Statins: From Fungus to Pharma
The curiosity of biochemists, mixed with some obvious economic incentives, created a family of powerful cardiovascular drugs
Akira Endo's decades-old adventure continues. In the mid-1990s, the U.K. Heart Protection Study—sponsored by the U.K. Medical Research Council, the British Heart Foundation, Merck and Hoffman-La Roche—examined 20,000 volunteers who were 40 to 80 years old. These subjects were considered at high risk of cardiovascular disease because of factors such as diabetes, but their physicians did not consider them candidates for statin therapy because their blood LDL-cholesterol levels were within the normal range. Nonetheless, this study put these people on either 40 milligrams per day of simvastatin or a placebo for an average of 5.5 years. The results were impressive. In those individuals with diabetes but no obvious arterial disease who were put on simvastatin, the risk of a heart attack or stroke decreased by about 20 percent. Rory Collins, who together with Richard Peto, headed this study, estimates that up to 20 million people worldwide would be eligible for statin therapy. On TheHeart.org (www.theheart.org), Collins noted that "even if an extra 10 million people took them, we would save 50,000 lives a year" and prevent untold numbers of debilitating heart attacks and strokes.
Other work shows the potential for still broader applications of statins. In April 2008, for example, Beatrice A. Golomb, a professor of medicine at the San Diego School of Medicine and director of the University of California, San Diego's statin study, and colleagues reported that statins lower blood pressure. Pending their confirmation or otherwise, these findings point to further expansion of the types of patients who stand to gain from being prescribed statins. Stroke prevention, not just of the occlusive but also of the hemorrhagic variety, is an obvious target in that statins may alleviate not just one but both of the main predisposing factors, atherosclerosis and high blood pressure.
The applications of statins might not stop here, however. Some studies suggest that these drugs can also help prevent Alzheimer's dementia, age-related bone loss and even prostate cancer. As is only becoming obvious now, one young man's curiosity about fungi is helping to fight a growing list of debilitating and life-threatening diseases. Stated plainly, the discovery of statins and the new insights into cardiovascular and other diseases that have and continue to come from their implementation represents one of the most significant accomplishments of the biomedical sciences in the 20th century.
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