Statins May Prevent Heart Attacks Even In People With Normal Cholesterols
By Dr. David Lipschitz
We have all heard the frightening stories of healthy people with normal cholesterol levels who die of heart attacks. Conventional wisdom typically states that there is nothing we can do to prevent these fatal events, but a seminal study just published in the New England Journal of Medicine suggests otherwise.
In a study called Jupiter, researchers investigated the effect of giving either the powerful cholesterol-lowering statin Crestor or a sugar pill (placebo) to 17,602 people, a combination of men over age 50 and women over age 60.
All participants had a normal LDL (or bad cholesterol) below 130 and no evidence of coronary artery disease. However, all had a modest elevation of C-reactive protein, a measure of minor inflammation in the body that indicates a higher risk of coronary artery disease or a heart attack.
Prescribing 20 mg of Crestor daily lowered the LDL cholesterol by 50 percent and reduced the level of C-reactive protein by 37 percent. Amazingly, prescribing Crestor also lowered the risk of a heart attack, stroke or cardiac-related death by 44 percent. The effect was so dramatic that the study was discontinued after 19 months. Based on this information, the researchers suggest that people with high C-reactive protein, who are otherwise healthy and have no elevated cholesterol level, benefit substantially by treatment with Crestor.
This could be amazing news for people with elevated C-reactive protein, but is it the magic bullet to prevent heart attacks for all healthy adults? What about other risk factors, such as a strong family history of heart disease at a young age, smoking, having high blood pressure or diabetes, or evidence of vascular disease in the lower limbs or carotid arteries? Will Crestor help everyone reduce the risk of heart attack? In the future the answer could be yes, but for now there are quite a few issues that must be addressed.
First, it is important to take a closer look at the data. Although the risk of heart disease was reduced by 44 percent, the actual number of the 17,000 people who developed a problem was quite small; 140 of the people treated with Crestor had a major cardiovascular event compared to 250 of those on the placebo.
Yes, this number is significant, but we do not know whether the benefit would be just as great if the patients were persuaded to live a heart-healthy lifestyle that included an improved diet and exercise regimen.
Second, using Crestor is not the only way to lower an elevated C-reactive protein. Any minor infection such as gingivitis, skin infections, or arthritis will raise C-reactive protein and localized treatment can readily return the levels to normal. Long-term statin therapy can have serious complications, including muscle and liver damage, insomnia and perhaps even memory loss.
Finally, there is the issue of cost. Annual screening of healthy adults for an elevated C-reactive protein will cost billions of dollars. On top of that, if an elevated level is detected, Crestor is very expensive. Treating a patient with Crestor would cost more than $100 per month.
By contrast, the use of generic simvistatin costs only $4 monthly. However, Crestor is much more powerful than simvistatin and further research will be needed to determine whether the generic is as effective. In addition, more research is needed to find out if at-risk people with normal cholesterols and C-reactive proteins would also have a reduced risk of heart attacks.
Although there are no definitive answers, based on the information we have today, I would readily treat an otherwise normal person at high risk of heart disease with a generic statin. Purely on the basis of cost, I would be much more reluctant to use Crestor. It can be hoped that AstraZeneca, the maker of Crestor, who supported this research, would consider substantially reducing the cost of their drug if we are to use it in healthy people.
Perhaps, in time, we will see over-the-counter statins that are already available, for example, in Great Britain. Until then, talk to your doctor if you are at risk of heart disease. Research shows that the future is bright and more breakthroughs are on the horizon.
========
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.
Copyright 2008 Creators Syndicate Inc.
We have all heard the frightening stories of healthy people with normal cholesterol levels who die of heart attacks. Conventional wisdom typically states that there is nothing we can do to prevent these fatal events, but a seminal study just published in the New England Journal of Medicine suggests otherwise.
In a study called Jupiter, researchers investigated the effect of giving either the powerful cholesterol-lowering statin Crestor or a sugar pill (placebo) to 17,602 people, a combination of men over age 50 and women over age 60.
All participants had a normal LDL (or bad cholesterol) below 130 and no evidence of coronary artery disease. However, all had a modest elevation of C-reactive protein, a measure of minor inflammation in the body that indicates a higher risk of coronary artery disease or a heart attack.
Prescribing 20 mg of Crestor daily lowered the LDL cholesterol by 50 percent and reduced the level of C-reactive protein by 37 percent. Amazingly, prescribing Crestor also lowered the risk of a heart attack, stroke or cardiac-related death by 44 percent. The effect was so dramatic that the study was discontinued after 19 months. Based on this information, the researchers suggest that people with high C-reactive protein, who are otherwise healthy and have no elevated cholesterol level, benefit substantially by treatment with Crestor.
This could be amazing news for people with elevated C-reactive protein, but is it the magic bullet to prevent heart attacks for all healthy adults? What about other risk factors, such as a strong family history of heart disease at a young age, smoking, having high blood pressure or diabetes, or evidence of vascular disease in the lower limbs or carotid arteries? Will Crestor help everyone reduce the risk of heart attack? In the future the answer could be yes, but for now there are quite a few issues that must be addressed.
First, it is important to take a closer look at the data. Although the risk of heart disease was reduced by 44 percent, the actual number of the 17,000 people who developed a problem was quite small; 140 of the people treated with Crestor had a major cardiovascular event compared to 250 of those on the placebo.
Yes, this number is significant, but we do not know whether the benefit would be just as great if the patients were persuaded to live a heart-healthy lifestyle that included an improved diet and exercise regimen.
Second, using Crestor is not the only way to lower an elevated C-reactive protein. Any minor infection such as gingivitis, skin infections, or arthritis will raise C-reactive protein and localized treatment can readily return the levels to normal. Long-term statin therapy can have serious complications, including muscle and liver damage, insomnia and perhaps even memory loss.
Finally, there is the issue of cost. Annual screening of healthy adults for an elevated C-reactive protein will cost billions of dollars. On top of that, if an elevated level is detected, Crestor is very expensive. Treating a patient with Crestor would cost more than $100 per month.
By contrast, the use of generic simvistatin costs only $4 monthly. However, Crestor is much more powerful than simvistatin and further research will be needed to determine whether the generic is as effective. In addition, more research is needed to find out if at-risk people with normal cholesterols and C-reactive proteins would also have a reduced risk of heart attacks.
Although there are no definitive answers, based on the information we have today, I would readily treat an otherwise normal person at high risk of heart disease with a generic statin. Purely on the basis of cost, I would be much more reluctant to use Crestor. It can be hoped that AstraZeneca, the maker of Crestor, who supported this research, would consider substantially reducing the cost of their drug if we are to use it in healthy people.
Perhaps, in time, we will see over-the-counter statins that are already available, for example, in Great Britain. Until then, talk to your doctor if you are at risk of heart disease. Research shows that the future is bright and more breakthroughs are on the horizon.
========
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.
Copyright 2008 Creators Syndicate Inc.
posted by Jacques Girard, Ph.D. at 11:40 PM
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