MUNICH - The statin war is hotting up, and the annual meeting of the European Association for the Study of Diabetes in Munich this week is the latest battleground for these cholesterol-lowering drugs.

More than 12,000 delegates are attending the five-day meeting, and companies such as Astra- Zeneca are chipping away at market leader Lipitor's supremacy.

Statins are one of the best-selling classes of drugs because of the clear link between lower cholesterol levels and a reduced risk of heart attacks and strokes. Large numbers of people cannot bring down their cholesterol levels with just exercise and diet.

Astra released the results of the first international study targeting people with metabolic syndrome, who are three times more at risk of a heart attack or stroke than a healthy person.

The results showed that given the same dose, Astra's Crestor is far more potent than Lipitor. This surprised no one as previous studies have consistently showed that it is the most potent on the market today.

The results also showed that Crestor is not only better at lowering the level of low density lipoproteins (LDL) or bad cholesterol, but also at raising the levels of high density lipoproteins (HDL) or good cholesterol, which offers additional protection against cardiovascular disease.

Dr Daphne Khoo, head of endocrinology at Singapore General Hospital who is in Munich for the meeting, said this is an important plus point for Crestor when treating patients who also have low HDL.

About 18 per cent of adults in Singapore suffer from this 'disease', which has yet to get an internationally accepted definition.

But all agree that such people are twice as likely to die of cardiovascular disease.

More than a third of all deaths in Singapore are caused by heart disease or stroke. The cost of treating people for these diseases is estimated at $110 million a year.

Dr Stanley Liew, associate consultant in endocrinology at the National University Hospital, said the results are good news for patients as 10mg of Crestor is 80 cents cheaper than 20mg of Lipitor, which provides about the equivalent benefit.

Aside from metabolic syndrome, statins are recommended for diabetics and people who suffer from cardiovascular disease. Between a quarter and a third of adults in Singapore may benefit from statin treatment.

The emerging belief is that the lower one's LDL, the better. Patients who are at risk of getting heart attacks or strokes should bring their LDL levels down to 100. But for patients at very high risk, the United States set a lower guideline of 70 this year.

While the majority can hit these targets with cheap generic statins, they are not powerful enough for some, who need the newer and stronger drugs.

The Crestor study was conducted in seven countries, including Britain and the US.

Its principal investigator, Professor Anton Stalenhoef of University Medical Centre Nijmegen of the Netherlands, said that as a general rule, it is better to go for lower doses of drugs.