JH: Lots to talk about this week. The study that made the biggest splash in the news showed that one of the cholesterol-lowering drugs in the group known as statins (such as Lipitor, Zocor, Crestor) prevented heart attacks and strokes even in people who did NOT have high cholesterol levels. Does that mean that everyone, regardless of their cholesterol levels should now take one of these meds?

RM: Well, it’s a bit more complicated than that. In a study in the New England Journal of Medicine of November 9 (published online ahead of its regular publication date), nearly 18,000 people – including men and women of diverse ethnic backgrounds – who had normal “bad” cholesterol levels (LDL) but high CRP levels, were given either a placebo or a statin drug and followed for almost 2 years. They were being watched for their first occurrence of an event involving the cardiovascular system, including a nonfatal heart attack, a nonfatal stroke, hospitalization for unstable angina, the need for a procedure to open blocked arteries, or death from one of these causes. The study had to be stopped because there was a significant difference found in the occurrence of these events between the group taking a statin drug and the group taking a placebo.

JH: So the group taking the statin drug had significantly fewer heart attacks and strokes and other cardiovascular events?

RM: Yes.

JH: Doesn’t that mean, then, that everyone should take one of these drugs regardless of their cholesterol level?

RM: No, but what it does mean is that you might want to find out what your CRP level is, especially if you have risk factors for stroke or heart attack.

JH: Ok. CRP stands for C-reactive protein, and has been used for years as an indication that some type of inflammation is going on in the body. It is measured by a simple blood test. That inflammation, however, can be due to many causes such as an ongoing infection, certain types of arthritis, like rheumatoid arthritis, and active heart disease. The high level of the CRP only says that inflammation is going on, but does not specify where the inflammation is coming from.

RM: Exactly. We say that the CRP test is nonspecific. Therefore, we’re not sure who in this study really had active heart disease, and who didn’t, even though they all had a high CRP.

JH: So, if someone has a normal cholesterol, but other risk factors for heart disease, they should ask for their CRP level to be checked, and then let their doctor decide if they need a statin, right?

RM: Yes. Although the statins are relatively safe, there can be side effects to them and they are expensive; therefore, one should only take them if they really need them. And that should be decided individually for each person. More studies need to be done to follow up this one.

JH: Another study receiving a lot of press attention recently showed that postmenopausal women who had a migraine diagnosis had a lower risk for breast cancer. The authors of this study, which appeared in Cancer Epidemiology, Biomarkers and Prevention, speculate that this difference is due to lower levels of estrogen occurring in migraine patients.

RM: I’ll bet you were especially interested in this study, right?

JH: Yes – it’s the first good thing about migraines I’ve seen! And since I have migraines, I’ll be very interested to see if further studies on this show the same thing. Another study, reported in the August 19 issue of Neurology, showed that chronic migraines were underdiagnosed and undertreated in this country.

RM: Interesting. That finding leads directly to one of the mantras in our book: that women need to advocate for themselves. If you have recurrent and severe headaches, even if your clinician does not make much of them, you should ask if it’s possible you are having migraines, or ask for a referral to see a neurologist.

JH: Absolutely. There are good treatments for migraines these days, including medications to prevent them from occurring. So, there’s a good possibility that if you have migraines, you don’t have to suffer as much, or at all, with them by taking treatment.

RM: Right. Next time we’ll talk about placebos and another new study on the relationship of exercise and breast cancer.