have coronary heart disease (CHD) annually. 1.1 million Americans experience a new or recurrent heart attack each year of which 45% are fatal. Several risk factors are associated with development and progression of CHD, including obesity, a family history of heart disease, smoking, diabetes, high blood pressure, advancing age, male > 45 years of age or female > 55 years of age and an abnormal lipid profile. Although diet and other lifestyle changes should form the basis of lipid management, the addition of lipid modifying drugs is often necessary. Many different lipid-reducing drugs exist, but the proven effectiveness of the statins has increasingly made them the drugs of choice.
It is estimated that there are currently 21 million untreated Americans who should be taking statins according to federal guidelines for hyperlipidemia treatment to prevent heart attacks and strokes. Treating Lipid Disorders with Statins
The bloodstream transports cholesterol throughout the body by special carriers called lipoproteins. The two major lipoproteins are low density lipoproteins (LDL) and high density lipoproteins (HDL). LDL is most often referred to as the "bad" cholesterol whereas HDL is knows the "good" cholesterol. In addition to the actual readings for the individual lipoproteins, the ratios between them provide an important tool for the risk of heart disease. TOTAL CHOLESTEROL (mg/dl) Desirable: Below 200 Borderline: 200-239 Undesirable: 240 and above LDL CHOLESTEROL (mg/dl) Desirable: Below 130 Borderline: 130-159 Undesirable: 160 and above HDL CHOLESTEROL (mg/dl) Desirable: Above 45 Borderline: 40-45 Undesirable: Below 40 Ratio of Total Cholesterol to HDL Desirable: Less than 3.0 Undesirable: 3.0 or greater There are currently six statin drugs on the market in the United States:
The major effect of the statins is to lower LDL-cholesterol levels, and they lower LDL-cholesterol more than other types of drugs. Statins inhibit an enzyme, HMG- CoA reductase, that controls the rate of cholesterol production in the body. These drugs lower cholesterol by slowing down its production. In addition, statins increase the liver's ability to remove the LDL-cholesterol already in the blood. Risks Associated with Statin Medications There are two main complications that can occur with statin use. The first complication is liver problems, which occur in about 1% of patients. When liver problems occur, livers first response is increased release of liver enzymes into the patient’s blood, hence patients on statin drugs have periodic liver enzyme blood studies done to screen for liver complications. The second complication is a painful muscle condition called myopathy. This may happen in about 1 in 1000 patients.
Multiple Sclerosis Over 400,000 people in the US have multiple sclerosis (MS). MS is an autoimmune disorder that destroys the myelin, a fatty sheath around nerve cells. Recent research has determined that statins limit progression of MS by blocking the immune response that damages nerve tissue. One small study with statins decreased new brain lesions associated with MS by 40%. It’s unknown if the statins will prevent the disabilities associated with MS. Osteoporosis Statins in rodents have been found to increase bone formation. If this holds up in human models, the statins would be a new treatment for osteoporosis by increasing bone density (i.e. building new bone). Current drugs for osteoporosis can only prevent further bone loss but can do nothing to increase bone density. Alzheimer’s disease Although the etiology of Alzheimer’s is not clearly understood yet, we know that patients with Alzheimer’s have amyloid plaques in the brain. In addition the presence of cholesterol drives the production of amyloid. Some Alzheimer researchers believe that high cholesterol contributes to the development of Alzheimer’s. If the presence of high cholesterol increases the development of Alzheimer’s, then we currently have in the US over 42 million Americans at risk for a second epidemic after obesity. One small study found a 39% decrease in the risk of Alzheimer’s among people of statins. Cancers In June 2003 a Dutch study showed people on statins for four years or more had a 20% decreased risk of cancer (prostate and liver). Depression An interesting study in the August 2003 Journal of the American College of Cardiology looked at patients receiving statin treatment for high cholesterol levels. The researchers found that statin use was associated with a reduced risk of anxiety, depression and hostility compared to people who are not taking the medication. All of these findings are based on very limited information and will require additional research to determine the role statins will play in preventing or controlling the disease process.
1. Can an applicant who is taking a statin be preferred? Yes. Assuming all of the other cardiac risk factors are normal and assuming that the use of a statin brings the client into the "low risk" lipid range, the applicant could qualify for preferred. 2. What about applicants who are taking a statin and now have elevated liver functions? Are they rated? The key to this type of case is knowing what the liver function tests were prior to using the statin. If they were normal and now the AST, ALT or GGTP are "slightly" elevated, then the client should not be rated. 3. Can a person be taking a statin to prevent Alzheimer’s disease? Yes. We have seen clients with a family history of Alzheimer’s disease request that their attending physician start them on a statin as a preventative measure. |
