David Fitchett, MD, FRCP(C), Cardiologist, St. Michael’s Hospital; Associate Professor of Medicine, University of Toronto, Toronto, ON.

Coronary and cerebrovascular disease is the leading cause of death and disability in the older population. Control of vascular risk factors such as blood pressure, lipids, and glucose is important in higher risk patients to reduce the impact of stroke and myocardial infarction, whatever their age. Although total and LDL cholesterol levels are less predictive of coronary heart disease in the older patient, clinical trials demonstrate an important benefit from statin therapy in high-risk individuals over a wide age range with either established cardiovascular disease or diabetes. Older patients with multiple risk factors for vascular disease, yet without coronary, cerebrovascular, or peripheral vascular disease, should also be considered for statin treatment.
Key words: cholesterol, lipid management, statin, cardiovascular disease.

In August, pharmaceutical giant Bayer issued a full recall for their lipid-lowering statin, cerivastatin (Baycol). The use of Baycol has been associated with the development of rhabdomyolysis, a condition in which muscle cells are destroyed and released into the bloodstream. The condition causes severe muscle pain and can potentially lead to fatal kidney failure in severe cases. Symptoms of rhabdomyolysis include weakness, tenderness, fever, dark urine, nausea and vomiting. Muscle pain most frequently occurs in the calves and lower back.

The drug was approved for use in Canada in February of 1998; since that time 1.3 million prescriptions have been filled. Every statin has been linked to very rare reports of rhabdomyolysis, but Baycol has been linked to significantly more fatal cases than have its competitors. At last count, 52 deaths had been reported from use of the drug.

At highest risk from Baycol are elderly patients, those patients who use higher doses of the medication and anyone using Baycol in combination with Gemfibrozil (Lopid), another cholesterol-lowering medication. It is recommended that any patients experiencing symptoms see a physician immediately.

Patients currently taking Baycol are advised to contact their general practitioner for an alternative medication.